Download - Meier Orthopedic Sports Medicine
TABLE OF CONTENTS
About&Meier&Orthopedic&Sports&Medicine..........................................................................................2510&Shoulder&Conditions&and&Treatment..................................................................................................11532&&&&&&&&&&&Rotator&Cuff&Tears&and&Treatment...........................................................................................18519&&&&&&&&&&&Shoulder&Instability,&Damage&and&Treatment......................................................................20522&&&&&&&&&&&Arthritis&and&Joint&Degeneration&of&the&Shoulder..............................................................23526&&&&&&&&&&&Fractures&and&Separations&of&the&Upper&Extremity..........................................................27531&Knee&Conditions&and&Treatment..........................................................................................................33562&&&&&&&&&&&Ligament&Injuries.............................................................................................................................40546&&&&&&&&&&&Cartilage&Injuries..............................................................................................................................47551&&&&&&&&&&&Fractures&and&Other&Injuries&of&the&Lower&Extremity.....................................................52563&&&&&&&&&&&R.I.C.E...........................................................................................................................................................64&Cartilage&Restoration.......................................................................................................................................65&&&&&&&&&&&Articular&Cartilage&Damage.........................................................................................................66567&&&&&&&&&&&Autologous&Chondrocyte&Implantation&(ACI)......................................................................68572&Follow&Us&On&Facebook...................................................................................................................................76
1
MEIER ORTHOPEDIC SPORTS MEDICINE
2
Whether&working&with&recreational&athletes,&injured&workers&or&any&other&individuals,&Dr.&Meier&provides&each&patient&with&the&quality&of&care&given&to&professional&athletes.&!
Dr.&Meier&utilizes&multiple&therapeutic&techniques&which&may&include&an&exercise&program,&rehabilitation,&or&minimally&invasive&surgery.&!
When&surgery&is&necessary,&the&most¤t&and&leading5edge&technologies&are&employed&which&result&in&less&postoperative&pain&and&faster&recovery.
ABOUT DR. MEIER
Steven&W.&Meier&is&a&board5certi[ied&orthopedic&surgeon&with&special&training&in&sports&medicine&and&arthroscopic&surgery.&&!
He&received&his&Medical&Degree&from&the&Loyola&University&Chicago&Stritch&School&of&Medicine.&He&completed&his&fellowship&at&University&of&California,&San&Diego&for&Sports&Medicine&and&Arthroscopic&Surgery.&!
Dr.&Meier&is&a&leader&in&his&[ield&in&the&surgical&treatment&of&shoulder&conditions&and&knee&conditions,&as&well&as&arthroscopic&surgical&techniques.
3
PATIENT CARE PHILOSOPHY
Dr.&Meier&uses&a&multi5faceted&approach&to&patient&treatment.&&!
He&believes&that&in&order&to&achieve&the&best&possible&outcome&for&any&particular&patient,&a&strategic&combination&of&surgical&and&non5surgical&techniques&should&be&utilized.&!
Dr.&Meier&often&uses:&!
•&&Strengthening&and&exercise&programs&•&&Formal&physical&therapy&and&rehabilitation&•&&Minimally5invasive&surgery
4
ACADEMIC MEMBERSHIP
5
WORLD RENOWNED
Dr.&Meier®ularly&publishes&and&lectures&internationally.&&!
He&is&often&called&upon&to&treat&dif[icult&cases&that&other&surgeons&may¬&be&comfortable&with.&He&performs&revisional&surgeries,&as&well,&for&people&who&have¬&had&an&optimal&outcome&from&previous&surgeries&performed&by&other&surgeons.&!
Dr.&Meier&serves&as&an&Assistant&Clinical&Professor&at&the&University&of&California,&Irvine&Department&of&Orthopedic&Surgery.&&
6
SHOULDER CONDITIONS
Dr.&Meier&treats&many&injuries&and&abnormal&conditions&of&the&shoulder.&The&common&conditions&he&treats&include:&!
•&&Rotator&cuff&tears&•&&AC&joint&sprains/separations&and&overuse&injuries&•&&Shoulder&dislocation&•&&Fractures&of&the&humerus&(upper&arm&bone)&•&&Tears&of&the&cartilage&of&the&shoulder&joint&•&&Arthritis&and°eneration&of&the&shoulder&joint&•&&Shoulder&instability&
7
KNEE CONDITIONS
8
Dr.&Steven&Meier&treats&many&knee&conditions,&especially&sports&and&activity5related&injuries.&!
Dr.&Meier&also&treats&complications&from&old&injuries&and&previous&surgeries,&as&well&as&knee&conditions&related&to&age.&
KNEE CONDITIONS
Dr.&Meier&treats:&!
•&Anterior&cruciate&ligament&(ACL)&injuries&•&Medial&collateral&ligament&(MCL)&injuries&•&Posterior&cruciate&ligament&(PCL)&injuries&•&Lateral&collateral&ligament&(LCL)&injuries&•&Meniscus&tears&and&fraying&•&Cartilage&lesions&and°eneration&•&Osteoarthritis&&•&Fractures&and&contusions&&•&Patellofemoral&instability&•&Patellofemoral&Pain&Syndrome&•&Baker’s&Cyst&•&Patellar&tendinitis&(Jumper’s&knee)
9
CARTILAGE RESTORATION
Cartilage&restoration&is&a&new&and&progressive&technique&used&to&replace&damaged&cartilage.&&!
