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Thursday, 11 December 2014 00:00

ACL Rupture in Children Information

Due to the nature of the knee joint, active children are prone to knee injuries. A torn or ruptured anterior cruciate ligament (ACL) is one of the most common type of knee injuries.

Contact sports or sports that involve swift, abrupt movements such as pivoting, stopping suddenly or changing direction quickly are the most common cause of ACL injuries.

An ACL injury can also occur when a child jumps and lands on the feet with knees straight and locked instead of flexed as this puts excessive pressure on the knee joint and can cause the rope like ACL to tear to break apart.

ACL rupture in three times more common in teenage girls than in boys. This is due to:

  • Oestrogen hormones which result in weaker collagen
  • Anatomical tight notch
  • A wider pelvis leads to altered mechanics which increases valgus stress on landing from a jump

 

ACL injuries can be very painful and can cause the child to be unsteady on their feet and to have difficulty walking. Depending on the age of the child and the severity of the injury, a torn ACL often requires surgery in addition to physiotherapy.

 

Symptoms:

  • Pain when bearing weight on the affected leg or at rest
  • Swelling of the knee joint which can occur within 24 hours of the injury
  • There will most likely be some instability when walking and the feeling of being unstable or ‘wobbly’ on the leg along with the sensation of the knee feeling not as tight or compact as it was previously
  • Often children will report feeling and hearing a ‘pop’ sound which occurs when the ligament tears

 

If a child has suffered a knee injury they should stop activity immediately and seek medical attention to prevent any further injury to the knee. 

In the interim, the knee should be iced regularly for 20 minute intervals. The knee should be elevated as much as possible to reduce swelling. It is advised not to bear weight on the affected leg.

 

Published in Information
Thursday, 11 December 2014 00:00

ACL Reconstruction Post Surgery Information

 The following can be expected post ACL reconstruction surgery:

  • On discharge the large outer dressing is removed leaving the water proof dressing in place
  • Tube-grip bandage may be applied
  • No brace or immobilisation will be needed
  • An ice pack should be applied regularly for 20 minute intervals until swelling subsides
  • Usually there will be a wound check after 14 days performed in Dr Al Muderis’ rooms
  • Physiotherapy should start at two to five days after surgery with the goal of a quick return to a full range of motion and the strengthening of both quadriceps muscles and hamstrings muscles

 

Recovery Photos:

  

Range of motion:

Passive and active range of motion exercises should be preformed to order to ensure full extension is achieved and maintained within one week post surgery. 90 degrees of flexion is the goal by week two followed by progression to full flexion as tolerated.

 

Weight bearing status and driving:

You can return to driving between one and two weeks after surgery.

Weight bear as tolerated, initially with crutches. Crutches can be discontinued when you can achieve full extension of the knee without an extensor lag and you are able to walk comfortably without a flexed knee gait pattern.

 

Muscle rehabilitation:

  • Static quadriceps and co-contraction will commence immediately post operatively
  • Closed kinetic chain exercises are advised for the first two to three months which will be demonstrated and prescribed by the physiotherapist
  • Cycling on an exercise bike, swimming and leg presses may commence after two weeks and proprioception training will begin four weeks after surgery

 

Sports:

Return to full activity should be eased into with care not to overdo it and over stress the knee. 

  • As the swelling settles cycling on a stationary exercise bike can begin
  • Low impact exercises such as swimming can commence after two weeks
  • After six weeks jogging can be commenced
  • Return to sport specific training at 12 to 16 weeks and when quadriceps strength is back to at least 80%.? When quadriceps strength is at least 90% and tolerating sport specific skills without symptoms a full return to sport can occur

Published in Post Surgery
Thursday, 11 December 2014 00:00

ACL Reconstruction Pre-Surgery Information

The following is what can be expected prior to ACL Reconstruction surgery:

Examinations: X-rays will be taken and a CT scan or MRI may also be needed to indentify the extent of the injury and damage.

