Patellar Tendon Tears

patellar1-300x300 Anatomy
The patellar tendon attaches the lower pole of the kneecap (patella) to the lower leg bone (tibia). The quadriceps muscle attaches to the upper pole of the kneecap and pulls through the kneecap and patellar tendon to allow one to straighten out ones leg or to support ones weight while squatting.

When the patellar tendon is torn, one cannot support their weight when the knee is bent, such as getting up from a chair or going down the stairs.

Injury Mechanism
The patellar tendon is usually injured with a sudden high force across the tendon, such as landing from a jump. The patellar tendon can be injured by a direct blow or a sharp laceration across the tendon.

Symptoms
Patellar tendon injuries present as significant pain across the front of the knee and immediate weakness in supporting ones weight while squatting. Patients usually cannot straighten their knee out fully with a complete tear of the patellar tendon. Rapid swelling occurs. Often, one can feel a gap under their kneecap at the site of the rupture.

Diagnosis
patellar2-300x235 The physician’s work-up will start with a careful history and exam. The physician can often feel the defect in the patellar tendon and can appreciate the weakness on trying to straighten out the knee against resistance.

X-rays reveal a very high riding patella, since the pull of the quadriceps is no longer opposed by the tethering effect of an intact patellar tendon.

An MRI scan is often obtained to confirm the diagnosis, especially if the physician is concerned that the injury may be just a partial tear that may be able to heal without surgical repair. Plain x-rays show the bones of the knee, while MRI scans reveal the soft tissues around the knee including the ligaments, menisci, muscles and tendons.

Treatment
Your physician will discuss treatment options with you. Treatment decisions are based on whether the injury is a complete tear or a partial tear. Partial tears may be able to be treated with a brace. The brace is initially locked out completely straight to take all of the pressure off of the injured tendon.

As healing occurs, the hinges are unlocked and motion and strengthening are initiated. With complete tears, surgery is almost always recommended. Surgery involves sewing the two ends of the tendon together with strong suture material. If the tendon has pulled directly off of the bone, drill holes are made into the bone to repair the tendon directly to the bone. Risks and benefits of surgery are discussed thoroughly with the patient.

What to expect after surgery
Patellar tendon surgery is usually performed as an outpatient procedure. Patients are sent home with crutches and a knee brace with the knee fully straightened to protect the repair. Depending on the strength of the repair, patients start gentle range of motion and progressive weight bearing over 6-8 weeks.

Patients are using a stationary bike by 2 months, and an elliptical or stair climber shortly thereafter. Jogging is restricted until 4 months following surgery and full sports activities are not resumed until 6 months after surgery. Most patients can return to full activities, with no restrictions and no bracing at the 6th month point.

Gel-One Injections for Arthritis Treatment

Patients, who have been suffering from chronic arthritis throughout their lives, have a new treatment option worth investigating. The new treatment is one Dr. Peterson is proud to be offering to his patients. Patients, that could not find relief before, may find relief with Gel-One. Zimmer Corporation, the company that developed Gel-One, created a brand new single use injection that is unlike the older ones on the market. This product has no false injections into the knee.

Out with the Old – Hyaluronic Acid Injection Therapy

The current treatment method, when used in patients who have had their arthritis for over a decade, has only around a 50 percent chance of actually relieving the pain of arthritis of the knee for an extended period of time. Those who find success with it have relief that lasts approximately 6 months, on average.

A second aspect of the current method of treatment is that even if the hyaluronic acid injection is successful in providing relief, some methods of therapy require a patient undergo multiple injections weekly, typically three to five per week depending on the severity of the arthritic pain.

In with the New – Gel -One

The Gel-One product by the Zimmer Corporation is not the first single-use injection treatment to be offered on the market. The previously used injection often provided an amount to be injected that was not sufficient to properly reduce pain and inflammation in the knee, producing what is affectionately called a pseudosepsis (fake infection). The Zimmer Corporation has worked hard to counter this first injection option by working to produce one that is much more effective while being processed in a way that still allows for delivery in a single use injection system.

