Tibial Tubercle Osteotomy

  • Tibial tubercle osteotomy (TTO) is a surgical procedure that is often done to help individuals who are have patella instability or are dealing with osteoarthritis. This procedure moves the attachment point of the patella tendon.
  • Chip Review @ (14:11): Red Rock Deli – Fire Roasted Jalapeno (Thank You Peter Jennings)
  • Trivia question of the week @ (11:14): Which planet is closest to earth?
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Brief overview of the episode:

Tibial tubercle osteotomy also know as tibial tuberosity osteotomy or TTO is a procedure that changes the attachment point of the patella tendon in hopes to improve the stability and tracking of the patella. This surgery becomes an option in the case of individuals who are recurrent patella dislocators or who are dealing with retro-patella arthritis and have not had improvement with non-surgical treatment.

This is done by separating the tibial tubercle from the tibia and moving it medial or lateral (less common) and then affixing it in place with screws. There are currently two acceptable techniques the Emslie-Trillat and the Fulkerson. With the Emslie-Trillat a straight cut is made across the tubercle. With the Fulkerson the cut is done in an anteromedial fashion. A third technique exists called the Maquet technique in which the tubercle is anteriorized by fully separating it and placing a bone graft behind it. This method should not be used at is has lead to necrosis and is much more likely to fail.

On average this surgery is performed more frequently with women under 30. It has been reported that 75% or more of individuals who under go a TTO will return to prior or improved level or sport function.

 

Other episodes you might enjoy:  

Patella Dislocation: Episode 128

Patellofemoral / Patellotibial Ligaments: Episode 113

Patella Femoral Pain Syndrome: Episode 32

 

 

Patella Dislocation

  • Patella Dislocations make up between 2-3% of all knee injuries. They are most common in young female athletes and are usually due to a number of factors: genetics, mechanics, activity and trauma.
  • Chip Review @ (10:36): Kettle Brand – Farmstand Ranch
  • Trivia question of the week @ (09:30): The “First Lord of the Treasury” is better known as?
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Brief overview of the episode:

Patella dislocations account for between 2-3% of all knee injuries, they occur most frequently in younger, female, athletes. Some of the common causes include: shallow trochlear groove, trauma and a powerful quad contraction with knee flexion and external rotation.

As with most dislocation, unfortunately, if you have had one you are more likely to have another. This does not necessarily mean that you will have a second only that your chance is higher. To better prevent a dislocation it is important to address not just quad and hamstring strength but to increase hip strength.

The most important of which is hip abduction. This will prevent the knee from moving into adduction and internal rotation. A position that places the patella in a shallower portion of the trochlear groove and makes it easier to dislocate.

Other episodes you might enjoy:  

Patellofemoral / Patellotibial Ligaments: Episode 113

Patella Fracture: Episode 85

Patella Femoral Pain Syndrome: Episode 32

 

 

Knee Capsular Corner Injury

  • A capsular corner injury of the knee is not often talked about but is often present for individuals who are dealing with instability of the knee and are having a more difficult time returning to activity. We’re talking primarily about posterolateral and little about posteromedial corner injuries of the knee.
  • Chip Review @ (17:35): Sabritas – Receta Crujiente – Chiles Rojos (Thank you Khem)
  • Trivia question of the week @ (15:12): How fast would Santa’s sleigh have to travel to deliver presents to all the children in the world?
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Brief overview of the episode:

Knee capsular corner injuries are not commonly referred to but they result in long-term instability of knee. The current incidence has not been widely reported but at least currently appears to not be that common. The incidence goes up depending on mechanism.

A direct blow into a posterolateral direction, hyperextension or other high-energy trauma is the most likely mechanism to injury the posterolateral corner of the knee capsule. Symptoms beyond instability include tendernesss, swelling, bruising, standing varus and varus or hyperextension varus during gait.

In most cases a corner injury of the knee does not occur in isolation. They are most common with posterior cruciate and anterior cruciate ligament ruptures.

 

Other episodes you might enjoy:  

Posterior Cruciate Ligament (PCL): Episode 112

ACL Recovery: Episode 13

Knee Pain: Episode 2

 

Osteochondritis Dissecans

  • In this episode: Osteochondritis Dissecans aka OCD. This is a bone injury that occurs most commonly in adolescents 10-20 years old who are active in sports. Symptoms include pain, weakness, range of motion loss, swelling and in more significant cases locking of the joint.

