• Torn ACL and Surgery

    Posted by Orthopaedic Specialists

    torn acl and acl surgery for athletesTorn ACL and Surgery – Learn More About Risk of Re-Tearing

    The incidence of second ACL injuries in the first year after ACL surgery is 15 times higher compared to an athlete that has never had a torn ACL.

    We have data looking at recurrence rates after one year post surgery for a torn ACL. Dr. Mark Paterno and Dr. Timothy Hewitt and colleagues studied a group of athletes from the time of ACL surgery until they were 2 years post surgery for a torn ACL.

    Key findings from this important research on ACL injuries after ACL surgery include the following:

    1. Having another ACL injury 2 years from the date of surgery is 6 times greater in patients that have undergone an ACL reconstruction, compared to the healthy control group that never had any injury.
    2. The group that underwent an ACL reconstruction and then returned back to sport had a 5 times greater rate of recurrent ACL injuries compared to the healthy control group.
    3. Female patients in the ACL reconstruction group were twice as likely to suffer a contra-lateral knee injury as compared to an ipsilateral knee ACL injury.
    4. Overall, approximately 30 percent of the athletes sustained another torn ACL within 24 months of returning back to sports. Out of the 30 percent that had a second torn ACL: 80 percent tore the opposite knee from the initial injury and 20 percent re-tore their surgical side/graft.

    Based on the results of this study, we can conclude that the opposite knee is at increased (more…)

    ACL Knee Surgery and Knee Injuries

    Posted by Orthopaedic Specialists

    acl knee surgery and college athletesKnee Surgeries and College Athletes

    – What are the effects of prior knee surgery including ACL knee surgery on subsequent injury, and surgery for NCAA college athletes?

    It is known that college athletes that have undergone knee surgery in the past are at risk for addition injuries to their knee.

    There is an excellent study by C. Rugg and Colleagues (2014) that quantified the risk of additional knee injury and knee surgery in a group if division 1 college athletes that had undergone knee surgery prior to entering college.

    A total of 456 division 1 athletes entering college were included in the study group.

    The college athletes, that had surgery prior to entering college, were divided up into four different groups. The groups included the following:
    – 22%: undergone some type of orthopaedic surgery (shoulder surgery, knee surgery, etc.)
    – 10%: knee surgery prior to admission to college
    – 3.5%: ACL knee surgery
    – 6%: multiple surgeries

    The group of college students that had undergone knee surgery prior to their admission to college had a risk of a repeat knee injury 6.8 fold more than the control group and there was a 14 fold increased risk of undergoing additional knee surgery.

    The group of college students that had ACL knee surgery prior to admission to college had a 19.6 fold increased risk of sustaining an additional knee injury and an 829 fold increase in undergoing additional knee surgery while in college when compared to the control (more…)

    Best Shoes for Travel

    Posted by Orthopaedic Specialists

    Best shoes for travel5 Tips for the Best Shoes for Travel –

    Whether you are going on vacation, or traveling for business, learn 5 helpful tips for the best shoes to pack for travel.

    1. Bring shoes you can slip in and out of easily. If you are flying, this is especially helpful at the airport, making it easier to go through security.

    2. Pack flip flops to wear in your resort, condo or hotel shower so that you do not pick up a foot fungus.

    3.  If you are in a sunny location, the best shoes for travel cover the tops of your feet or apply sun block to this easily overlooked area. The skin on the top of the feet is very sensitive and can burn easily when exposed to sun.

    4. If you are wearing new sandals, remember to throw some band aids into your bag just in case you start to develop a blister. The top part of your foot is very sensitive and new sandals may have different pressure points that cause your skin to tear.

    5. If you are traveling to a cold / winter destination, it is important to make sure that your boots are slightly larger and definitely not smaller than your regular shoe size. Tight shoes or boots in cold weather results in colder toes. (more…)

    What Are Orthotics including Custom Orthotics?

    Posted by Orthopaedic Specialists

    Custom orthoticsAn orthotic is a device that is placed inside your shoe to help correct foot malalignment. An orthotic, including custom orthotics, is a supportive insert that fits into your shoe.

    Orthotics can help people with foot pain and common foot conditions such as: plantar fascitiis, foot pronation, patella femoral pain, bunion deformities, metatarsalgia, posterior tibialis tendinitis, posterior tibialis tendon ruptures / tears, stress fractures and Achilles tendinitis, just to name a few.

    3 Different Types of Orthotics including Custom Orthotics

    There are three different types of orthotics: 1) custom, 2) semi-custom and 3) off the shelf.

