What is an ACL Injury?

ACL, scientifically known as the anterior cruciate ligament, is one of the major stabilizers of the knee joint. Its primary action predominantly is to prevent anterior (Infront) translation (movement) of the lower bone (tibia) over the upper bone (femur). When this ligament is torn, patients exhibit sudden give way of joint when coming down stairs, walking on uneven surfaces, or participating in sports activities that require sudden turning, such as during sports. Each of these episodes of giving way/ instability may lead to further damage in joints by crushing cushions of knee joints, also known as menisci, between bones. Tear in menisci affects weight distribution in the knee and may lead to early osteoarthritis. Thus, every ACL injury must be taken seriously.

ACL Injury Treatments

ACL injury is most commonly treated by keyhole surgery, also known as arthroscopy. It is usually performed by an orthopedic surgeon with fellowship training in arthroscopy. The procedure is known as ACL reconstruction surgery.  An end of the muscle, also known as a tendon is harvested from distal thigh, upper or lower leg. It is fixed in knee joint made by tunnels in tibia and femur. Over a period, this tendon completely transforms into an ACL. This period, also known as ligamentization, varies in individual and the reconstructed ligament needs protection during this period.

ACL Injury Recovery

The rehabilitation of the ACL ligament is straightforward. The patient is out of bed on the same day of surgery. Initial walking is done with the help of a walker. Partial weight bearing is allowed for 2 weeks, followed by complete weight bearing. The target knee range of motion is 90 degrees by 2- weeks and complete movement by 4–6 weeks. Physiotherapy is required for 6–12 weeks, depending on the level of athletics. A person is allowed to run after 6–9 months when a detailed evaluation of muscle power, stability of reconstruction, and patients’ confidence has been performed.

ACL injuries, if ignored, may lead to devastating complications of early arthritis. Consult an orthopedic surgeon trained in arthroscopy/ sports medicine if you suspect to have this injury.

Osteoporosis

The World Health Organization defines osteoporosis as a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. In simpler terms, it is a disease in which bones become weak and may lead to fractures.

A loss of height, a stooped posture, back or neck pain, and bone fractures are often the most common symptoms of later-stage osteoporosis. Fractures of the spine, hip, and wrist are commonly associated with osteoporosis. Osteoporosis is a silent disease, usually, the patient has no symptoms until the first fracture.

Osteoporosis Risk Factors

The following are risk factors for osteoporosis:

Gender: Women are at higher risk than men
Age: Risk increases with age
Family history: Osteoporosis in first-degree relatives increases risk
Body size: Small, thin-framed people are more at risk
Calcium and vitamin D: A lifetime diet low in calcium and vitamin D is a risk factor for osteoporosis
Medications: anticonvulsants (anti-seizure medications)
Steroids
Lifestyle: An inactive lifestyle or extended bed rest/immobilization
Cigarette smoking: Increased risk with consumption
Alcohol Increased: risk with excessive intake

Diagnosis

The diagnosis of osteoporosis can be made in the presence of a fragility fracture (a fracture is a fracture resulting from a fall from standing height or less), particularly at the spine, hip, wrist, humerus, rib, or pelvis, or with measurement of bone mineral density using specialised DEXA scan in the presence of a T score of less than -2.5.

Treatment

All men and women who meet the criteria for the diagnosis of osteoporosis should be counseled about nonpharmacologic preventive measures including exercise, diet, smoking cessation, and reduction of fall risk.

All patients meeting the diagnostic criteria for osteoporosis should be offered drugs that increase bone mineral density. Many kinds of drugs ranging from daily oral tablets to daily/ 6 monthly injections are available for same. Patients should consult orthopaedic surgeons to know about individual drugs and pros and cons of each before starting therapy.

What is a Recurrent Shoulder Dislocation?

Recurrent shoulder dislocation is a common problem faced by young individuals. Individuals with this problem face restriction of certain movements resulting in curtailment of sports activities. Also, there is this constant fear that the shoulder may pop out anytime.

There is usually a definite history of trauma leading to the first episodes of dislocation. The dislocation leads to an abnormal contour of the shoulder with associated severe pain and an inability to move the shoulder. The dislocation lands the person in an emergency and requires an orthopedic surgeon to reduce the shoulder after x-ray confirmation.  Young individuals have higher chances of repeat dislocations after the first episode. This often occurs during overhead activity. There is often a feeling of the shoulder giving way prior to frank dislocation, which is known as an apprehension sign.

Treatment of Recurrent Shoulder Dislocation

The recurrent shoulder dislocation needs some form of surgical management. Surgeons usually get an MRI and CT done to look for signs of bone loss in the shoulder joint to arrive at a decision. Patients with fewer amounts of bone loss are amenable to repair of joint by arthroscopy. This is usually followed by a supervised physiotherapy regimen. Patients who have more bone loss in shoulder joint due to repeated rubbing of bones against each other during each episode of dislocation will need open surgery. Both open and arthroscopic surgeries are performed by orthopedic surgeons who subspecialize in shoulder surgery.

There is a subset of patients who will require surgery even after the first episode of dislocation. Individuals who are in high-activity or contact sports, manual laborers, army men will require a thorough evaluation and probably surgery even after the first dislocation.

Thus, recurrent shoulder dislocations are a common but treatable condition. We should seek an immediate medical opinion after a dislocation. If the condition becomes recurrent or in certain high-activity individuals, surgery provides benefits with predictable outcomes. Please see your orthopedic surgeon if you have this condition.

What is Rheumatoid Arthritis?

It is an inflammatory autoimmune disorder. In simple language, body cells itself act against other body cells due to inherent unique genetic makeup, which, when exposed to external stimuli or factors, leads to chronic inflammatory state. This leads to specific pathology in all organs in the body, with joint symptoms being the most prominent visible manifestation if the same. 

Rheumatoid Arthritis Symptoms

Symptoms of Rheumatoid arthritis are

• Early morning stiffness
• Involvement of multiple small joints of hand and feet with pain and stiffness in early stages. 
• Advanced disease may lead to deformities of the hands ( swan neck and boutonnière deformity), bowlegs, and knock knees, and may cause hip, ankle, and feet deformities. 
• Patients may be unable to squat, sit cross legged and simple walk may lead to excruciating pain in advanced stages of the disease.
• Chronic pain, stiffness and hyperinflammation leads to osteoporosis ( weakness ) of bones and the tendency to fracture. 

The best thing to do is to seek medical help if you have the above symptoms. Orthopaedic surgeons prescribe specific blood tests which are used to diagnose rheumatoid Arthritis. Once diagnosed, the patient is kept on medicines which suppress harmful exaggerated inflammatory states. The medicines are to be taken for a long period of time. Patients should be well aware of the long-term need for medications for good compliance. Long-term medications are needed to prevent joint complications such as arthritis, which require surgery mostly in the form of replacement. 

Remaining physically active is another aspect which is often missed. Active lifestyle leads to endorphin release, which keeps mood elevated and prevents disuse osteoporosis.

Experiencing early morning stiffness, pain in your hands and feet, or difficulty moving? These could be signs of rheumatoid arthritis (RA).