  • Chip Review @ (10:05): Pringles – Reuben (Thank You Ian Wells)

  • Trivia question of the week @ (07:45): How many golfers have won at least 10 majors?

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Brief overview of the episode:

            Osteochondritis Dissecans (OCD) is a process in which the blood supply to the end of a bone is interrupted. This results in bone softening or death and subsequently changes to the cartilage. In sever cases the cartilage will fall into the joint and cause locking.

            The most common symptoms are pain, swelling, range of motion loss, weakness and reduction in sports performance. OCD mostly affects highly active adolescents between 10-20 years old. The mechanism is thought be repetitive low-level traumas sustained though running, jumping and cutting. But it is not fully understood and there is likely also a genetic component.

            OCD has a prevalence of between 9-22/100,000, not too common. Because it shares so many symptoms with more typical knee juvenile complaints like tendonitis, bursitis, Osgood-Schlatter and growing pains it can be difficult to diagnosis. There are a few tests that can be done but in most cases an x-ray, MRI or CT scan will be the most conclusive.

            It is really important to stop participation in sports if OCD is suspected because the possibility for long-term cartilage injury is present. The good news is that if the growth plate has not closed the potential for the bone and cartilage to heal is high.

            If you or your child suspects that something is wrong please schedule and appointment with your local physical therapist, orthopedic surgeon or sports medicine doctor.

 

Other episodes you might enjoy:  

Ankle Sprain_Inversion Type: Episode 3

Ice or Heat?: Episode 23

Shin Splint: Episode 17

Patella Fracture: Episode 85

  • In this episode: Patella fractures are thankfully not common. They do however; pose a unique set of challenges when recovering from them.

  • Chip Review @ (13:42): Kettle – New York Cheddar (Thank You Karin)

  • Trivia question of the week @ (12:27): What was stolen in the Shel Silverstein poem “Stop Thief!”?

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Brief overview of the episode:

 

            The Patella, better known as the kneecap can sustain a fractured. This will typical happen as a result of trauma, usually a fall directly onto the knee, or any blunt trauma directly to the front of the knee. In rare instances a large eccentric (lengthening while contracting) load through the quadriceps can also cause a patella fracture.
            Thankfully a patella fracture makes up only 1% of all bone injuries. This occurs at a 2:1 ratio male to female and generally ages 20-50.
            Fractures are labeled either simple or complex. With patella fractures typically a complex fracture is a horizontal break causing disruption of the extensor mechanism, while simple fracture are vertical or partial fractures.
            Knee pain following blunt trauma that results in inability or sharp decline in walking ability, as well as swelling, range of motion loss, weakness and difficulty or inability to straighten knee are all signs of patella fracture. X-ray is the best way to visual the patella and will show any fracture.
            Treatment will be either surgical for complex fractures or at a minimum bracing for simple. The patella will heal in 6-8 weeks to point where increased physical activity can be performed. Depending on the specifics of the fracture physical therapy will usually be initiated following an immobilization period this can be a short as a few days but will be typically be following 6-8 weeks.
            Long-term problems do arise with osteoarthritis. Anytime a surface containing cartilage is damaged there is much higher potential for longer-term arthritic changes. In the short term return to most activities will occur between 3-6 months and return to sport and higher level activities is usually between 6-12 months.

Other episodes you might enjoy:  

Ice or Heat?: Episode 23

Shin Splint: Episode 17

ACL Recovery: Episode 13

Patella Femoral Pain Syndrome: Episode 32

 

Knee Bursitis: Episode 73

  • In this episode: We discuss the 4 main kinds of bursitis around the knee. Prepatellar, Infrapatellar, Suprapatella and Pez Anserine bursitis.

  • Chip Review: Kettle Brand – Deep River – New York Spicy Dill Pickle 2nd review for Old Dutch Dill Pickle – (10:34)

  • Trivia question of the week: Which US states boarder the Gulf of Mexico? – (09:34)

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Brief overview of the episode:

           In this episode we discuss bursitis around the knee. There are four named bursitis near the knee. Prepatellar bursitis, Infrapatellar bursitis, Suprapatella bursitis, and Pez anserine bursitis.
            Prepatellar bursitis is basically on the knee cap. Infrapatllar bursits is behind the patella tendon. Suprapatella bursitis is behind the quad tendon and Pez anserine bursitis is on the medial aspect of the proximal tibia.
            The pez anserine is the French word for goose foot. This is named because there are three tendons that attach there and that formation looks like a webbed foot.
            Bursitis in general and at the knee more so present with similar signs and symptoms; swelling, pain, range of motion loss and possibly some redness. Pain is the most limiting symptom. In more intense cases swelling can be significant but often times swelling is only minor.
            In most cases long duration kneeling or trauma are the inciting mechanism. In some cases repetitive motion is the cause. This is much more likely with pez anserine bursitis than the three patellar versions. Prepatellar and intrapatellar bursitis are mostly due to knee and suprapatella bursitis is rare.
            The initial goal when managing any bursitis is to stop or greatly limit the activity that is causing symptoms. With trauma that is pretty simple if it is a work related activity than more modification is required. In conjunction with reducing the cause light activity as well as modalities will be helpful.
            Modalities could include, ice, heat, ultra-sound, e-stim, etc… The goal is to reduce the pain as well as the inflammation and pressure from the inflammation. We have found that bursitis responds well to kinesio-taping, especially an effusion control method.
            In most cases pain will greatly reduce in the first 1-2 weeks, with complete reduction of pain and inflammation within 6-8. There are chronic conditions associated with bursitis but they are exceedingly rare and not the focus of this podcast.

 

Other episodes you might enjoy:

Shin Splint: Episode 17

Knee Pain: Episode 2

Ice or Heat?: Episode 23

 

Patellar Tendonitis: Episode 61

  • In this episode: We discuss patellar tendonitis (inflammatory) and tendonosis (chronic). Signs, symptoms and some treatment options available.

  • Chip Review: Kettle Brand – Wood Smoked Sea Salt (13:52)

  • Trivia question of the week: Why is this sentence special? The quick brown fox jumps over the lazy dog. (12:25)

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Brief except from the episode:

Patellar Tendonitis, pain and discomfort directly in the front of your knee. Your patella tendon is the soft portion between your knee cap (patella) and shin (tibial tuberosity).
Generally speaking there is a gradual onset. Hurts a little goes away, hurts again later a little more etc… This is also called “jumpers’ Knee”.
It has been linked to early sport specialization. Younger individuals who perform the same activity the whole year around tend to have a higher incidence of patella tendonitis.
Some differential diagnosis for this can be Osgood-Schlatter disease, which is bone pain on the tibial tuberosity or Sinding larsen johansson syndrome. Which is bone pain of the inferior patella pole (bottom of the knee cap). These both occur in the immature skeleton.
There is good article by Mark F. Reinking called Current Concepts in the Treatment of Patellar Tendinopathy. Which looks at the intrinsic and extrinsic aspect related to patellar tendon issues. (Give it a read if you have the time).
Treatment wise we are always looking to find related issues whether that is weakness, range of motion loss or excess, shoe wear and activity level.
Patellar tendonitis is highlighted by local inflammation. If left untreated it can progress to patellar tendonosis, which is more difficult to recover from. If you think you might have tendonitis come see us or your local physical therapist and have it addressed sooner rather than later.

Other Episodes you might Enjoy

Knee Pain: Episode 2

Patella Femoral Pain Syndrome: Episode 32

Shin Splint: Episode 17

Iliotibial Band Syndrome (ITBS): Episode 9

Knee Pain: Episode 2

 

Knee replacement: Episode 58

  • In this episode: Officially Total Knee Arthroplasty (TKA), it is a difficult recovery and will eventually be worth it. This is likely the most difficult and painful joint replacement to recovery from.

  • Chip Review: Zapp’s Voodoo Heat – Skylar & Connie (12:53)

  • Trivia question of the week: Name the Author of Her Majesty’s Secret Service, Dr No and Thunderball? (11:12)

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Brief except from the episode:

Total knee arthroplasty, also known as a Knee replacement or TKA. This procedure is common, about 600,000 occur per year in the USA. This number is expected to increase to 1.2million in the next 10 years.
The average age for knee replacement is 70 years old. With the typical range stretching from 50-80 years old. Women make up about 60% of those having their knees replaced. The current expected life span of a knee replacement is about 20 years. With 85% of replacements lasting at least that long.
Of the common joint replacements a total knee arthroplasty is the most painful and typically the most difficult to recover from. Long term a knee replacement does amazing. For the first 3-6 months you are going to have to work hard at regaining strength and ROM and there is going to be daily pain.
You can’t sit with your knee propped up and expect to improve. You are going to need to start moving it the day of surgery and are going to need to keep moving it until you reach 0 degrees of knee extension (straightening) and 120 degrees of flexion (bending).
Some people struggle with bending some with straightening. ROM will take anywhere from 3months to 12 months to get back. It can be frustrating to be working on your range of motion 6 months out. But, by and large by 12 months everyone following knee replacement is at more or less the same place.