Gel-One however has been clinically tested in a controlled study group to confirm that it does not produce a pseudosepsis effect. The study consisted of 379 randomized patients, which 248 of them receiving the Gel-One formula. The patients were compared to the control at the thirteenth week beyond the baseline and demonstrated a greater amount of pain relief, averaging out at approximately 40% reduced amount of pain.

Also in this study there were no unexpected side effects observed, lending to the confidence our clinic has in this product as a new therapy option for those with chronic arthritic pain.

Gel-One and Our Clinic

Dr. Peterson offers Gel-One to his patients, and early results seem promising. He is continuing to use other forms of hyaluronic acid for those patients who have done well with them, and prefer not to switch.

If you would like to discuss your arthritis treatment options and find out if Gel-One is right for you, make an appointment with Dr. Peterson at Orthopedic Specialists of Seattle. OSS is a comprehensive orthopedic practice.

Direct Anterior Approach Total Hip Replacement

Over the last decade, direct anterior approach (also called anterior supine incision or ASI) total hip replacement has been gaining popularity in the United States. The reasons for this surge in popularity can be traced to three factors.

More traditional posterior or anterolateral surgical approaches to total hip replacement have to cut muscles attached to the hip joint in order to expose the joint. In ASI total hip replacement, no muscles are cut, which results in less initial postoperative pain and faster early recovery with a shorter hospital stay for many patients. Most patients have a one-night stay after surgery, and are off crutches by about 2 weeks after surgery.

The ASI approach allows for the use of x-ray imaging during surgery to precisely position the components, and to ensure very accurate measurement of leg lengths. Since component position is critical to optimal long-term function of the implant, and leg-length inequality is one of the most common reasons for repeat surgery after older methods of hip replacement, this use of precise x-ray control is very advantageous.

Dislocation of the prosthesis is one of the more frustrating and challenging complications of total hip replacement. With other techniques, the reported rate of dislocation over the lifetime of the prosthesis is 3-5% (Medicare data). To try and minimize this, many surgeons performing those older techniques will tell their patients never to bend more than a right angle at the waist, and not to scissor their legs.

Because no muscles are cut during the ASI approach, the dislocation rate is markedly less. After more than 2000 total hips performed by surgeons at Orthopedic Specialists of Seattle, the dislocation rate is less than 0.1% (less than 1 in 1000). We therefore put no restriction on patient motion after surgery. Dr. Peterson’s only restriction for his patients is no running for exercise.

An excellent YouTube animation video of how the ASI approach is performed is available below. While this video was made in Omaha by Dr. Ajoy Jana, the technique used by Dr. Peterson is very similar in all regards.

The surgeons at OSS perform more ASI hip replacements than any other practice in the Northwest. Dr. Peterson has been performing total hip replacements for over 20 years, and switched to the ASI approach for most cases several years ago after seeing the significant benefits for his patients. He would be happy to discuss this remarkable new technique with you during your office visit.

WNBA Star Sue Bird Recovering from Knee Surgery

Seattle Storm Star Sue Bird | Knee Surgery Seattle

Photo Via WNBA.com

As ESPN recently reported, Sue Bird, “The Seattle Storm star point guard is recovering from recent left knee surgery, which will sideline her for the entire summer season that began this weekend and runs through August.” Bird underwent knee surgery earlier this May to repair a cyst. She is hopeful that she will be able to play this fall when the team plays against Russia. In addition, she is optimistic that she will be back next spring.

In an interview, Bird said, “I’m doing well, I’m about almost two weeks post-op and had my follow-up appointment, everything’s good. It’s a waiting game now.” … read more

How to Prevent Achilles Tendon Injuries

Achilles Tendon

The tendon connecting your calf muscle to your heel bone is called your Achilles tendon. It is the largest tendon in your body. You use it every day when you jump, run, and walk. The Achilles tendon is prone to overuse (called tendinitis) because of the stresses it sees every day.