Skin preparation: Night prior to and morning of operation, patient is required to wash leg with a sponge provided in the pre-admission clinic. Occasionally a Betadine Skin test is used if there is suspicion of an allergy to iodine.

Bowel Prep: Glycerin suppositories will be provided at the pre-admission clinic. Patient to is required to administer the evening prior to surgery (instruction leaflet given at the pre-admission clinic).

Patient education: Physiotherapy assessment will include: instruction of gait training, use of crutches and pre and postoperative exercises. Patient will be fitted for crutches to take home and practice preoperatively.

Medications: Cease aspirin or anti-inflammatory medications 10 days prior to surgery as well as any naturopathic or herbal medications.

 

Day of Surgery:

Surgical paperwork will be administered by the nurses and the anaesthetist will meet with you to ask a few questions.

A hospital gown will be given and the operation site will be shaved and cleaned.

Betadine skin prep will be applied to above area and wrapped.

All x-rays are to be sent with patient to theatre.

Published in Pre Surgery

Meniscus tears are among the most common knee injuries. Following an acute injury to the knee it is usually the lateral meniscus that is torn. Athetes and those that play contact sports are at the most risk for meniscus tears. However, meniscus injury can happen to anyone at any age. 

During sport players may twist and bend their knee resulting in a tear to the meniscus. This is usually accompanied by a popping sound. Older people are more likely to acquire a degenerative meniscus tear due to cartilage weakening and wearing with age. An awkward twist or bend can result in a meniscus tear. 

Chronic ACL rupture can also lead to medial meniscus injury.?

Meniscal repair surgery is a delicate surgery to the meniscus and should be perfected until healing is achieved. Depending on the individual nature of the injury surgical interventions can involve carefully suturing the tear back together, knee arthroscopy or a partial meniscectomy in conjunction with traditional ACL reconstructive surgery.

 

Post Operative Precautions after ACL reconstruction with additional meniscal repair:

  • ACL rehabilitation must be adjusted to protect the meniscal repair
  • Mobilising weight bearing as tolerated with crutches for the first six weeks
  • Avoid knee flexion beyond 90 degrees for the first six weeks and ensure the knee is extended during the stance phase of gait
  • No resisted quadriceps exercises until six weeks post-surgery
  • Avoid deep knee squats and leg presses beyond 90 degrees of knee flexion for three months
  • All other instructions are similar to standard ACL protocol and post-surgery recovery

 

For more information on ACL reconstruction symptoms and surgical interventions please see ACL Reconstruction.

Published in Information
Thursday, 11 December 2014 00:00

ACL Reconstruction Treatment Options

Not everyone with an ACL injury will require surgery. Conservative and non-surgerical management is ideal in older non-active patients as it is possible to compensate for the injured ligament with strengthening exercises or a brace.

However, it is currently recommended that ACL rupture in young active patients is treated by reconstruction surgery since it is menisci-protective. 

Surgery is indicated if the patient in unable to live with their current level of stability of the knee and if they are wish to maintain an active lifestyle.

Surgical techniques for ACL reconstruction have improved dramatically during the past ten years. Complications are now less frequent and recovery time is much quicker than in the past.

 

Surgical Approaches 

The surgery is performed arthroscopically. Professor Munjed Al Muderis is skilled in All-Inside ACL Reconstruction which is a minimally invasive surgical alternative to traditional ACL reconstruction surgery. 

Both traditional ACL reconstruction surgery and All-Inside ACL reconstruction surgery involve replacing the ACL with a tendon graft. The ruptured ligament is removed and the bone prepared in order for it to accept the new graft which replaces the old ACL. Options for the tendon graft are outlined below. The difference between traditional ACL surgery and All-Inside ACL surgery is the approach taken, in particular the drilling of a tibial tunnel. Traditional ACL reconstruction techniques involve drilling a tunnel from the outer tibial cortex into the proximal tibia and knee joint. Through this tunnel the ACL graft is inserted and securely fixed onto the tibia. This tibial tunnel is a significant source of pain following ACL surgery.

