John C. Kagan MD – Board Certified Orthopedic Surgeon

Orthopedic surgeons have long known that female athletes rupture their ACL or anterior cruciate ligament more often than men. The ACL, one of the primary ligaments in the knee, helps stabilize the knee and leg bones.

Now a team of researchers at Yale University has published an article in this month’s issue of the Journal of the American Academy of Orthopedic Surgeons suggesting that women are three times more likely to suffer from this injury – and the reason may be the unique difference in anatomy between male and female athletes.

Female Anatomy vs. Male Anatomy

The lead author of the article, Dr. Karen Sutton, assistant professor of orthopaedics and rehabilitation at Yale, suggests that the quadriceps angle or “Q angle,” which is where the upper and lower leg bones meet, is larger and angled downward more sharply in women than in men. That’s because women have wider pelvic structure than men. Where is the quadriceps? It’s the large muscle in the front of the thigh.

Because of this unique structure, women may experience a “greater stress and pull of the knee muscles” during strenuous activity like running, soccer, basketball, volleyball and similar sports, says Dr. Sutton.  

Women have ACL tears not from a direct blow to the knee, but from a hard landing after a jump, or stopping and turning abruptly when using techniques like pivoting and cutting. Female athletes also tend to land in a more upright position, rather than bending their knees like men do. They also land more frequently with a slight inner rotation of the knee, which puts stress on the ligaments.

Researchers not involved in the Yale study have also suggested that the difference in injury rate between men and women may be due to muscle strength – women tend to have weaker hamstring muscles in the back of the thigh relative to their quadriceps muscle in the front, a structural difference than can compromise knee stability.

In addition, women’s ligaments are known to be more flexible or “lax” than men’s, which could make the tissue more susceptible to tearing. However, Yale researchers found “no conclusive link between female hormones, the menstrual cycle and increased risk of ACL injury.”

Prevention Tips

Prevention is the key when it comes to ACL tears. Dr. Sutton recommends that women undergo fitness conditioning routines that improve core strength and increase knee stability by building up the gluteal, quadriceps and hamstring muscles. Female athletes should also be taught the correct way to jump and land, pivot and turn to prevent injury, she says.

Other prevention tips include an adequate warm-up to stretch the various muscles, including hip flexors, and crosss-training to avoid overuse injuries.

An ACL tear can be a painful injury that may require reconstructive surgery, followed by physical therapy for a full recovery and return to the game. For more information about how the ACL is reconstructed, go to http://www.kaganortho.com/learn-more/.

Whether you’re a teen playing high school sports, an adult who is an avid runner or a senior who plays weekly doubles tennis, chances are that at some point, you’ll experience the discomfort of an occasional sprain and strain – the most common injury sustained in sports today, reports the American Academy of Orthopedic Surgeons.

Many people think of sprains and strains as the same injury. They’re similar, but distinct. Here’s the difference.

A sprain occurs when you overstretch or tear a ligament. For example, step awkwardly off the curb and land on the side of your feet and chances are you’ll sprain your ankle. Jump down from break wall at the beach onto a sidewalk and you can twist and sprain your knee. Or try to break your fall by stretching out your arm and chances are you’ll sprain your wrist or shoulder.

When you sprain something, it means that you’ve injured one or more ligaments, the fibrous band of connective tissue that connects the bones and stabilizes the joint. Overstretching or tearing a ligament puts pressure on the joint and can force it out of alignment.

A strain is an injury to a muscle or tendon. Just like ligaments connect the bones, the tendons connect the muscles to the bones. Overstretching or the opposite, contracting a muscle or tendon, can cause injury. Chronic overuse and repetitive movement, perhaps caused by intensive training, can set up a repetitive injury cycle.

Who’s at risk for sprains and strains?

Just about everyone, but especially athletes. RICE or rest, ice, compression and elevation are typically the first line of defense prescribed by the physician. Anti-inflammatory over-the-counter medication can also help reduce swelling and decrease discomfort.

But a severe sprain or strain may require medical treatment. If the pain and swelling continue after initial treatment with RICE, call your doctor. You may need X-rays, more intensive treatment or even physical therapy to help strengthen and rebuild the injured tissues.

Prevention Tips

It’s not always possible to prevent a sprain or strain if you’ve an avid athlete. But NIAMS (The National Institute of Arthritis and Musculoskeletal and Skin Disease) offers these prevention tips: 1. Wear appropriate shoes for the sport and make sure they fit well. 2. Warm up and stretch before intensive exercise. 3. Run on flat surfaces. 4. Stop exercising when you’re tired or in pain.

Want to know more about orthopedic-related injuries? Go to www.kaganortho.com/learn-more.

