Different Types of Meniscal Tears

In a recent blog post, we discussed meniscal tears and treatment of these injuries.  Today we will take a look at the 3 different shapes of meniscal tears. To recap, the meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between the thigh bone and shin bone. The primary function of the meniscus is to keep the knee stable and act as a shock absorber.

Types of Meniscal Tears:

1.      Longitudinal 
2.      Radial 
3.      Horizontal
  
Longitudinal Meniscal Tears

A longitudinal tear runs along the meniscus.  If the longitudinal tear is partial, it can heal without surgical intervention. If it does not heal properly, however, it can often lead to a full bucket handle tear (a complete tear that goes through the meniscus). Longitudinal tears are very common in young athletes and often present in conjunction with an ACL tear.

Radial Tears

Radial Tears occur along the inner edge of the meniscus and can be either partial or full.  Two common radial tears are oblique tears and parrot’s beak tears.  Oblique tears are probably the most common type of meniscal tears.  

Horizontal Tears

This type of tear goes through the meniscus and splits the meniscus into a top and bottom section. These tears are not as common and often begin as a result of degeneration or a minor injury.  Unfortunately, if left untreated, horizontal tears can leave the patient more susceptible to the more serious horizontal flap tear and can become complicated to fix. 

Developing a Treatment Plan:

It is important to remember that there are some key factors to consider when developing a treatment plan for a meniscal tear.  These factors include:

1. Patient’s age
2. Patient’s activity level 
3. Shape/location of the tear (complex tears can be a combination of longitudinal, radial and horizontal)
4. Related injuries (if any) that are present

Age and activity level are important to the success of a surgical repair of the meniscus. The younger and more active the patient, the more likely the repair will be successful. It is also extremely important to evaluate other injuries. For example, if you repair the meniscus, but fail to repair an ACL tear, recovery will be compromised. A full evaluation of each patient is necessary to determine an appropriate treatment plan.

If you feel you have a meniscal tear, it is important to see a doctor and he/she will develop a treatment plan that is best for you. 

Case Study: Shoulder Injury - Old and New

As an orthopedic surgeon it is my goal to treat injuries by restoring the normal anatomy that has been disrupted. In this case study we will discuss an unusual combination of shoulder injuries which required a unique treatment plan.

In this case, a patient came into the office with a dislocated shoulder. Upon examination, we found remnants of an old injury that left his shoulder anatomy compromised and a new injury that was severely hindering his shoulder function. Many doctors may have opted to only address the new injury, but we knew that the first objective was to restore the patient’s anatomy to normal (fix the old injury) and then address the new injury. 

After thorough evaluation, we discovered scapular dyskinesis (abnormal movement) with winging, a prominent AC joint (the AC joint is the joint where the collarbone and shoulder blade meet) and unstable left shoulder. An MRI further revealed an anterior labral tear and bankart lesion.  The scapular dyskinesis and prominent AC joint were due to the old injury that had not healed properly and likely led to the anterior labral tear and bankart lesion.  In order to give the patient the best chance of full recovery and normal shoulder function, we had to address both injuries. 

We opted for staged surgical procedures.  First, we would need to reconstruct the AC Joint, then 2 months later we would perform a second arthroscopic surgery to repair the bankart lesion and anterior labral tear.  Reconstructing the AC Joint was the first priority.  By performing the reconstruction, we would be restoring the shoulder to its natural anatomy. Restoration of the natural anatomy gives the patient the best chances for a full recovery from the second injury.  By ignoring the old injury (which led to the abnormality of the AC Joint), the chances of a full recovery from the labral tear and bankart lesion would be slim and leave the shoulder more prone to future injury.

Following the surgeries and postoperative physical therapy, we could not be more pleased with the results.  Four months after the second procedure: the scapular winging disappeared, the patient was pain-free, the instability of the shoulder was gone and the patient was able to return to full work duty without any restrictions.  The patient is thrilled with the results.  Following his first injury, he had never returned to “normal”, but now he reports that he is better than ever.  He has complete range of motion in the shoulder and is living pain free. A complete success in our book!

 

Ask the Orthopedic Surgeon: What is the meniscus?

Question:
I keep hearing of athletes tearing their meniscus.  What exactly is the meniscus and what does it do and what happens if it is torn?

Answer: 

What is the meniscus?
The meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between thigh bone and shin bone.  The meniscus acts as a shock absorber and keeps the knee stable.  The meniscus also distributes our weight evenly over the knee. The most common causes of a meniscal tear are a sudden twist of the knee or overuse.

What are the symptoms of a torn meniscus?

-        A “pop” may be felt at the time of the injury

-        Pain

-        Stiffness & Swelling

-        Limited range of motion

-        “Locking or Catching”

How is a torn meniscus treated?

