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Tanner Clinic,

Robert S. Rice, MD.

Sports Surgeon Utah

PROCEDURES

Specialized Procedures

ACL

Injuries to the Anterior Cruciate Ligament (ACL) in the knee are fairly common. When the ACL is injured the result is instability of the knee joint. This can be manifest through knee buckling or giving way. This abnormal motion in the knee can cause injury to other structures such as the meniscus or cartilage. In order to restore the normal function of the ACL and knee stability, reconstruction surgery can be performed. Prior to undergoing surgery, it is important that the injured knee have near normal motion, but in achieving the ability to fully straighten (extension) the knee, as well as bending (flexion) the knee. If surgery is performed before acceptable motion is present, then there is a significantly increased risk of knee stiffness following the operation.

There are various techniques currently utilized to surgically repair the ACL. In all techniques, the goal is to provide a new ACL that restores the normal stability of the knee allowing return to normal activity. The technique I use most regularly is all- inside ACL reconstruction. In this manner, smaller tunnels are created in the bone and the hard surface (cortex) of the bone is not violated. This allows for smaller incisions in the skin and typically less pain. With the reduction in immediate post- procedure pain, patients are more likely to achieve normal motion earlier in their recovery.

Equally important as the surgical repair is the post-operative rehabilitation in achieving full knee recovery and function. Patients are allowed to begin walking on the surgically repaired leg the same day of surgery. Physical therapy is an integral piece in the recovery process. Most patients will work with their therapist for approximately three months following the operation. Physical therapy assists with swelling reduction, range of motion and strength return, and balance training. When full recovery from ACL surgery is achieved, it is anticipated that patients will be able to return to all of their normal activities.

Cartilage

Injuries to the cartilage of the knee are fairly rare. Knee cartilage is the smooth firm covering of the bones that allows for the gliding movement of the joint. When the cartilage is injured the result can be instability, swelling, catching, and pain of the knee joint. Unfortunately, the cartilage in our joints does not possess the ability to repair itself. In order to restore the smooth joint surface and normal function of the reparative surgery can be performed.

There are several procedures currently utilized to surgically repair injured cartilage. In all techniques, the goal is to provide covering cartilage that restores the normal smooth surface of the knee allowing return to normal activity. These techniques range from drilling holes in the bone to access bone marrow stem cells, to transfer of cartilage from other areas within the knee, to obtaining cartilage from a donor.

Each cartilage injury is different and the size, shape, and location of the injury determine which technique is best employed. Just as each surgical procedure is different, so are the post-surgical recovery and restrictions. Just as important as the surgical repair is the post-operative rehabilitation in achieving full knee recovery and function. Some of the procedures allow for immediate weight bearing (walking), while others require a period of crutch use with the leg protected from weight. Physical therapy is an integral piece in the recovery process.

Most patients will work with their therapist for approximately three months following the operation. Physical therapy assists with swelling reduction, range of motion and strength return, and balance training. When full recovery from ACL surgery is achieved, it is anticipated that patients will be able to return to all of their normal activities.

Rotator Cuff

Injuries to the Rotator Cuff in the shoulder are fairly common. When the Rotator Cuff is injured the result is pain, weakness, and motion loss of the shoulder. This abnormal function in the shoulder can cause difficulty sleeping and an inability to use the shoulder for normal activities. In order to restore the normal function of the shoulder and to reduce pain, reparative surgery can be performed. The goal of rotator cuff repair is to reattach the torn tendon back to the bone and restore the function of this important muscle group.

There are various techniques currently utilized to surgically repair the rotator cuff. In all techniques, the goal is to provide tendon to bone healing in the shoulder allowing return to normal activity. The technique I use most regularly is arthroscopic rotator cuff repair. This allows for smaller incisions in the skin and typically less pain. With the reduction in immediate post-procedure pain, patients are more likely to achieve normal motion earlier in their recovery.

Just as important as the operative repair is the post-surgical rehabilitation in achieving full shoulder recovery and function. Patients are allowed to begin gentle motion exercises shortly after surgery. A shoulder brace is worn for six weeks following surgery to protect the repair and promote a healthy healing environment in the shoulder. Physical therapy is an integral piece in the recovery process. Most patients will work with their therapist for approximately three months following the operation. Physical therapy assists with swelling reduction, range of motion and strength return. When full recovery from shoulder surgery is achieved, it is anticipated that patients will be able to return to all of their normal activities.

Shoulder Instability

Injuries that affect shoulder stability are fairly common. Dislocation or subluxation (partial dislocation) events to the shoulder result in damage to the labrum and capsular ligaments, important stabilizing structures of the shoulder joint. When the shoulder stability is compromised the result is pain, weakness, instability and motion loss of the shoulder. This abnormal function in the shoulder can cause difficulty sleeping and an inability to use the shoulder for normal activities. In order to restore the normal function of the shoulder and to reduce pain, reparative surgery can be performed. The goal of shoulder stabilization repair is to reattach the torn labrum and capsule back to the shoulder socket and restore the function of these important stabilizing structures.

There are various techniques currently utilized to surgically repair the unstable shoulder. In all techniques, the goal is to provide soft tissue to bone healing in the shoulder allowing return to normal activity. The technique I use most regularly is arthroscopic stabilization. This allows for smaller incisions in the skin and typically less pain. With the reduction in immediate post-procedure pain, patients are more likely to achieve normal motion earlier in their recovery.

Equally as important as the surgical repair is the post-surgical rehabilitation in achieving full shoulder recovery and function. Patients are allowed to begin gentle motion exercises shortly after surgery. A shoulder brace is worn for six weeks following surgery to protect the repair and promote a healthy healing environment in the shoulder. Physical therapy is an integral piece in the recovery process. Most patients will work with their therapist for approximately three months following the operation. Physical therapy assists with swelling reduction, range of motion and strength return. When full recovery from shoulder surgery is achieved, it is anticipated that patients will be able to return to all of their normal activities.