However, with All-Inside ACL reconstruction such a tibial tunnel is not created. Instead a specialised tool called a reamer is used to create a tibial socket, which does not violate the tibial cortex as it does in traditional ACL surgery. All-Inside ACL surgery also doesn’t involve any formal incisions, only three to four small arthroscopy incisions.

The advantages of All-Inside ACL surgery include less pain and a faster recovery time than traditional techniques. Due to the specialised instrumentation used All-Inside ACL surgery can also help to create a more anatomic ACL reconstruction.

 

ACL Grafts

There are a number of different surgical options that can be used to reconstruct the ACL ligament. These include the use of autologus hamstring or patellar tendon graft, cadaveric donor grafts and synthetic graft (LARS). From the literature there is no overall significant difference between any of the options; but each method has its own advantages and disadvantages. The best option is the one that is most suited to both the individual patient and their injury. 

The graft of choice is then prepared in order to take the form of a new tendon and is passed through into the bone.

The new tendon is then fixed into the bone with various devices to hold it into place while the ligament heals into the bone (this usually takes about six months).

 

There are pros and cons for each graft option:

Graft Type

Pros

Cons

Hamstring tendon

  • Biological
  • Eventually fully replaced by new tissue
  • Scar is reasonably small and causes no irritation
  • Relatively weaker
  • May stretch
  • Donor site pathology (weakness in hamstring)

Patellar tendon

  • Biological
  • Eventually fully replaced by new tissue
  • Stronger than hamstring
  • Scar cause irritation especially kneeling
  • Donor site pathology (weaker patellar tendon and bone)

Cadaver graft

  • No donor site pathology
  • Faster operation than previous hamstring or patellar tendon
  • Eventually fully replaced by new tissue
  • Chance of rejection
  • Chance of transmission of infection
  • Weakest of all options
  • Depends on availability

LARS

  • No donor site pathology
  • Fastest of all the graft options
  • New tissue integrates with it
  • Minimal scar
  • Strongest of all the methods
  • Faster return to full activity
  • Requires good surgical experience with the technique and the material
  • Implant does not dissolve with time

 

Published in Information
Thursday, 11 December 2014 00:00

Hip Revision Arthroplasty Surgical Procedure

The surgical procedure for your hip arthroplasty revision will be explained to you prior to surgery including what is likely to be done. However, with revision surgery the unexpected can occur and good planning can prevent most potential problems. The surgery can be, but not always, more extensive than your previous surgery and the complications are similar but often more frequent than the first operation.

The surgery varies from a simple liner exchange to changing one or all of the components. Extra bone (cadaver bone) may need to be used to make up for any bone loss.

Published in Surgery
Thursday, 11 December 2014 00:00

Hip Revision Arthroplasty Information

The majority of patients who receive a hip replacement will retain the prosthesis for 15 to 20 years and sometimes for life. This is especially the case for elderly patients. However, some patients may need one or more revisions of a hip replacement. Revisions are most common in patients who had a total hip replacement at a young age and hip replacement patients who lead a very active life.

Depending on the damage to the hip prothesis and the circumstances, a hip revision can involve part or all of your previous hip replacment needing to be revised. Thus hip revision operations vary from minor adjustments to a more significant surgery. The surgery can vary from a simple liner exchange to changing one or all of the components of the previous hip replacement. Extra bone (cadavar bone) may be needed to compensate for any bone loss.

The most frequent reasons for hip revision arthroplasty include:

  • Repetitive dislocation and instability: This involves the hip popping out of place and can cause significant pain and distress.
  • Mechanical failure (implant wear and tear, loosening, breakage): This will usually present as pain and can be identified by an x-ray.
  • Plastic (polyethylene wear): This is one of the simpler revisions as only the plastic insert is replaced.
  • Infection: This will usually present as pain but other symptoms can include acute fever or a general feeling of being unwell. 
  • Osteolysis (bone loss): This can occur if particles are released into the hip joint and can result in bone being broken down and destroyed.