Treatment of meniscal tears vary depending on the size, severity and location of the tear.  Tears that are small in size and on the outer edge of the meniscus may not require surgery.  In these cases, the protocol is RICE:  Rest, Ice, Compression and Elevation combined with anti-inflammatory medications (aspirin or ibruprofen). The patient may or may not be required to wear a brace.

If the meniscal tear is moderate to severe, a knee arthroscopy is often needed. Knee arthroscopies are performed through a small incision in the knee.  An orthopedic surgeon then inserts a small camera, which provides a clear view of the knee.  From there, the orthopedic surgeon either repairs the tear or removes the torn portion of the menisci.

Depending on the location of the tear, an orthopedic surgeon decides whether to remove or repair a tear.  The outer layer of the meniscus is often referred to as the ‘red zone’ because it has a good blood supply, which is necessary for healing.  The inner layer is sometimes referred to as the ‘white zone’, which lacks a decent blood supply and makes healing difficult.  If the tear is located in the red zone it is normally repaired, but if it is in the white zone, it is normally fully or partially removed.  Full removal is normally avoided, if possible, as it can leave the patient more prone to osteoarthritis in the future.

For a meniscal repair, the recovery time is about 3 months, with 4-6 weeks on crutches and physical therapy.  A partial menisectomy (removal of the meniscus) has a recovery time of about 6 weeks and only 3 days on crutches.  Physical therapy is needed as well.  In both cases, patients are able to return to full activity. 

If you have an orthopedic question for John Vitolo, MD, please email your question to kim_abbasi@skyvieworthopedic.com.  John Vitolo, MD is Board Certified in Orthopedic Surgery and Sports Medicine.  Skyview Orthopedic has offices in Sparta and Randolph.

*Picture Source:  American Academy of Orthopedic Surgeons

Stay Safe on the Slopes: Preventing Snowboarding Injuries

With the winter sports season quickly approaching, it is important to consider how to stay injury-free on the slopes. How do you make sure that you get the most of this year’s snow and not wind up in the operating room? We will discuss some important ways to stay safe and injury-free.

The two most common mechanisms of injuries in snowboarding are falling or a direct/traumatic blow. The most commonly injured body parts are the arm, shoulder, head and wrist. Many injuries are minor, but others can require surgery and have a recovery time of 3 to 6 months. 

Be smart and take some precautions so that you can get the most out of this year’s snow and not wind up in the ER.  There are a few simple precautions that one can take to prevent injury. 

Take a Lesson

If you are new to the sport, get a licensed instructor to help you learn the sport. Instructors can be instrumental in helping you master the sport of snowboarding.  They can make sure you have the proper equipment and guide you to the appropriate training terrain.  With an instructor, you will also be taught proper techniques and form.  An instructor will even teach you the best way to fall without getting hurt. 

Proper Equipment

Make sure you have equipment that fits properly. This is extremely important. Bindings that are too loose or too tight are definitely a contributing factor to many injuries.  Helmets are also extremely important for injury prevention. In addition to a helmet, it is recommended that boarders wear wrist guards, knee pads and elbow pads.  It is estimated that using protective equipment can reduce injuries by 43%!

Use Common Sense

Most injuries occur after lunch, when the boarder is tired and fatigued.  The conditions also change after lunch and can become more icy or ‘skied-off’.  Make sure to stay hydrated, take breaks and stay alert. If you feel tired; stop and rest. 

Obey the Rules – National Ski Associations Responsibility Code

Know the code!  Follow the responsibility code and prevent injury. 

·        Always stay in control

·        People ahead of you have the right-of-way

·        Stop in a safe place for you and others

·        Whenever starting downhill or merging, look uphill and yield

·        Use devices to help prevent runaway equipment

·        Observe signs and warnings, and keep off closed trails

·        Know how to use the lifts safely

There are many ways to prevent injury and stay safe this year on the slopes.  Be aware, wear proper equipment and stop when you are tired.  Follow these simple guidelines and have a great time on the slopes!

John Vitolo, MD is an orthopedic surgeon in Sparta, NJ.  He currently holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information visit us online at www.skyvieworthopedic.com.

 

Why are women more susceptible to ACL tears?

In recent years, there has been discussion on why women and young girls are more susceptible to ACL tears. There are many theories on the reasons why, but today we will examine a main anatomic difference between men and women that is a contributing factor: the Q-Angle and wider pelvis.

The Q-angle is the angle at which the femur (upper leg bone) meets the tibia (lower leg bone). The Q-angle is determined by three areas of the human anatomy – the Anterior Superior Iliac Spine (ASIS), the center of the kneecap (patella) and the tibia tubercle.  The Q-angle is basically a line drawn from the ASIS down to the center of the kneecap to the tibia tubercle (see picture below).

The Q-angle in women is greater because women are anatomically built with a wider pelvis than men.  A normal Q-angle in men is 14 degrees, while women have a normal angle of 17 degrees. The greater the angle, the more at risk the person is for knee injuries, including ACL tears.