Other episodes you might be interested in:

Stretching: Episode 25

Robert Castillo_Active Fit Bootcamp: Episode 16

Fall prevention & Balance: Episode 19

ACL Recovery: Episode 13

Knee Pain: Episode 2

 

 

ACL Reconstruction Options: Episode 46

  • In this episode: We discuss the various options for ACL reconstruction.

  • Chip Review: Lorenz Crunchips – Voodoo Party (Liz Schneider)

  • Trivia question of the week: How many minutes of playtime are there during an average baseball game?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

 

What options do you have when you tear your ACL? Lots of them actually. Saying ACL reconstruction is more specific then repair. The tissue is gone, it has exploded even, and so you are not able to repair that in most cases.
There are two main types of graft tissue, allograft that is from something else. Usually we call this cadaver. There is also an autograft, which is from you. So another area of the body is being repurposed. Usually, patella tendon or hamstring tendon.
Djimmer is actually an expert on this. He has had a patella tendon graft on his right knee and a hamstring graft on the left knee. So a lot of first hand experaince. In addition Djimmer has had a child who has undergone ACL reconstruction. He had a hamstring graft. So you can also speak to the parental aspect of recovery.
Christiaan is also a member of this club. He is ACL deficient. So he has partial torn his ACL and chosen to not have it reconstructed.
Graft type wise. Allo is from a cadaver and traditionally you will see patella but you can see a variety and sometime you won’t know exactly where your graft is coming from.
Outside of graft type one of the most important aspects of a successful reconstruction is getting the angle right. The impact of the surgeon is much more important in recovery and function then the tissue used for the reconstruction. This is because the location of the new “ligament” has much more impact on the function of the knee then what the tissue is made of.
The selection of tissue during an autograft is important because it will immediately impact your recovery. Selecting tissue from your patella or hamstring will cause a second location that also needs to recovery. The benefit of the autograft is that the tissue is fresher, there is almost no chance of rejection and the long-term laxity is typically much lower.
In our opinion the most important aspect to keep in mind when choosing what to do for your ACL reconstruction is to pick the surgeon you feel will do the best job. Within that selection it is typically best to have the surgeon perform the procedure and graft tissue they use most often and would more then likely do best. This will give you the best chance for quicker recovery and long term function and effectiveness.

Other Episodes you might be interested in:

ACL Recovery: Episode 13

Meniscus Injury: Episode 39

  • In this episode: Meniscus injury. Tears, non tears and types of tears are discussed as well as common signs and treatment options.

  • Chip Review: Osem Bamba Peanut snack. Thank you Joan Saliman

  • Trivia question of the week: Why are sneakers called sneakers?

  • Follow us on Instagram: 2pts_n_a_bagofchips and/or Twitter @2PTsNaBagOChips to see photos, video and get additional episode specific information throughout the week.

  • Thanks for listening!!

Meniscus injury is our topic this week. What does the meniscus do? One of the best explanations I have heard, is from my good friend Dr. Parker. He says the meniscus functions as a gasket. It works to guide movement and provides stability. Probably not as much shock absorptions as we think it might do. It works to protect the cartilage. It helps to increase joint congruency is what a gasket tends to do. Those are the big things. Cushioning is not it’s main function. The main function is kinematical and guiding the direction of movement. The knee is much more complex than just a simple hinge joint.
There is a medial meniscus and a lateral meniscus. So there are 2 pairs in each knee. Then you talk about a blood zone area. There is the outer most area called the Red-Red, red meaning blood flow. A middle 1/3rd that is called the Red-White and the inner 1/3rd called the White-White. White-White has minimal if any blood flow at all this comes into play when you start talking about surgery and healing potential.
Biggest signs with meniscus injury are pain, swelling, some people experience locking or catching depending on the type of tear they are dealing with. Generally range of motion loss is a huge one. Because the knee is either full with fluid or because something is stopping the range from bending, straightening or both. Yes, it can be pain but it can also be painful and then go away for a little bit. Depending on the size of the tear, the location of the tear, your activity level.
Meniscus tear is a very, very common injury. You don’t have to tear it for it to feel not particularly good. You can have a lot of compression on it and bruise your knee and bruise you meniscus so to speak.
Similar topics:

Patella Femoral Pain Syndrome: Episode 32

Iliotibial Band Syndrome (ITBS): Episode 9

Knee Pain: Episode 2

 

 

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