Common Knee Injuries

The knee is a complex structure with many components that make it vulnerable to a variety of sports injuries. Most people suffer a minor knee problem at one time or another. Knee injuries often occur during sporting activities, too. In 2009, knee injuries were the most common reason for visiting an orthopedic specialist.

Knee Anatomy and Function

The knee joint is the largest joint of the body and the one that is most easily injured. Two cushioning discs call menisci separate the upper and lower bones of the knee. The upper leg bone (the femur) and the bones of the lower legs are connected by ligaments, tendons, and muscles.

The surface of the bones is covered by cartilage, a substance that absorbs shock and provides a smooth, gliding surface. Knee injuries are the result of damage to one or more of these structures. Of the four major ligaments found in the knee, the three that are injured the most are the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), and the posterior cruciate ligament (PCL).

ACL Injury

The ACL is injured when athletes are changing direction rapidly, slowing down when running, or landing from a jump. Individuals who play basketball, football, and soccer and those who ski are particularly at high risk for ACL injuries. If this structure is damaged, you could require surgery to regain full function of your knee. This will all depend on the severity of your injury and your activity level.

Most of the time ACL tears are too severe to be stitched back together. The orthopedic surgeon will have to surgically repair this structure by reconstructing the ligament. Most of the time the doctor will use a tissue graft to repair the ligament. This graft acts as scaffolding for new ligament to grow on. Most of the time grafts are taken from the patellar tendon or the hamstring tendons.

MCL Injury

A direct blow to the outer aspect of the knee commonly causes injuries to the MCL. Those athletes who play football and soccer are at the highest risk. When the knee is forced sideways, the MCL can tear and result in knee pain. Swelling will occur with a MCL injury as well and the knee will become unstable and give way.

When the MCL is torn severely and cannot heal correctly, surgery is necessary. This will involve grafting a piece of tendon to allow the portions of the torn ligament to connect to. Most of the time, however, these injuries can be treated without surgical intervention.

PCL Injury

The PCL is most commonly injured when an athlete receives a blow to the front of the knee. This structure can also be torn or injured if the individual makes a simple misstep on the playing field. Those who participate in football and soccer are at the greatest risk for a PCL injury. This ligament is located in the back of the knee and connects the femur to the shinbone (the tibia).

When an athlete suffers a PCL tear or injury, the orthopedic specialist will most likely recommend surgery. This is done to rebuild the ligament by replacing the torn structure with a tissue graft. During the procedure the doctor will rebuild the PCL. A tendon or other structure is used to replace the torn ligament.

Meniscus Injury

The menisci tear in different ways. The orthopedic specialist depending on how they look, where they occur, and how complex they are classes the tears. Common tears include the parrot-beak, flap, bucket handle, longitudinal, and mixed/complex. Sports-related tears of the meniscus often happen along with other knee injury. Sudden tears can occur when the athlete squats or twists the knee. Direct contact or a sharp blow can also cause meniscus injury.

When a meniscus tear is serious and the symptoms persist with nonsurgical treatment, your doctor may recommend an arthroscopic procedure of the knee. This is one of the most commonly performed surgical procedures where the orthopedic specialist inserts a miniature camera into the knee joint to trim and repair the tear to the meniscus. While he is doing this surgery, other torn structures can be repaired and treated as well.

Though shoulder pain is quite common, it is usually not normal. Many shoulders become stiff or inflamed for no apparent reason. However, with a shoulder injury, persistent shoulder pain is often a sign that there might be a structural abnormality about the shoulder.

The most common shoulder tear involves the Rotator cuff, but it takes a thorough clinical exam along with an MRI to properly diagnose.Many rotator cuff disorders can be treated without surgery, but if the injury is severe or does not respond to conventional treatment measures, surgery may be considered. Most of the time our orthopedic specialists recommend surgery if your shoulder doesn’t get better after 3 to 6 months of nonsurgical treatment such as rest, ice or heat, and physical therapy.

The procedure to repair a torn rotator cuff involves reattaching the tendon to the head of the upper arm bone (the humerus). Those patients with a partial tear may need surgery in order to trim or smooth the tendon, or often repair the tendon back to the bone to prevent the tear from propigating. With a complete tear, the surgeon repairs the tendon by stitching the two sides back together.

When is Rotator Cuff Surgery Recommended?

Rotator cuff surgery is a safe and effective way to regain full range of motion to your arm. Our orthopedic specialists perform this type of surgery often, and most patients who are active and use their arms for overhead work or sporting activities greatly benefit from this procedure.  Our doctors may recommend surgery if your pain does not improve, as continued pain is the main indication for surgical repair of the rotator cuff. Other signs that this procedure is a good option for you include:

• You have a large tear of more than three centimeters.
• Your symptoms have persisted for greater than six months.
• Your tear was the result of a recent acute injury.
• You have major weakness and loss of function of your shoulder area.