The&idea&is&that,&instead&of&removing&the&damaged&joint&and&replacing&it&with&an&arti[icial&joint&or&surface,&your&own&cartilage&may&be&grown&in&a&laboratory,&and&later&placed&into&the&affected&joint&in&order&to&provide&healing&and&pain&relief.&!
Dr.&Meier&is&one&of&a&few&physicians&in&the&country&who&perform&this&cutting&edge&procedure.&
10
SHOULDER CONDITIONS AND TREATMENTS
11
SHOULDER ANATOMY
Your&shoulder&is&made&up&of&three&bones:&&!
•&Humerus&(upper&arm&bone)&•&Scapula&(shoulder&blade)&•&Clavicle&(collarbone)&!
The&shoulder&is&a&ball5and5socket&joint.&The&ball,&or&head,&of&your&upper&arm&bone&[its&into&a&shallow&socket&in&your&shoulder&blade.
12
SHOULDER INJURIES
The&shoulder’s&unique&structure&allows&for&nearly&unrestrained&positioning&and&rotation&of&the&arm&in&many&directions&and&planes.&!
However,&the&price&of&the&shoulder’s&great&mobility&is&that&it&can&easily&be&injured&if&one&is¬&careful.
13
SHOULDER INJURIES
How&do&you&know&if&you&have&injured&your&shoulder?&!
Many&patients&feel&a&pop,&pain,&weakness,&swelling,&or&an&inability&to&move&the&arm&after&injuring&their&shoulder.&!
If&you&have&decreased&mobility&and&pain&for&more&than&357&days,&you&should&call&Dr.&Meier,&or&another&doctor,&in&order&to&make&an&appointment&to&be&examined.&!
Certain&shoulder&injuries&can&lead&to&more&serious&conditions&if&left&untreated.
14
COMMON SHOULDER INJURIES
Dr.&Meier&routinely&performs&surgery&to&treat&shoulder&injuries.&He&performs:&!
•&Arthroscopic&rotator&cuff&repair&•&Arthroscopic&shoulder&decompression&•&Biceps&tendon&relocation&•&Shoulder&cartilage&repair/shaping&•&Arthroscopic&shoulder&capsule&release&•&Fracture&[ixation
15
SHOULDER ARTHROSCOPY
Arthroscopic&procedures&are&commonly&used&to&treat&shoulder&injuries&and&conditions&that&cannot&heal&on&their&own.&Shoulder&arthroscopy&provides&the&following&bene[its:&!
•&Less&invasive&•&Requires&less&heal&time&•&Causes&less&blood&loss&•&Less&painful&than&open&surgery
16
17
SHOULDER ARTHROSCOPY
Arthroscopic&surgery&is&a&minimally&invasive&surgical&technique&where&small&incisions&are&made&into&the&tissue&surrounding&the&shoulder.&!
Dr.&Meier&inserts&a&light&and&camera&through&one&portal&and&an&extremely&specialized&instrument&through&another&portal.&!
Shoulder&arthroscopy&can&be&used&to&treat&many&different&shoulder&conditions.
ROTATOR CUFF TEARS
The&rotator&cuff&is&a&network&of&four&tendons&that&keep&the&humerus&and&shoulder&blade&fastened&together.&!
The&rotator&cuff&allows&the&shoulder&to&move&freely&while&keeping&the&shoulder&in&place.&&!
The&tendons&of&the&rotator&cuff&can&be&torn&either&partially&or&completely.&&!
Did&you&know?&It&is&estimated&2&million&adults&suffer&from&rotator&cuff&injuries&each&year.
18
ARTHROSCOPIC ROTATOR CUFF REPAIR
When&the&rotator&cuff&is&torn,&Dr.&Meier&can&perform&surgery&to&repair&the&rotator&cuff.&!
Signi[icant&tears&of&the&rotator&cuff¬&only&present&with&pain&and&lack&of&mobility,&but¬iceable&weakness&of&the&arm,&and&decreased&function.&!
Rotator&cuff&repair&surgery&is&performed&arthroscopically&in&order&to&reattach&the&rotator&cuff&to&the&humerus.
19
SHOULDER DISLOCATION
The&shoulder&is&one&of&the&most&[lexible&joints&in&the&human&body.&!
Because&of&its&great&mobility,&the&shoulder&can&be&very&prone&to&injury,&and&the&arm&bone&can&become&dislodged&from&its&socket.&!
A&dislocated&shoulder&is&very&painful&and&debilitating.&!
If&you&suspect&you&have&dislocated&your&shoulder,&it&is&important&to&see&a&good&orthopedist.&!
The&damage&from&a&dislocated&shoulder&can&become&very&severe&or&irreversible&if&left&for&too&long.
20
SHOULDER DISLOCATION
Important)Note),)!