Published in Information
Wednesday, 03 December 2014 00:00

Tumour Removal Post Surgery Information

The following is what can be expected following tumour removal surgery: 

On the day following surgery your drains will usually be removed and you will be allowed to sit out of bed or walk.

You can expect to be discharged home or to a rehabilitation hospital approximately 5-7 days after surgery depending on your pain and availability of help at home.

Your rehabilitation plan will vary depending on the surgical procedure and approach decided upon but you can expect to use crutches or a walker for a period of time. 

Physiotherapy is recommended and a physiotherapist will run through with you what is involved in the post-surgical program.

 

Concerns:

Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf. 

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Published in Post Surgery
Wednesday, 03 December 2014 00:00

Tumour Information

Tumour growth or behavior will vary according to the type of tumour and depending on whether the tumour is non-cancerous (benign) or cancerous (malignant).

Most bone tumours are benign. They tend to grow slowly and don't usually tend to reoccur once removed from surgery. Benign tumours tend to stay non-cancerous except in rare cases. 

The most common benign types of tumour include:

  • Non-ossifying fibromaunicameral (simple) bone cyst
  • Osteochondroma
  • Giant cell tumour
  • Enchondroma
  • Fibrous dysplasia

 

Malignant tumours are cancerous and vary in size and shape. They grow in an uncontrolled and abnormal ways, interfere with bodily functions and can be life-threatening if not treated.

A malignant tumour which begins in the bone (primary bone cancer) is different from a tumour that begins somewhere else in the body and spreads to bone (secondary bone cancer).

 

The four most common types of primary bone cancer occurring in the hip are:

  • Multiple Myeloma: Multiple myeloma is the most common primary bone cancer. It is a malignant tumor of bone marrow
  • Osteosarcoma: Osteosarcoma is the second most common bone cancer and is commonly found in teenagers
  • Chondrosarcoma: Chondrosarcoma occurs most commonly in middle aged to elderly patients

 

Symptoms:

Most patients with a bone tumor will experience pain in the area where the tumour occurs. The pain is generally described as dull and achy and may get worse with activity but this is not always the case. The pain often keeps the patient awake at night. 

Tumours are not caused by trauma, however, in some cases an injury can cause the tumour to start hurting. Injury can also cause a bone that is already weakened by tumour to break or fracture.

In some cases patients will not experience any symptoms of pain but instead notice a mass or lump.

Depending on the type of tumour they can be treated either surgically or non-surgically. 

Published in Information

The following is what can be expected following hip revision arthroplasty: 

On the day following surgery your drains will usually be removed and you will be allowed to sit out of bed or walk with a physiotherapist.

You can expect be discharged home or to a rehabilitation hospital approximately 5-7 days after surgery depending on your level of pain and available help at home.

Your rehabilitation plan will vary depending on the surgical procedure and approach decided upon but you can expect to use crutches or a walker for a period of time. 

Physiotherapy is recommended and a physiotherapist will run through what is involved in the post-surgical program. 

 

Post-op precautions:

It is important that you avoid any movements that will stress, damage or lead to dislocation of your new hip:

  • For the first six weeks it is recommended you sleep with a pillow between your legs
  • Avoid crossing your legs and bending your hip past a right angle
  • Avoid low chairs and bending over to pick things up. Grabbers can be helpful with this as well as shoe horns
  • Avoid the combined movement of bending your hip and turning your foot in as this can lead to dislocation

 

Concerns: 

Please contact the office if you are worried about your level of pain, have significant bleeding, or have fever or redness around the surgical site.

If you require assistance after hours, please contact the hospital where the surgery was performed and they will contact Professor Al Muderis on your behalf.

Norwest Private Hospital: (02) 8882 8882?

Sydney Adventist Hospital: (02) 9487 9111

Macquarie University Hospital: (02) 9812 3000

 

Published in Post Surgery