    Custom orthotics are the best type of orthotic. Custom orthotics fit your foot perfectly and are specifically designed for your foot type and alignment. A healthcare provider who is certified in making custom orthotics will measure your foot. This typically involves creating some type of cast of your foot to get precise measurements.

    The different type of healthcare providers that can make orthotics are: physical therapists, orthotists, and podiatrists. Typically after the custom orthotics are made there will need to be minor adjustments completed once you have tried the orthotic on inside your shoe.

    How to Buy Custom Orthotics?

    Most insurance plans will pay for custom orthotics. Another option if your healthcare provider does not include orthotics as a benefit is an off-the-shelf orthotic that is heated in the store and molded to your foot. These typically run about $30 to $50 dollars a pair.  A large percentage of running shoe stores will carry this option.

    Be careful of “Foot” stores that claim to make custom orthotics and are actually pulling an off-the-shelf device and just molding it to your foot. These places sometimes charge hundreds of dollars and your money is best spent with a true pair of custom orthotics (more…)

    Heel Pain Causes – Is It Plantar Fasciitis?

    Posted by Orthopaedic Specialists

    Heel Pain CausesPlantar Fasciitis and Other Common Heel Pain Causes

    Some of the most common causes of heel pain are: plantar fasciitis / heel spurs (also known as plantar fasciitis), calcaneal stress fracture, achilles tendinitis, and tarsal tunnel syndrome.

    Follow along to learn more about identifying the cause of your heel pain, along with common treatment recommendations for plantar fasciitis and other causes of heel pain.

    When Do Your Heel Pain Symptoms Occur?

    The timing of your heel pain may provide important information about different heel pain causes.  Is your heel pain most severe in the morning or in the evening or does it hurt the same amount all day long?

    • Plantar fasciitis will hurt when you get out of bed first thing in the morning or if you have been sitting for any period of time and then stand up.
    • Achilles tendinitis will also hurt first thing in the morning and when going from a prolonged sitting position to a standing position.
    • Calcaneal stress fractures are just the opposite. The pain will get worse as the foot gets used more. Typically first thing in the morning after a night of rest without any weight bearing, a stress fracture will be less symptomatic in the morning.
    • Tarsal tunnel syndrome will cause numbness and tingling typically on the innerside of the heel. Pain with tarsal tunnel syndrome is fairly constant.

    What is the Exact Location of your Heel Pain?

    Plantar fasciitis pain is located in the bottom part of the foot in the heel region. It is mostly on the inner side of the heel.

    Achilles tendinitis is located in the area of the Achilles’ tendon. This is the big tendon located on the back of the heel. It connects your calf muscle to your ankle. It’s a thick cord-like structure in that area.

    A calcaneal stress fracture will cause a more diffuse non specific pain involving the heel bone. It may be difficult to pinpoint the exact location of the pain.

    Pain from tarsal tunnel syndrome is located on the inner side of the ankle and may have numbness associated with the condition.

    Treatment for Different Types of Heel Pain

    • Treatment for Plantar Fasciitis: a visit to a physical therapist to work on a stretching program, shoe wear modification, a night splint, oral NSAIDs, orthotics if the foot is pronated (flat), and refraining from walking barefoot. On rare occasion a cortisone shot is given in the area where the plantar fasciitis is present. Surgical resection of the plantar fascia has variable results. PRP treatment is currently being researched. Treatment for plantar fasciitis usually takes 6-8 to work. Recurrence is very common.
    • Treatment for Achilles Tendinitis: a visit to a physical therapist, night splint, shoe lift that slightly elevates the heel, and an oral NSAID if not medically contraindicated. Cortisone injections are not recommended in this area because of the risk of tendon rupture.
    • Treatment for a Calcaneal Stress Fracture: relative rest. Reduce activity until there is no pain. Crutches / walker / knee walker may be needed. A cast boot may also help to reduce the pain and speed up the healing phase. A bone stimulator can also be used. If there is concern that the patient has poor bone quality that has contributed to the fracture a DEXA scan is recommended.

    (more…)

    Foot Bones Quiz

    Posted by Orthopaedic Specialists

    Foot BonesHow Much Do You Know About The Bones In Your Feet? Take this quiz about foot bones and find out!

    Q 1. How many bones are in your foot?

    A. 26

    Q 2. Can you name all the bones in the foot?

    A. Calcaneus, talus, navicular, cuneiforms, cuboid , metatarsals, proximal phalanx, middle phalanx and distal phalanx (also known as phalanges)

    Q 3.  Can you be born with an extra bone in your foot?

