• What is Hyaluronic Acid?

    Posted by Orthopaedic Specialists

    This is an injection that is given for knee osteoarthritis. It is called by many names. Here are a few names my patients have called it: rooster comb injection, chicken fat shot, cock comb injection, jelly shot, gel shot, cushion injection, just to name a few… It’s brand name depending on the company that produces it is: monovisc, synvisc, gel one and its generic name is hyaluronic acid or shortened to HA.

    What is this mysterious multiple named injectable material???

    A little background information, first. HA is a naturally occurring fluid in your knee joint. It is a thick viscous fluid that lubricants the knee joint. The fluid is produced by the cells lining the wall of the knee called synoviocytes.

    When a knee becomes arthritic the synoviocytes start producing a fluid that is very thin and water like which does not lubricate the knee very well. The principle behind injecting the HA into the knee is it tricks the synoviocytes to start producing a thicker fluid for 5-6 months which makes the knee feel better. Eventually the arthritic knee goes back to producing the water like fluid again which is why the injection is given about every six months.

    HA is a “bandaid” in the sense that it helps for a while to reduce pain but eventually stops working and the injection will have to be repeated. As the osteoarthritis worsens or advances, which all arthritis does, the injection may become ineffective.

    An Overview of The New Fitness Trend F45

    Posted by Orthopaedic Specialists

    Originating out of Australia, F45 is a group training facility designed to help members reach their health and fitness goals. With a new location now open in Middletown, Kentucky, those interested in a workout that offers structure, motivation as well as a sense of community, all in a realistic time frame, can attend classes starting April 20th.

    What does F45 stand for?

    F45 combines high intensity interval training, circuit training and function training; three methods that have proven most effective for burning fat and building lean muscle. High intensity interval training consists of rapid fire exercises that shock the body into shape. Circuit training involves strength training, cardiovascular and muscular endurance. The “F” in F45 stands for function training. F45 describes function training as, “exercises that mimic or recreate everyday movement.” The “45” is how long each workout takes: exactly 45 minutes.

    With 31 45 minute workouts and 3,000 variations, members never get the same workout twice. Each routine is challenging and utilizes the whole body as well as all it’s joints and muscle groups. In support of day to day activities, the workouts focus on movements such as lifting, squatting, jumping, twisting, pulling, pushing, punching, kicking, rowing and biking. Stations are stocked with items like barbells, ropes, rowing machines, mats, stationary bikes, sandbags and bosu balls.

    At the beginning of each class, two instructors demonstrate each exercise. Further instruction is shown on monitors around the room. As for the 31 workouts, they are each themed around movement patterns for various sporting activities. Some of the most popular include:

    Brooklyn: Boxing A mix of boxing, MMA and martial arts.

    Brixton Brooklyn’s sister workout is structured to mimic the training of a fighter and features a mixture of MMA, combat, and self defense.

    Foxtrot: Cardio Based A military style resistance workout.

    Atheltica An agile focused workout.

    Romans: Resistance It is scientifically proven that resistance based training can actually burn more calories than cardio.

    Hollywood Circuit and West Hollywood Although these are a whole hour, they’re perhaps the most popular and well known for their fun curated playlists.

    So I’ve Torn My Meniscus, Why Should I Have My Knee Scoped?

    Posted by Orthopaedic Specialists

    1. The meniscus is the major shock absorber in your knee.
    2. Once there is a tear in the meniscus it can easily propagate.
    3. If the tear gets larger, more meniscus has to be removed at the time of surgery, resulting in a greater force to the articular cartilage of the knee joint, increasing your risk of early onset arthritis.

    What is a Baker’s Cyst?

    Posted by Orthopaedic Specialists

    Unfortunately it has nothing to do with chocolate cake…A Baker’s cyst is a collection of fluid that accumulates in the back of the knee. It typically occurs from one of three different sources.

    1. The most common reason people develop a Baker’s cyst is from osteoarthritis. If you have an arthritic joint that gets inflamed, and is in the inflammatory stage, it produces fluid. The fluid can leak out of the knee joint and accumulate in the back (posterior) part of the knee outside of the actual knee joint.
    2. The second source of a Baker’s cyst is a tear of the meniscus. When you have a meniscal tear fluid can leak out of the knee joint. It creates a one way valve where fluid leaks out and cannot get back into the knee joint. Therefore it collects and forms a cyst.
    3. You can also have a tear in one of your tendon sheath that surrounds your hamstring tendons and fluid can leak out in that area and create a Baker’s cyst as well.

    Can Baker’s cyst get bigger and smaller?

    Yes, if your arthritis goes into a non-inflammatory stage. When the knee joint produces less fluid, the baker cyst will get smaller and sometimes completely resolved. Baker’s cysts can also get so big that they rupture on their own. If you have a meniscal tear and you undergo surgery, the bakers cyst tends to go away on its own.

