ACL Frequently Asked Questions
ACL tears are often associated with sports that involve jumping, cutting or twisting. It is estimated that 70% of ACL injuries occur through non-contact, while 30 % result from direct contact with another player or object.1 The ACL can be injured in several ways, including:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision – i.e., a football tackle
People who tear their ACL generally hear a “popping” noise and feel their knees give out from under them. Additional symptoms include:

  • Pain with swelling
  • Loss of full range of motion of the knee
  • Tenderness along the joint line
  • Discomfort while walking
Patients who aren’t active in sports and who are willing to stop doing activities that require a stable knee may choose to try to heal their ACL with rest and rehabilitation.
Some physicians may have their patients manage pain with medication or non-surgical methods. However, your orthopaedic surgeon may decide that a surgical procedure is needed to reconstruct a new ACL.
Those patients who wish to continue being active in sports, who need their knee to be strong and stable and who don’t want risk further injury may want to consider ACL reconstruction surgery.
Treatment options should be discussed with your orthopedic surgeon.
ACL reconstructive surgery is an outpatient procedure generally done using an arthroscope through very small incisions, and performed by an orthopedic surgeon while the patient is under general anesthesia.
During the procedure, the patient’s torn ligament is removed and replaced with a graft, which can either come from the patient (autograft), or can come from donor tissue (allograft).
ACL reconstruction is generally a safe procedure. As with all types of surgery, there is a limited chance complications may arise during surgery or recovery. Discuss these potential risks with your physician.
The two most common tissues used to reconstruct the ACL are the patellar tendon (a.k.a. BTB) and the hamstring tendon. The patellar tendon graft is taken from the patient’s knee cap and has two small pieces of bone on either end called “bone blocks.” The hamstring tendon is considered a soft tissue graft because it doesn’t have bone blocks, and is a less invasive procedure.
The type of graft that is used determines how the newly reconstructed ligament is secured in the knee.
The AperFix® System is among the strongest devices on the market and offers a minimally invasive ACL reconstruction that is getting patients back to activities of daily life and their pre-injury level of play quicker and with less pain than traditional treatments. The device is designed to use soft tissue grafts to reconstruct the ligament, which results in less pain for the patient during recovery. AperFix® II offers a strong, stiffer ligament that delivers a more stable and natural feel during movement. AperFix® has also been shown to perform more like the natural knee compared to traditional ACL reconstruction techniques.2
Patients work with a physical therapist to develop a program that fits their personal needs. Regular rehabilitation to restore your knee mobility and strength is necessary.2
References
1. American Academy of Orthopedic Surgery. ACL Injury: Does it Require Surgery.
2. American Journal of Sports Medicine. Biomechanical Comparison of Single Tunnel – Double Bundle and Single Bundle Anterior Cruciate ligament Reconstructions. 2009

Meniscal Frequently Asked Questions
Meniscal tears usually occur during sport-related activities such as squatting, sudden twisting of the knee or stepping on an uneven surface. Over time, knee cartilage weakens and wears thin; therefore older people are more prone to tears from normal daily activity
Symptoms of a meniscal tear include:

  • Pain on the side or center of the knee
  • Stiffness and swelling
  • Catching or locking of the knee
  • Loss of mobility
  • Sensation of the knee “giving way” or feeling unstable
Only tears located in the middle and outer area of the meniscus can be repaired because that is the only area where enough blood supply is delivered that promotes healing. However, meniscal tears in children and adolescents have a higher chance of healing compared to adults because of the better blood supply to the meniscal tissue during youth.
Some tears cannot be repaired due to the severity or type of tear pattern. In this case, a partial removal of the meniscus is performed.
For a small tear on the outer edge of the meniscus, generally rest and physical therapy may be all that is required. However, your physician may choose to manage pain with medication or non-surgical methods. Additionally, if your type of meniscal tear is deeper and on the outer rim of the meniscus, your surgeon may elect the repair the tear.
For larger tears on the outside of the meniscus, surgical repair may be considered.
If the tear is irreparable due to location or degenerative conditions such as osteoarthritis, a meniscectomy (surgical removal of part of the meniscus) may be performed.
Treatment options should be discussed with your orthopedic surgeon.
Meniscal repair surgery is an outpatient procedure generally performed using an arthroscope through small incisions and performed by an orthopedic surgeon while the patient is under general anesthesia. The procedure time for a minimally invasive repair vary but is generally under an hour.
Meniscal repair is generally a safe procedure. As with all types of surgery, there is a limited chance complications may arise during surgery or recovery. Discuss these potential risks with your physician.
The most common meniscal repair techniques involve using either a tack (device left in the knee) or a surgical stitch (suture) to close the tear. Suturing is considered the “gold standard”; however, it has mostly been performed as an open surgical procedure.
The CrossFix® II System is an all-inside, all-suture device that replicates the strength of open suturing, but offers a less invasive alternative through a single incision in the front of the knee. The unique CrossFix® II device allows surgeons to repair the meniscus in minutes, compared to traditional open suturing which requires much more time to complete the procedure.
Patients work with a physical therapist to develop a program that fits their personal needs. Regular rehabilitation to restore your knee mobility and strength is necessary.
Meniscal repair and other knee ligament reconstruction can be performed during the same surgical procedure. In fact 20% of meniscal repairs are done in conjunction with an ACL reconstruction.
Rotator Cuff Frequently Asked Questions
A rotator cuff tear may result from an injury or be caused by wear and tear with degeneration of one or more shoulder tendons.  Most rotator cuff tears are degenerative, putting individuals over 40 years old at a greater risk.  Factors that can contribute to rotator cuff tears include:

  • Repetitive lifting, shoulder motions or overhead activities
  • Athletes who repeatedly use their shoulder – Baseball, tennis, rowing, and weightlifting
  • Lack of blood supply as we get older
  • Bone spurs
The most common symptoms of a rotator cuff tear include:

  • Night pain when lying on the affected shoulder
  • Pain and weakness when lifting or rotating your arm
  • Crackling sensation when moving your shoulder in certain positions
  • Sudden tears may cause intense pain, a snapping sensation and immediate weakness in your upper arm
Non-surgical measures may be recommended by your physician through pain medication and rest to relieve the symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles are also an option. However, your surgeon may decide that a surgical procedure is needed to repair the torn rotator cuff. Different repair methods can be utilized to re-attach the tissue to the bone. All treatment options should be discussed with your surgeon prior to surgery.
Most rotator cuff repairs are performed as an outpatient procedure using an arthroscope (small camera) through small incisions. Your physician will discuss with you the best procedure for your tear and what to expect.
Rotator Cuff surgery is generally a safe procedure. As with all types of surgery, there is a limited chance complications may arise during surgery or recovery. Discuss these potential risks with your physician.
There are three techniques most commonly used for rotator cuff repair: traditional open repair, mini-open repair, and all-arthroscopic repair. Typically, small anchors with suture are used to re-attach the tendon to the bone. Your physician will recommend which technique is best for you.
Open Repair
Open Rotator Cuff Repair surgery was the first technique used for rotator cuff tears.  With this technique, an incision is made over the shoulder and the shoulder muscle (deltoid) is detached in order to have better visualization and gain access to the tear.  Open repairs are utilized if the rotator cuff tear is large or complex or if additional reconstruction in the shoulder is needed.
Mini-Open Repair
Mini-open repair surgery is a combination of the open repair technique (deltoid is not detached) and using an arthroscope (small camera) through a mid-sized incision.  The arthroscope allows the surgeon to use arthroscopic instruments to assess the tear and treat damage to other structures within the joint.  The rotator cuff is then repaired through the mini incision rather than using the arthroscopic instruments.
All-Arthroscopic Repair:
All-Arthroscopic repair uses an arthroscope inserted into your shoulder joint through small incisions. The arthroscope allows the physician to guide arthroscopic instruments in the joint to repair the rotator cuff tear without making a large incision.  All-arthroscopic repair is the least invasive rotator cuff procedure.
Patients will avoid using their arm for several weeks after surgery, followed by a strengthening exercise program set up with a physical therapist to fit their individual needs. Rehabilitation plays an important role to regain shoulder strength and motion.
References
American Academy of Orthopedic Surgeons (AAOS) and National Athletic Trainers Association
Glenoid Labrum Frequently Asked Questions
The glenoid labrum can tear from a traumatic injury or repetitive shoulder motion. Examples of traumatic injury to the shoulder include:

  • Falling on an outstretched arm
  • A direct blow to the shoulder
  • A sudden pull
  • A violent overhead reach
  • Athletes with repetitive shoulder motion
The symptoms of a torn Glenoid Labrum include:

  • Pain with overhead activities
  • Catching, locking, popping, or grinding
  • Occasional night pain
  • Pain with daily activities
  • A sense of instability in the shoulder
  • Decreased range of motion
  • Loss of strength
Non-surgical measures may be recommended by your physician through pain medication and rest to relieve the symptoms. Rehabilitation exercises to strengthen the rotator cuff muscles are also an option. However, your physician may decide that a surgical procedure is needed to repair the torn glenoid labrum. Different repair methods can be utilized to re-attach the tissue to the bone. All treatment options should be discussed with your physician prior to surgery.
Glenoid labrum repair is an outpatient procedure commonly performed using an arthroscope through small incisions while the patient is under general anesthesia. Typically, small anchors with suture are used to re-attach the labrum to the glenoid.
Glenoid labrum repair is generally a safe procedure. As with all types of surgery, there is a limited chance complications may arise during surgery or recovery. Discuss these potential risks with your physician.
Patients will avoid using their arm for several weeks after surgery, followed by a strengthening exercise program set up with a physical therapist to fit their individual needs. Rehabilitation plays an important role to regain shoulder strength and motion.
References
American Academy of Orthopedic Surgeons (AAOS) and National Athletic Trainers Association
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