The Achilles tendon is one of the most commonly injured tendons, especially among athletes. Tendinitis is the most common form of injury, resulting in pain and swelling either within the tendon or where the tendon inserts into the heel bone (calcaneus). In worse cases, too much pressure on the Achilles tendon can cause it to partially tear or even rupture completely.

What can cause an Achilles tendon injury?

A rupture of your Achilles tendon often occurs when you abruptly start moving, such as while sprinting. Men age 30 years and up have more Achilles tendon injuries than other groups. We see these injuries a lot in so-called “weekend warriors.” There are a number of things that can cause or contribute to an Achilles tendon injury. Some of these might be:

Overuse
Inadequate stretching before a strenuous activity
Performing high-impact activities, such as jumping or plyometrics
Foot deformities, such as flat feet or high arches
Tight muscles and tendons in your legs

Athletes who participate in the following activities may experience Achilles tendon injuries:

Gymnastics & Dance
Running
Football
Baseball
Softball
Basketball
Volleyball
Tennis

How can I prevent an Achilles tendon injury?

There are many ways to prevent an Achilles tendon injury.

Maintain a Healthy Weight: Make sure you maintain a healthy weight range that is ideal for you. Avoid being underweight or overweight.

Eat Well: Make sure that you are getting the recommended amounts of vitamins and minerals. A diet lacking in calcium could cause Achilles tendon injuries. The U.S. Institute of Medicine’s Recommended Dietary Allowance (RDA) and Dietary Reference Intake (DRI) suggest that adults should get 1,000-1,200 mg of calcium daily and at least 700 mg of phosphorous.

Calcium is essential for your bones to grow and also helps with muscle contraction. Too little calcium or phosphorous intake will result in your body taking what is needed from other places, and this can lead to weaker bones.

Exercise Regularly: Injury prevention involves exercising often to keep your tendons, muscles, and bones strong. Make sure you only do exercises approved by your doctor. If you go to a gym, ask a trainer to help you use the equipment properly.

Pick the Right Shoes: Make sure that you are wearing the correct shoes for your feet. Shoes vary in the amount of cushioning and arch support they provide. Have your athletic shoes fitted by a specialist.

Avoid Hard Surfaces: Soft surfaces, such as cushioned floors, are better on your feet than hardwood. Too much time spent on hard surfaces can cause injuries to the Achilles tendon. Simple choices such as picking a grass court over a hard court, or running on a dirt trail instead of a sidewalk will help to reduce impact and may reduce your risk of injury.

Warm Up and Cool Down: To avoid injury to your Achilles tendon, you should always warm up and cool down before and after exercising or any physical activity.

Start Low and Go Slow: As is the case with other structures in the body, the Achilles tendon responds better to gradual increases in intensity. To avoid injury you should not suddenly increase your distance, speed, or steepness. Gradually increase your exercises rather than jumping right in and making big changes to your work out.

Get Strong: Calf muscles tend to be weak in many people, so it is important to strengthen them through exercise. You can do leg exercises with machines, elastic pull bands, and weights. Some good techniques to strengthen your leg muscles include lunges, leg presses, calf raises, squats, and leg curls.

Do Aerobics First: If you are planning on doing aerobics and strengthening on the same day, make sure that you do the aerobic exercise first. This includes running, stair climbing, and playing sports. These activities put strain on the Achilles tendon. If you perform your strengthening activities first, you put your Achilles tendon at risk for injury because it temporarily weakens the tendon.

Test Your Achilles Tendon: You should test your Achilles tendon for injuries after you finish working out. Use your thumb and forefinger to pinch different areas along your Achilles tendon looking for tenderness. If you experience any pain, this could indicate tendinitis.

What do I do if I have pain?

If you develop pain in your Achilles tendon, see an orthopedic foot and ankle surgeon as soon as possible. If the diagnosis of Achilles tendinitis is made early enough, several options such as immobilization, physical therapy, and stretching are available.

If you continue to exercise and do strenuous activity after you develop pain in the tendon, you risk rupturing the tendon. If this occurs, your surgeon may recommend surgical repair of the tendon.