    Frequently Asked Questions:

    1. Can a Baker’s cyst become malignant or cancerous? – No
    2. If a Baker’s cyst is drained will it come back? – Yes, you must stop the source of the fluid that’s creating the Baker’s cyst. Simply draining the cyst with a needle will decompress the cyst for a short period of time typically less than 24 hours and then the fluid will accumulate again. If you have arthritis, reducing the inflammatory phase of the arthritis will reduce the size of the Baker’s cyst. If you have a meniscal tear, having a knee arthroscopy will eliminate the Baker’s cyst.
    3. Can a Baker’s cyst be surgically removed? – Yes, but they tend to come back very quickly if you don’t stop the source of the fluid that is causing the bakers cyst to occur.
    4. What is inside of a Baker’s cyst? – Synovial fluid, located inside of your knee joint that helps to lubricate your knee.
    5. Will you remove the Baker’s cyst at the time of a knee arthroscopy which is being done for a meniscal tear? – No, the Baker’s cyst is actually located outside of the knee joint and outside of the capsule of the knee. You cannot access the Baker’s cyst from the inner part of the knee joint while doing a knee arthroscopy. By resecting the meniscal tear the Baker’s cyst typically will go away.

    What Happens If You Remove the Whole Meniscus?

    Posted by Orthopaedic Specialists

    1. The force on the cartilage in the knee joint increases by almost 300%.
    2. This huge increase of force accelerates the wear of the articulations cartilage which ultimately results in early onset osteoarthritis.
    3. Prior to knee arthroscopy: pre 1980’s, Orthopaedic surgeons would remove the whole meniscus when there was a tear and a large majority of those folks went on to develop advance osteoarthritis in their knee; resulting in knee replacement surgery at an early age.

     

     

    Carpal Tunnel Release

    Posted by Orthopaedic Specialists

    Now that is a hand I would NOT like to do a carpal tunnel release on in the operating room. Instead of having to stand on to step stools like I typically do when operating, I would need a full-fledged extension ladder.

    Carpal tunnel syndrome is a condition where the retinaculum, which is a structure that lies over your median nerve, gets inflamed and thickened. When this occurs the inflamed retinaculum can push on the median nerve which irritates it. This causes pain, numbness and tingling involving your thumb, index finger and middle finger. Pain can shoot up to your elbow with carpal tunnel syndrome.
    The treatment starts with physical therapy, wearing a night brace, taking B vitamins and sometimes a cortisone injection. Diagnostic imaging includes a plain x-ray and an EMG/nerve conduction study.
    If this treatment fails surgery is an option.

    Can a Torn Meniscus be Repaired?

    Posted by Orthopaedic Specialists

    Yes, but not often, only less than 5% of the time. Why?

    The meniscus is divided up into three zones. Two of the three zones have a very poor blood supply. Blood is needed to aid in a repair. Sutures can be placed to hold the torn meniscus together, but if there is no blood supply the meniscus will not heal.

    Most meniscus tears occur in the area where there is poor blood supply. Therefore repairing the meniscus is not an option, only removing the torn portion is the treatment. The majority of people when they have their knee scoped are NOT getting a meniscal repair they are undergoing a partial menisectomy.

    Those that can get their meniscal tear repaired usually have tears that occur at the same time an ACL injury occurs. The meniscal tear pattern in that injury tends to occur in the region of the meniscus that has a good blood supply.

    This image with red circle reveals a tear in the red zone of the meniscus.


    The blue arrow in this image indicates the white zone, while the red arrow points to the red zone.


    The blue arrow in this next image shows the white zone of the meniscus while the red arrow indicates the red zone.


    This shows an ACL tear.

    Does Removing a Torn Meniscus Harm the Knee Joint?

    Posted by Orthopaedic Specialists

    The meniscus is a shock absorber in the knee. The part of the meniscus that tears no longer has shock absorber properties.

    The torn part of the meniscus causes pain, irritation to the knee and on occasion mechanical symptoms such as catching and locking. By removing the torn part of the meniscus it doesn’t not harm the knee because the torn part of the meniscus was not functioning.

    If large portions of the meniscus are torn, that can lead to early onset osteoarthritis because a large portion of the meniscus is missing and therefore a larger portion of the shocker absorber is gone. The knee scope just removes the torn portion of the meniscus removing the pain source.

    Below are tools I use to remove the torn portion of the meniscus.

    Snowboarder Vs. Skier

    Posted by Orthopaedic Specialists

    The skier lost …

    Image on left is a normal pelvis. Image on right with red circle and arrows points to the fracture of the inferior and superior pubic rami.

    What is that area in the bone?

    Posted by Orthopaedic Specialists

    What is that area in the bone that is white, where the red arrow is pointing ?

    This patient fell and has acute onset pain involving her ankle. She has a bone cyst also known as a aneurysmal bone cyst. She was most likely born with this cyst and never knew it until she had a trauma. We took an x-ray in the office which showed the cyst and then obtained an MRI scan. The arrow is actually pointing to where she broke through the bone where the cyst is located. This does not appear to be malignant. This will heal with immobilization in a cast boot.