Advances seen in treatment of knee ligament injury

	Tweet

New surgical techniques are helping to improve treatment of a lesser-known type of knee ligament injury, according to a research review.

The ligament in question is called the posterior cruciate ligament, or PCL—a band of strong tissue that connects the shinbone to the thighbone and prevents the shinbone from moving too far backward.

When it comes to knee injuries, the anterior cruciate ligament (ACL) gets most of the attention, as ACL tears are far more common. However, the PCL can be torn when a heavy force strikes the front of the knee—if, for instance, the knee hits the dashboard in a car accident, or an athlete falls hard onto a bent knee. 

Partial tears to the PCL are generally treated with rest, physical therapy or other non-invasive measures. When it is completely torn, though, surgery may be recommended.

The new review, published in the Journal of the American Academy of Orthopedic Surgeons, charts the recent progress that has been made in reconstructing damaged PCLs.

The traditional surgical method is to replace the ligament with a so- called “one-bundle” graft taken from another part of the patient’s body or from a cadaver. The graft is passed through a “tunnel” in the front of the shinbone and attached to the bone at a single site.

Newer methods have been developed, however—one being the “two- bundle” approach, which uses thinner individual tissue grafts that are attached to the bone at two sites. The other option is known as in-lay reconstruction, where instead of using a tunnel in the shinbone, the surgeon screws the new tissue directly into the shinbone.

Lab research suggests that the newer methods may be more effective than traditional surgery, according to Dr. Matthew Matava, an orthopedic surgeon at the Washington University School of Medicine in Chesterfield, Missouri, and the lead researcher on the review.

With in-lay reconstruction, the tissue graft is likely to fray or become stretched out, as it is not wound around the shinbone tunnel, Matava explained in a news release from the American Academy of Orthopedic Surgeons (AAOS).

The evidence, however, comes from biomechanical studies, and clinical trials have not yet shown the newer methods to be superior.

“Although we believe the newer treatments are better,” Matava said, “we still must prove it.”

According to the AAOS, some surgeons believe that the new means of PCL reconstruction are more complex, and therefore more risky. The group advises patients who need the procedure to find an orthopedic surgeon with specific experience in PCL reconstruction.

SOURCE: Journal of the American Academy of Orthopedic Surgeons, July 2009.

RELATED STORIES:
Teens’ growth-plate injuries need early care   Survival after surgical complications appears better at teaching hospitals for whites but not blacks   Kneepads, often optional, can curb sports injuries   Blacks twice as susceptible and more likely to die of severe sepsis than whites   New Surgery for Atrial Fibrillation Shows Promise   Patients who gave up smoking before surgery had half as many complications afterwards   Simple test spots athletes at risk of ankle sprains   UN says post-tsunami disease could kill thousands   Boxing Injuries on the Rise; Youth Head Injury Rates Also Concerning   Former President Clinton set for low-risk surgery   Separated Twins Heading Home   Jefferson doctors strengthen case for high-dose radiotherapy technique after radical prostatectomy

Comments

[ + Post Your Own ]

Now you're in the public comment zone. What follows is not Armenian Medical Network's stuff; it comes from other people and we don't vouch for it. A reminder: By using this Web site you agree to accept our Terms of Service. Click here to read the Rules of Engagement.

Almost all knee injuries will need more than one visit to the doctor. If no operation is indicated, then RICE (rest, ice, compression, and elevation) with some strengthening exercises and perhaps physical therapy will be needed. Sometimes the decision for surgery is delayed to see if the RICE and physical therapy will be effective. Each injury is unique, and treatment decisions depend on what the expectation for function will be. As an example, a torn ACL (anterior cruciate ligament) would usually require surgery in a young athlete or a construction worker, but the ACL may be allowed to heal with physical therapy in an 80-year-old who is not very mobile. With the technology available, many knee injuries that require surgery can be treated surgically with an arthroscope, in which a camera is used and small punctures are made in the knee to insert instruments.Its is known as knee arthroscopy surgery.

posted by Tanu on 01/06/2011 at 8:27 am -08:00