    A. Yes, it is called an accessory navicular. Most of the time they do not cause any problems. It it does become problematic it can be removed.

    Q 4. Does your foot have any bones encased in a tendon?

    A. Yes, you have two on each foot. They are called sesomoids. They are located under the great toe joints they can become fractured in runner.

    Q 5. Can your shoe size get larger after you have stopped growing taller?

    A. Yes, however it is not from the foot bones growing longer. It typically has to do with bunion formations or tendon ruptures that can change the shape of the foot and make a larger shoe size needed. (more…)

    Do You Have Foot Pain? It’s “Be Good To Your Feet Month” At Orthopaedic Specialists

    Posted by Orthopaedic Specialists

    Foot Pain and Foot CareLouisville’s Orthopaedic Specialists is celebrating “Be Good To Your Feet Month” to offer some relief to those suffering from foot pain. Board certified orthopedic surgeon and sports medicine physician Dr. Stacie Grossfeld is focusing on the importance of healthy feet and foot care to eliminate foot pain during the month of October.

    With 26 bones in each foot, 33 joints, over 100 ligaments, and around 125,000 sweat glands, the team at Orthopaedic Specialists emphasizes that caring for your feet is an important part of health and wellness.

    As an orthopedic surgeon and sports medicine doctor with a private practice in Louisville, Kentucky, Dr. Grossfeld is accustomed to seeing patients with foot pain and a wide range of foot injuries and problems. This month Orthopaedic Specialists is focused on offering educational information and preventive tips to help people treat their feet a little better. Some upcoming blog topics include: plantar fasciitis, bunions, orthotics, the best footwear, and much more.

    While people of all ages suffer from some type of foot pain or injury, foot problems tend to become increasingly common as people get older.  Many seniors experience some type of foot injury or problem, and this can cause pain and disability, paired with problems with mobility and independence.

    Some common foot conditions that Dr. Grossfeld sees at her Louisville orthopedic and sports medicine practice include: osteoarthritis, bunions, plantar fasciitis, blisters, toe deformities, bone fractures, heel spurs, stress fractures, and tendinitis.

    While basic foot care is important to everyone, certain athletes may be prone to specific types of foot injuries and problems. For example, football players may be more likely to suffer from turf toe, while some long distance runners may be prone to plantar fasciitis and ballet dancers may be more likely to experience pain under their big toe caused by sesamoiditis.

    If you are suffering from some type of foot pain that is not going away, you may need to seek help from a qualified medical provider like orthopedic surgeon Dr. Stacie Grossfeld at Orthopaedic Specialists. (more…)

    Rotator Cuff Surgery and Risk for Recurrent Tearing

    Posted by Orthopaedic Specialists

    Rotator cuff surgery and repairFactors Predicting Rotator Cuff Tears that are at Risk for Recurrence Tearing at the Time of Surgery

    Once the rotator cuff is repaired what are the chances of a tear recurring? There have been multiple studies completed to verify risk factors for recurrence of re-tearing of the surgically repaired tendon.

    Surgical reconstructed is recommended on symptomatic patients that have full thickness tears and have partial thickness tears that involve over 50% of the tendon. One of the most common postoperative complications in reference to rotator cuff surgery is a recurrent tear.

    Even after surgical reconstruction the rotator cuff can re-tear. There have been studies reporting recurrent tear rates from 11 to 94%. What are the risk factors that would indicate a surgically repaired rotator cuff could re-tear? Risk factors  that have been identified in prior studies are: large tear size measuring from anterior to posterior  in addition to medial and lateral tear size ( retraction distance) , surface area of the tear size, older age of the patient, the existence of fatty replacement of muscle  , presence of muscle atrophy and quality of the torn tendon.

    The above factors have been reported in smaller sized studies typically under 200 patients. The biggest study to date with the most amount of patients was reported in the May, 2014  issue of the American Journal of Sports Medicine. The study was led by Brian Le MD from the University of South Wales, Sydney, Australia.  Their study included 1,000 consecutive patients who it undergone a primary rotator cuff repair by a single surgeon using arthroscopic technique.

    Six months after the rotator cuff surgery an ultrasound was completed to assess the repair integrity. The authors found that the most important factor in predicting recurrent tearing of the rotator cuff was the size of the rotator cuff tear at the index surgery. The research team also found a strong relationship between recurrence rates in patients who had poor tissue quality, poor intra operative tendon immobility and had a second surgical procedure performed in the shoulder at the time of the rotator cuff tear.