The fact that the q-angle is more pronounced in women than men leads to more stress on the knee joint and makes it less stable when put under stress. For this reason, when a woman participates in sports involving jumping, running or pivoting, she is naturally more likely to suffer an ACL tear. 

What can we do to prevent ACL tears in women?

Recently, emphasis is being placed on neuromuscular training programs.  Neuromuscular training teaches the body better biomechanic movements to improve the control of the dynamic knee stabilizers (the ACL and major ligaments that surround the knee).  Exercises that are included in a neuromuscular training program include stretching, plyometrics and strength training.  The goal of these programs is to teach athletes how to land, pivot and control the knee without placing as much force on the ACL.  One program was developed by the Santa Monica Sports Medicine Research Foundation and is known as the PEP Program: Prevent Injury and Enhance Performance. To learn more about this program, please visit http://smsmf.org/files/PEP_Program_04122011.pdf.  

If you suspect that you have an ACL tear or other orthopedic injury, it is important to see an Orthopedic Surgeon.  Skyview Orthopedic, the office of John Vitolo, MD is available to treat all your orthopedic injuries and concerns.  Our office is focused on treating each patient individually and offering the highest quality orthopedic care.  John Vitolo, MD holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information call the office, 973-300-1553 or visit us online at www.skyvieworthopedic.com.

Prevention of Shoulder Impingement/Tendonitis/Bursitis

The shoulder is a very important part of the human body. When injured, inflammation occurs causing pain and weakness in the shoulder. This can greatly impact a person’s quality of life. Today we will discuss a common condition, known as Shoulder Impingement and/or Bursitis. 

In order to understand shoulder pain and injury, it is important to learn about the anatomy of this joint. The shoulder is a ball-and-socket joint made up of three bones: the humerus (upper arm bone), scapula (shoulder blade), and clavicle (collarbone). The head of the humerus fits into the glenoid (a rounded socket in the scapula). These bones are held in place by muscles, tendons and ligaments. The ligaments hold the bones together and create stability, while the tendons connect the muscles to the bones and the muscles make movement possible.

Three common shoulder conditions are: Shoulder Impingement, Tendonitis and Bursitis. Shoulder Impingement occurs when the space between the acromion and rotator cuff narrows and the acromion rubs on the tendon or bursa.  This results in pain and irritation. Tendonitis occurs when the rotator cuff tendons and/or the bursa become irritated and inflamed and Bursitis occurs when the Bursa becomes inflamed and swollen with fluid. It is common for these conditions to occur in conjunction with one another since they are adjacent structures.

Symptoms of these conditions include: 

• Pain while performing an activity and at rest
• Pain that radiates from the front of the shoulder to the side of the arm
• Pain with throwing
• Pain with overhead motion 
• Sudden pain when lifting/reaching

These conditions are often caused by overuse and improper lifting techniques. To help prevent these common shoulder injuries, follow these helpful tips:

• Exercise regularly and strengthen the muscles of the shoulder joint
• Focus on upper body strength and flexibility
• When lifting and reaching overhead, pay attention to the position and form of your back
• When lifting, keep back as straight as possible, bend and lift with your legs
• When reaching to place or retrieve heavy objects, use a stable platform or stool
• Know when to say when – when you are tired and fatigued; take a break!

Depending on the severity of the injury, shoulder impingement or bursitis can be treated non-surgically through rest, cortisone injections and physical therapy, and in some cases requires surgery.  Should surgery be required, minimally invasive, arthroscopic surgery to is the best method to repair the injury, followed by a rehabilitation program to get you back to full activity as quickly as possible. For more information or to schedule and appointment with John Vitolo, MD, please call 973-300-1553 or visit skyvieworthopedic.com.

Proper Protocol Following Rotator Cuff Surgery

For years, my practice has found that immobilizing the Rotator Cuff for 3-4 weeks after surgery has led to more positive post-surgical results.  Recently a study was released from the Center for Special Surgery that confirms doing this leads to more favorable healing. 

The rotator cuff consists of 4 small muscles in the shoulder blade and allows the arm to rotate.  A rotator cuff tear occurs when the muscles are torn from the bone in the upper arm. When torn, surgery is often needed to repair the injury.  Surgery is performed to reattach the torn muscle to the bone. 

Historically, many surgeons have pushed to have the patient start physical therapy one week post-surgery. However, we have found that allowing the rotator cuff to stay immobile for 3-4 weeks has led to better post-operative results. 

Recent studies have shown that up to 20-40% of Rotator Cuff Repairs fail or patients experience decreased strength and range of motion.  Due to this alarming number, the Center for Special Surgery conducted a study on post-operative protocol and found that immobilization for a longer period, does help the healing process. 

At Skyview Orthopedic, we strive to offer our patients the highest quality care and stay current with all the latest advances in orthopedic care.  We are proud to see that new studies confirm the protocol that we use is the best option for our patients.

www.skyvieworthopedic.com