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How To Hurt Your Knees

There’s quite a bit of controversy between fitness professionals and medical professionals about the safety of various lower extremity conditioning activities. As an orthopedic surgeon, I typically see folks in the clinic after something has gone wrong so it’s a skewed population. But over and over again I see common themes emerge. I think of these as three easy ways to hurt your knees.

Deep squats (thighs below parallel), lunge with a short stride, and unaccustomed plyometric activities are more likely than not, in my opinion, to land you in the orthopedic or sports medicine specialist’s office. I suggest below some modifications to help you avoid trouble.

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A Simple Way To Reduce Kneecap Pain

Pain in the front of the knee with running is extremely common in all age groups, but particularly so in teenagers and women in their 20s and 30s. Physicians often use the vague and generally unhelpful phrase “patellofemoral pain” when describing this condition.

A recently published study shows that a simple 10% increase in the step rate (i.e. cadence) is an effective way to improve pain symptoms and improve running mechanics. The beauty of the method is that it took only a single 10-minute session, can be done by the individual runner, and results lasted at least 3 months.

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One ACL Tear Is Disappointing; A Re-tear Is A Problem

ACL tears in young athletes are becoming more common, and surgery to rebuild a new ACL is also increasingly common. If you happen to be a young athlete with an ACL tear, the thought of needing surgery, a lengthy recovery, and time away from your favorite sport activities can be truly disappointing.

Technical advancements allow us to do the surgery with accuracy, avoid growth disturbances, and with a very favorable outcome in about 90% of teenagers and adolescents. But some people will re-tear the new ACL, requiring what is called “revision ACL reconstruction.” The unfortunate reality is that the results from revision surgery are not as good as the original surgery. The failure rate is about 20%, which is a real problem for those athletes needing the second surgery.

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Two Great Reasons To Do ACL Injury Prevention Warmups

There is convincing evidence that major factors contributing to noncontact ACL tear risk include improper mechanics when landing from a jump or when rapidly changing direction. Training programs to reduce this risk have focused on improving landing mechanics and improving strength imbalances. Typically, these programs are incorporated into a team warm-up.

Two recently published scientific studies show that ACL injury prevention warm-up programs are very effective in reducing the risk of getting a noncontact ACL tear, and these programs lead to improved athletic performance. These are two really great reasons to utilize ACL injury prevention warm-ups for your sport.

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If You Have Knee Pain You Need BFR Training (Blood Flow Restriction)

Orthopedic surgeons will commonly recommend lower extremity strengthening for any of their patients with chronic painful conditions and almost everyone who’s had knee surgery. Strength gains and strength symmetry are necessary for proper function but individuals who have one of these conditions frequently report one common drawback: the exercises needed to increase muscle strength often lead to significant knee pain.

Blood flow restriction (BFR) training is becoming increasingly popular as a means of strengthening using low loads and without the same type of risk of increased joint pain found with traditional methods of strength training.

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Artificial Turf vs. Grass: The Debate Continues

We’ve come a long way from the earliest versions of artificial turf, which were essentially large pieces of green plastic laid down over cement. The newest generations of artificial turf are radically better than the very first versions, yet the debate over which type of surface is best from a safety standpoint continues.

We’ll highlight this week some of the latest published research in this debate. In a large series specifically studying collegiate tackle football, it was determined that playing on artificial turf was an increased risk for PCL injuries in Division I players and for ACL injuries in Division II and Division III players.

While there are many strengths in this study, I would caution that the results are specific to American collegiate tackle football and may not be similar in other sports or in youth age groups.

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Exciting Early Results: ACL Scaffold Repair

Our current best ways to treat a torn ACL is a surgical procedure called a “reconstruction”, where a substitute tissue (a “graft”) is used to replace the torn ACL. Tunnels or sockets are drilled in the bone, so the bone essentially grows into the new tissue and makes a new ACL. 

ACL surgery has improved substantially over the last 30 years, with generally excellent results. But there can be issues related to the bone tunnels potentially causing growth disturbance in young athletes, and issues related to the removal of the graft. A new type of ACL repair using stitches and a biologic scaffold to enhance healing is showing very exciting early results. If this ACL repair technique proves itself in larger clinical studies, we can expect it to be an excellent option to avoid tunnels and grafts for some ACL tear types.

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What Should You Expect After Surgery For A Kneecap Dislocation?

The kneecap (“patella”) can sometimes come completely out of its normal alignment. This is called a “dislocation” and if you’ve ever had one you know how incredibly painful this can be. If you have a single dislocation, we’ll typically recommend rehab without surgery. If you go on to have multiple dislocations, surgery is often recommended to stabilize the kneecap.

Results from surgery are reliable as far as stabilizing the kneecap, but return to sports results are widely variable. Some published medical data show return to sports at about 55% and others as high as 85%. Some of the key factors in successful return to sports are normalized function as measured on specific tests, and near-normal strength when compared to the normal knee. It may take more than 8 months after surgery to achieve these milestones.

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Are You Ready For Sports After Your ACL Surgery?

Does your brain think you’re ready to return to sports after your ACL surgery?

Readiness for return to sports activity after ACL surgery depends on many factors. We like to see evidence from our physical exam that the graft is properly healed, motion is back to normal, and strength is nearly normal. My partners at Stanford and I also place a lot of emphasis on normalized landing mechanics and other movement-based measurements. And another area we like to consider is whether the athlete herself/himself feels ready to return to sports. It turns out the psychological readiness is a bigger factor than we’ve realized.

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ACL Suture Repair For Adolescents: High Failure Rates

What if it was possible to repair the torn ACL by using stitches rather than replacing it with tissue removed from another area in the body? This is attractive as it would theoretically lead to an easier rehab, and avoid possible injury to the growth plates in adolescents. However, a recently published study showed a 49% failure rate at 3 years, compared to a 5% failure rate for traditional ACL reconstruction. This is an unacceptably high failure rate, and ACL repair with stitches is not advised for young athletes.

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