The trend in surgery today is toward a minimally invasive approach that is less traumatic to the body. This is especially true for knee surgery, where it’s possible to repair damage to ligaments, tendons, cartilage and bone without the need for large, open incisions, an overnight hospital stay and a very lengthy recovery period.

Minimally invasive procedures are possible thanks to improvements in technology, such as the development of tiny fiber-optic scopes that can be inserted into the body through incisions or “portals” only three to four millimeters in diameter.

While the incision is small, the surgeon’s ability to perform the procedure isn’t compromised by a tiny view. Instead, a small lens, light source and video camera on the end of the scope sends images of the knee joint to a large monitor in the operating room, which gives the surgeon a “big picture” and a clear view of the operating field.

Additional incisions are made to allow the surgeon to insert small surgical instruments into the knee joint. These tiny instruments are used to repair damage to the knee caused by an accident, sports or other situations or to reduce pain and disability caused by degenerative conditions like osteoarthritis.

The American Academy of Orthopedic Surgeons reports five common reasons why patients undergoing knee arthroscopy:

1. Remove or repair a torn meniscus
2. Reconstruct a torn ACL, anterior cruciate ligament
3. Trim torn pieces of articular cartilage
4. Remove loose fragments of bone or cartilage
5. Remove inflamed synovial tissue

For more information about the kinds of conditions that benefit from arthroscopic knee surgery, go to http://www.kaganortho.com/learn-more/

Meniscus tears are one of the most common knee injuries for athletes. For example, a meniscus tear ended the competition for basketball star Blake Griffin at recent the London Olympics. In March of this year, the New York Knick star point guard, Jeremy Lin, had surgery to repair a small chronic meniscus tear in his left knee. And last summer New York Yankees third basemen Alex Rodriguez tore the meniscus in his right knee.

What makes the meniscus so vulnerable to injury and what exactly is it? The knee has two wedge-shaped pieces of cartilage called the meniscus. The cartilage, which is a thick, rubbery tissue, functions like a shock absorber. It prevents the upper and lower leg bones from grinding against each other. It also helps keep the knee stable.

A sudden twist of the knee, an abrupt change of direction, stopping quickly or a blow to the knee (like in a football tackle) can tear the meniscus. So can lifting a heavy object, falling, or even stepping incorrectly off a curb. Meniscus tears can also be the result of degenerative conditions like osteoarthritis that cause the cartilage to be less flexible.

You can reduce your risk a meniscus tear by wearing proper footwear for the sports, remembering to warm up and stretch before the game, bracing your knee if you’ve had previous injuries, and strength training with exercises designed to keep your leg and knee muscles strong.

Minor tears may heal on their own, but more serious meniscus injuries will require arthroscopic surgery to repair the damage.

Want to know more about treating knee injuries? Go to www.kaganortho.com/learn-more.

How many times have you read a national news report about a superstar athlete tearing his or her ACL and being sidelined for weeks during recovery? But it’s not just football, soccer or baseball stars who can sustain this type of extremely painful injury. According to the American Academy of Orthopedic Surgeons, the ACL or anterior cruciate ligament, is one of the most commonly injured ligaments of the knee.

Ligaments are bands of fibrous tissue that connect two bones together or the bones to the cartilage. The ACL’s primary function is to keep the tibia (shinbone) and femur (thighbone) in alignment and to stabilize the knee joint to perform all those functions we demand of it.

Forceful contact, such as from a football tackle, landing incorrectly from a jump or fall with the knee extended — a common problem in tennis, basketball, gymnastics and volleyball – can cause the ACL to tear.

But so can twisting your knee from something simple as stepping onto uneven pavement or falling off a curb when you’re out for a run or walking the dog. Even a car or work-related accident can do damage to the ACL if you injure your knee.

Serious ACL injuries require surgery – usually an arthroscopic outpatient procedure. But rather than sew the torn ligament together, the orthopedic surgeon will replace the damaged ACL with a new ligament or “graft.”

The graft is usually a tendon taken from the patient’s own tissue, typically a hamstring, patellar or quadriceps tendon. Your doctor will discuss which type of graft is right for you. Fortunately for everyone who has ever torn their ACL, this type of surgery has an excellent success rate of 82 to 95 percent. Surgery, followed by rehab, will help both athletes and non-athletes to get back on their feet faster with less potential for long-term impairment.

For more information about the latest treatments for knee injuries, go to www.kaganortho.com/learn-more/animations/educational-animations-orthopedics-pain-management/

If you’re an avid golfer or tennis player, the repetitive motion of swinging a club or hitting the ball can wreak havoc on the elbow, causing pain and tenderness, as well as decreased grip strength. Certain occupations that involve painting, sawing wood, pounding a hammer or turning a wrench can also put you at risk for elbow-related problems. Children and teens can develop overuse injuries, too, especially if they are active on a Little League softball team.