    In addition, the researchers found that a patient’s age at the time of rotator cuff surgery was a strong independent predictor of recurrent tear rates, with increasing age linked to increasing likelihood. When comparing the rotator cuff tear size from side to side versus the distance the tear was retracted, they found that the side to side tear size was more (more…)

    Nineteen Key Facts About Anterior Traumatic Shoulder Dislocation

    Posted by Orthopaedic Specialists

    shoulder dislocation1. Almost half of the people suffering from a shoulder dislocation are between 15 and 29 years of age.

    2. Males dislocate their shoulders three times more than females.

    3. A quarter of the people who have an anterior shoulder dislocation will require surgical stabilization secondary to persistent instability.

    4. Half of the patients who sustain a first episode of shoulder dislocation will most likely experience two more episodes.

    5. Moderate to severe osteoarthritis has been reported in 18% of patients with a first time dislocation, and up to 40% of patients who have more than one shoulder dislocation.

    6. Recurrence rate following nonsurgical management of traumatic shoulder dislocation ranges from 30% to 67%. This rate increases to 55% up to 82% in young male athletes.

    7. The biggest risk factors for recurrent instability after shoulder dislocation includes: young age, athletic activity, male gender, and the presence of a bony Bankart lesion. There are some studies that have concluded that males, that play contact sports, under age 20 are the highest risk for recurrence of anterior shoulder instability after first time this location.

    8. Nonsurgical management is the initial treatment of choice for first time dislocators. It is recommended that the athletes be in a sling for up to 1 to 4 weeks. Range of motion is typically started at one week post injury.

    9. Stabilizing structures at risk after dislocation: the glenoid labrum, the bony glenoid rim, the anterior capsule and the anterior band of the inferior glenohumeral ligament

    10. The shoulder is at risk for dislocation because of its wide range of motion, a shallow glenoid articulating with a nearly spherical humeral head. This makes an inherently unstable configuration relying on other structures to prevent instability, including static structures such as the glenoid labrum, joint capsule, and the glenohumeral ligaments.

    11. The glenoid is pear-shaped and measures 5 cm in its position from top to bottom and 2.5 cm and it’s inferior anterior posterior dimension. It is relatively shallow with a concave any measuring 2.5 mm deep.

    12. The labrum increases the depth of the glenoid by 2.5–5 mm. The capsule provide the negative hydrostatic pressure between the humeral head and glenoid making it more stable.

    13. The anterior inferior rim of the glenoid is important to anterior inferior glenohumeral stability. During an anterior shoulder dislocation, the glenoid rim may have avulsed at the bony attachment of the anterioinferior capsulolabral complex. (more…)

    Dancing and ACL Tear

    Posted by Orthopaedic Specialists

    Ballet dancers less likely to experience ACL injuryWhy do dancers (ballet and modern) have a lower incidence of ACL injury compared to other athletes?

    A great study conducted at the Harkness Center for Dance injuries in New York City in conjunction with the Langone Medical Center Hospital for Joint Diseases looked at the biomechanics of landing from a jump between the two groups. It was a two part study published in the American Journal of Sports Medicine in May of 2014. The research group was headed by Dr. Marijeanne Liederbach.

    It is documented that poor landing mechanics from a jump such as a rebound can lead to an ACL tear and injury. Poor biomechanics such as an increase in knee abduction, hip adduction, low flexion angle when landing, increase use of quadricep muscles compared to hamstring muscles, and excessive truck tilt results in a higher incidence of ACL injury.

    The study looked at 4 groups of athletes: male and female, dancers and team sport athletes. They had the athletes do a single leg drop jump from a 30 cm platform. Joint kinematics and kinetics were compared between groups and genders using multivariate analysis of variance and pair wise t tests.

    They found that the male team sport group was similar to both the male and female dancers. They found that the team sport females exhibited poor landing techniques which would place their knee at increased risk of an ACL tear or injury.

    The hypothesis from the authors as to the reason the female dancers had excellent landing techniques was that dancers spend hours working on jumping and landing techniques which start at an early age in their training and continue throughout their career.

    The second part of the study looked at the 4 groups and what happened to their landing technique when they were fatigued. The study found that the dancers took typically a longer period of time before they became fatigued. Once they did become fatigued they start exhibiting signs of poor landing techniques.

    This study shows how it is important to focus on strengthening the muscles around the hip and knee in addition to making sure that the athletes have excellent landing techniques if an ACL tear is going to be prevented. (more…)