What are the Types of Surgical Options?

There are several different options that the orthopedic specialist can do to repair your rotator cuff and alleviate your problems. This will all depend on the size of your tear, the quality of your tendon tissue and bone, and your personal anatomy. These repairs include:

Open Repair:  This is a traditional approach to rotator cuff repair. With this procedure, the surgeon makes an incision at the shoulder area and detaches the shoulder muscles to gain better access to the torn tendon. During open repair, the orthopedic specialist will remove bone spurs and repair the torn structure. This option is best when the tear is complex and large or if additional reconstruction is necessary. Usually most open repairs done in our office employ the Mini-open approach described below.

Arthroscopic Repair:  Arthroscopy involves the use of a tiny camera (called an arthroscope) inserted into your shoulder joint. The camera will display images on a TV monitor so the surgeon can use these images to guide the scope and tiny instruments to make necessary repairs. Our orthopedic specialists makes several small incisions around the shoulder area to allow the arthroscope to be placed where the doctor needs it to be in order to see and repair the shoulder structures. The shoulder arthroscopic technique is minimally invasive and done on an outpatient basis. There is quicker recovery time and less pain with this procedure.

Mini-Open Repair:  Another option our orthopedic specialists utilize includes a mini-open repair technique. The orthopedic specialist makes an incision that is 3 to 5 centimeters long and uses an arthroscope to access and treat the torn rotator cuff and shoulder structures. This procedure avoids the need to detach the deltoid muscle, allowing for quicker recovery time and minimal pain. This procedure is similar to the arthroscopic repair method and generally is quite successful in the correct circumstance.

Parents often hear the word fracture for the first time and think it is less severe than a broken bone. Fractures, however, are broken bones. The severity of a break depends on the force that caused the fracture, where the fracture is located, and if the break is complex or simple.

If a bone breaks and fragments of it stick out through the skin, this is called an open fracture. These are particularly serious because the skin is broken and the child is at risk for infection. … read more

Have you felt a pop in your arm and been concerned that you may have torn your biceps?  You are not alone – this common injury affects thousands of Americans every day, with the typical tear occurring in males 30-50 years old, often with a distinct tearing feeling or even an audible “pop”.

These tears often cause significant bruising and loss of function and tend to do poorly without surgical reattachment of the torn tendon. Fortunately, there have been significant advances in the understanding of the tear and proper repair within the last couple of years that not only allows for a significantly stronger repair, but also allows for earlier recovery through minimally invasive treatments.

What is a biceps tear?

It is important to understand a bit of anatomy before delving into the specifics of the biceps tear rupture specifics.  The biceps tendon has two attachments at the shoulder and one attachment at the elbow. The biceps tendon is not only important for elbow flexion, but also forearm supinaton –rotation of the forearm that allows us to open up a door or hold our hand out for change. Rupture of the biceps tendon at the shoulder or elbow will cause dysfunction in both functions.

Proximal Biceps Tendon Rupture

The typical injury to the upper end of the biceps is where the biceps tendon ruptures from its attachment at the shoulder joint, specifically at the superior labrum of the glenoid bone.  Typical symptoms include shoulder pain, bruising, and often a bulging, shortened biceps muscle known as a “Popeye muscle.”

Often patients who tear their biceps tendon describe preexisting pain at the front of the shoulder and pain with shoulder movement called biceps tendonitis.  Biceps tendonitis can often be prophylactically treated to prevent or minimize biceps rupture, often through physical therapy, steroid injections or shoulder arthroscopy to debride or repair the tendon.

With Proximal Biceps tendon rupture, many active patients notice a slight loss of strength and a significant cosmetic change in their arm with the bulging muscle and many benefit from repair. I perform the proximal biceps tendon repair as an outpatient procedure and is often quite successful, typically allowing for full return to previous activity.

Distal Biceps Tendon Rupture

Injury to the distal biceps occurs when the biceps tendon is being flexed against a significant force. There is typically a “pop” or a tearing sensation followed by bruising and retraction of the biceps muscle. In a significant percentage of patients, this initial episode is followed by a reasonable return to activity over the next several weeks, delaying care.

Active patients often notice pain, weakness and difficulty in twisting activities such as opening a door. Elbow flexion is somewhat preserved due to the presence of the brachialis muscle, which is quite strong and rarely injured.