What happens to the tissues during an overuse injury? The muscles, tendons and ligaments in the upper and lower arm that attach the bones to the elbow joint become inflamed. Over time, microscopic tears can develop, causing muscle weakness.

Treatment Options

For people who love sports, giving up their favorite recreational activity for even a short time doesn’t sound like much fun. But it is never a good idea to play through the pain, especially for children. Resting the elbow, icing it and taking over-the-counter non-steroidal anti-inflammatory medication can help relieve discomfort and give the muscles time to heal.

But if elbow pain and tenderness continue, affecting your ability to get back in the game, it’s best to schedule a physical exam with your physician. Medical evaluation can prevent the injury from getting worse and becoming a chronic problem.

Most overuse injuries can be treated by a combination of nonsurgical treatment options. Wearing a brace on the forearm can reduce tension on the muscles. Physical therapy may be prescribed. Physical therapists may use ultrasound, massage and other muscle-stimulating techniques to promote healing, as well as recommend specific exercises to strengthen the muscles.

When Surgery is Required

Although it is not common, it is possible to partially or completely tear the biceps tendon, the tendon that attaches the muscle in the upper arm bone in the elbow joint. Usually this type of tear is caused by a sudden trauma to the body or lifting something extremely heavy.

A popping sound usually signals the tendon has ruptured and there will be severe pain, swelling, bruising and muscle weakness. Be sure to have an injury of this severity seen quickly to avoid doing more damage to the tissue. Once the biceps tendon is torn, it will not grow back to the bone and you may have permanent weakness in the arm if it is left untreated.

If surgery is indicated, the physician will reattach the biceps tendon to the forearm bone using stitches or small metal implants. You can expect the arm to take two to three months to heal completely. The vast majority of patients can expect a complete recovery with a return to full range of motion.

For more information about sports-related injuries and other orthopedic conditions, go to www.kaganortho.com.

If your physician suggests scoping your knee to look for an answer to acute or chronic knee pain, what can you expect? Arthroscopy is a minimally invasive technique in which a tiny tube, called an arthroscope, is inserted into the knee joint. The arthroscope is connected to a video camera, which sends high-resolution images of the knee to a TV monitor, making it possible for the physician to see the interior structures and diagnose the problem, while also repairing or removing damaged tissue.

The American Orthopaedic Society for Sports Medicine reports some 4 million people around the world undergo knee arthroscopy each year due to sports or work injuries, arthritis, or simple aging of the joints. The most common reasons for the procedure include removing or repairing torn cartilage (meniscus tears); reconstructing a torn ligament (ACL tear); trimming torn articular cartilage; removing loose chips of bone or cartilage; and removing inflamed synovial tissue.

Compared with surgical techniques of the past, arthroscopy has a quick recovery time, with less pain and less trauma to the body. Since arthroscopic surgery is done on an outpatient basis, patients go home the same day. Most people can return to light activity and a desk job within one week, but it may take several weeks to get back to sports, depending on the severity of the procedure.

For more information or to schedule a consultation, please call 239-936-6778 or visit www.kaganortho.com

While the warm weather may beckon you outside, activities such as gardening or exercise may cause swollen and aching joints, which should not be ignored. A common cause of painful hips, knees, heels and elbows, bursitis results from inflamed or infected fluid-filled sacs or bursae that surround the joints. Prompt medical attention by an orthopaedic doctor can help you get to the source of the pain and treatment options to help alleviate it. Since bursitis symptoms resemble other joint problems such as arthritis or ligament injuries, a thorough evaluation by a trained orthopaedic surgeon is the best option. If bursitis is diagnosed, your physician can determine whether infection is involved and prevent it from spreading.

Typical symptoms of bursitis include:

• Pain with or without joint movement
• Swelling of the area surrounding the joint
• Redness of the skin near the joint
• Warmth of the area near the joint
• Pain or tenderness when the bursa is touched

All types of bursitis often can be successfully managed non-surgically, and possible treatments include:

• Use of ice packs or compressive dressings
• Activity modification that may reduce stress or irritation
• Administration of nonsteroidal anti-inflammatory drugs (NSAIDs) or antibiotics
• Corticosteroid injections (knee and elbow)
• Stretching exercises
• Change of footwear (heel).

Surgery may be required in patients whose symptoms remain following these treatments and in certain situations when infection is involved. An accurate diagnosis is important to determine the best treatment options to help the patient resolve pain and other symptoms and regain mobility and quality of life.

If you are suffering with joint pain, contact Dr. Kagan at 239-936-6778. Visit http://www.KaganOrtho.com/learn-more/informational-web-sites-your-condition-treatment/ or http://www.webmd.com/osteoarthritis/guide/arthritis-bursitis for more resources.