Treatment for distal biceps tendon rupture includes prompt early diagnosis as the retracted muscle and tendon quickly scars into its retracted position. For the vast majority of patients, surgical reattachment is recommended and can be done as an outpatient procedure.

New Repair Treatment Technique

I perform a newer technique of Biceps Tendon repair, which includes performing the surgery through a very small incision, typically 2 centimeters at the elbow. The smaller incision is utilized due to a newer biceps button technique that provides not only stronger fixation and proper tension, but also earlier recovery due to the strength of the repair and the limited nature of the incision and dissection.

Chronic biceps tendon ruptures (typically over 3 months old) might require larger dissection, due to the retracted scarred nature of the tear.  They can occasionally require the use of additional tendon graft, but still utilize newer more-reliable fixation techniques that allow for quicker rehabilitation.

All in all, advances in Biceps tendon tear repair allows for early return to activity and strength. The key to proper treatment includes early identification and diagnosis and is quite rewarding to help patients return to their pre-injury state of function.
Do not hesitate to contact us for further questions or for a prompt evaluation.

Have you felt a pop in your arm and been concerned that you may have torn your biceps?

You are not alone – this common injury affects thousands of Americans every day, with the typical tear occurring in males 30-50 years old, often with a distinct tearing feeling or even an audible “pop.”

These tears often cause significant bruising and loss of function and tend to do poorly without surgical reattachment of the torn tendon. Fortunately, there have been significant advances in the understanding of the tear and proper repair within the last couple of years that not only allows for a significantly stronger repair, but also allows for earlier recovery through minimally invasive treatments.

What is a biceps tear?

It is important to understand a bit of anatomy before delving into the specifics of the biceps tear rupture specifics. The biceps tendon has two attachments at the shoulder and one attachment at the elbow. The biceps tendon is not only important for elbow flexion, but also forearm supinaton –rotation of the forearm that allows us to open up a door or hold our hand out for change. Rupture of the biceps tendon at the shoulder or elbow will cause dysfunction in both functions.

Proximal Biceps Tendon Rupture

The typical injury to the upper end of the biceps is where the biceps tendon ruptures from its attachment at the shoulder joint, specifically at the superior labrum of the glenoid bone. Typical symptoms include shoulder pain, bruising, and often a bulging, shortened biceps muscle known as a “Popeye muscle.” Often patients who tear their biceps tendon describe preexisting pain at the front of the shoulder and pain with shoulder movement called biceps tendonitis. Biceps tendonitis can often be prophylactically treated to prevent or minimize biceps rupture, often through physical therapy, steroid injections or shoulder arthroscopy to debride or repair the tendon.

With Proximal Biceps tendon rupture, many active patients notice a slight loss of strength and a significant cosmetic change in their arm with the bulging muscle and many benefit from repair. I perform the proximal biceps tendon repair as an outpatient procedure and is often quite successful, typically allowing for full return to previous activity.

Distal Biceps Tendon Rupture

Injury to the distal biceps occurs when the biceps tendon is being flexed against a significant force. There is typically a “pop” or a tearing sensation followed by bruising and retraction of the biceps muscle. In a significant percentage of patients, this initial episode is followed by a reasonable return to activity over the next several weeks, delaying care. Active patients often notice pain, weakness and difficulty in twisting activities such as opening a door. Elbow flexion is somewhat preserved due to the presence of the brachialis muscle, which is quite strong and rarely injured.

Treatment for distal biceps tendon rupture includes prompt early diagnosis as the retracted muscle and tendon quickly scars into its retracted position. For the vast majority of patients, surgical reattachment is recommended and can be done as an outpatient procedure.

New Repair Treatment Technique

I perform a newer technique of Biceps Tendon repair, which includes performing the surgery through a very small incision, typically 2 centimeters at the elbow. The smaller incision is utilized due to a newer biceps button technique that provides not only stronger fixation and proper tension, but also earlier recovery due to the strength of the repair and the limited nature of the incision and dissection.

Chronic biceps tendon ruptures (typically over 3 months old) might require larger dissection, due to the retracted scarred nature of the tear. They can occasionally require the use of additional tendon graft, but still utilize newer more-reliable fixation techniques that allow for quicker rehabilitation.

All in all, advances in Biceps tendon tear repair allows for early return to activity and strength. The key to proper treatment includes early identification and diagnosis and is quite rewarding to help patients return to their pre-injury state of function.

Do not hesitate to contact us for further questions or for a prompt evaluation.

Read the original article on by our very own Dr. Scott Ruhlman. He performs the new surgical technique that allows for stronger repair and earlier recovery.