A&general&practitioner’s&of[ice&typically&does¬&have&the&equipment&necessary&to&treat&a&dislocated&shoulder.&!
It&is&best&to&head&to&an&emergency&room&if&you&think&you&have&very&recently&dislocated&your&shoulder.&!
Severe&cases&may&require&surgery&to&realign&the&shoulder&and&restore&proper&function.
21
SHOULDER INSTABILITY
When&the&arm&bone&of&the&shoulder&has&a&recurring&tendency&to&come&out&of&its&normal&position,&this&is&called&shoulder&instability.&!
Shoulder&instability&is&due&to&a&de[iciency&in&stabilizing&forces,&typically&resulting&from&prior&injury.
22
BANKART REPAIR
A&Bankart&repair&is&a&type&of&surgery&done&to&correct&habitual&shoulder&dislocations&or&shoulder&instability.&!
Also&known&as&an&arthroscopic&glenohumeral&capsulorrhaphy,&this&procedure&involves&repairing&the&over5stretched&or&torn&labrum&and&capsule&deep&within&the&shoulder&joint.
23
SHOULDER CARTILAGE REPAIR/RESHAPING
The&cartilage&in&the&shoulder&can&be&damaged&due&to&injury&or&overuse.&Dr.&Meier&can&perform&surgery&to&repair&damaged&cartilage&and&remove&any&loose&[laps&or&fraying&that&can&cause&pain&and&instability.&!
This&procedure&is&typically&performed&with&an&arthroscope.
24
ARTHRITIS/JOINT DEGENERATION
People&may&also&develop&arthritis&over&time&due&to&overuse&and&overexertion&of&the&shoulder.
25
ARTHROSCOPIC SHOULDER DECOMPRESSION
Shoulder&decompression&is&a&procedure&used&to&treat&shoulder&impingement&syndrome.&!
Shoulder&decompression&is&an&option&when&patients&have¬&responded&well&to&non5surgical&techniques.
26
Dr.&Meier&will&insert&an&arthroscope&to&visualize&the&shoulder&joint,&tendons,&and&ligaments.&!
He&will&then&remove&any&fraying&and&bone&spurs&that&are&present.&This&can&signi[icantly&reduce&pain&for&the&patient.
ARTHROSCOPIC SHOULDER CAPSULE RELEASE
A&shoulder&can&become&“frozen”&and&patients&may&[ind&it&dif[icult&to&reach&overhead&or&lift&the&arm&above&shoulder&level.&!
A&rigorous&physical&therapy&program&may&help,&but&if&the&patient&does¬&respond&well&to&physical&therapy,&Dr.&Meier&can&perform&arthroscopic&surgery&to&release&the&shoulder&from&its&“frozen”&position.
27
Dr.&Meier&will&perform&an&arthroscopic&procedure&to&surgically&remove&the&adhesions&in&the&shoulder&that&are&preventing&a&normal&range&of&motion.
AC JOINT SPRAINS AND SEPARATIONS
A&few&ligaments&connect&these&two&bones&together,&and&these&ligaments&can&be&separated&or&torn.
28
The&acromioclavicular&joint,&or&AC&joint,&is&the&joint&between&the&clavicle&(collarbone)&and&scapula&(shoulder&blade).
BICEPS TENDON REPAIR/RELOCATION
The&biceps&tendon&can&tear&with&activity&or&trauma.&!
When&surgery&is&necessary,&Dr.&Meier&can&surgically&repair&or&reposition&the&ruptured&tendon.
29
FRACTURES OF THE HUMERUS
The&humerus&is&the&upper&arm&bone&that&ends&in&the&shoulder&socket.&Humerus&fractures&can&often&occur&from&falling.&!
Treatment&for&a&broken&humerus&depends&on&the&location&of&the&fracture&and&the&age&of&the&patient.&!
Typically,&a&fractured&humerus&may&be&able&to&heal&without&surgery&if&there&is&minimal&displacement.&!
The&x5ray&image&is&a&spiral&fracture&of&the&humerus.
30
FRACTURE FIXATION
A&severe&fracture&requires&surgery&to&repair&and&realign&the&bone.&!
Dr.&Meier&may&utilize&pins,&plates,&or&rods&to&ensure&the&bone&is&correctly&re5aligned&to&heal&properly.
31
32
KNEE CONDITIONS AND TREATMENTS
33
KNEE ANATOMY
The&knee&is&incredibly&[lexible&and&able&to&withstand&tremendous&pressure&while&we&run,&jump,&move,&and&stand.&!
The&structure&of&the&knee&includes&tendons,&ligaments,&and&bone.&!
Tendons&are&[ibrous&bands&that&connect&the&muscle&tissue&to&the&bone.&!
Ligaments&are&bands&of&[ibrous&tissue&which&connect&two&bones&together.
34
KNEE ANATOMY
The&knee&has&four&main&ligaments:&&!
•&Anterior&Cruciate&Ligament&(ACL)&•&Posterior&Cruciate&Ligament&(PCL)&•&Medial&Collateral&Ligament&(MCL)&&•&Lateral&Collateral&Ligament&(LCL)&!
These&ligaments&are&essential&to&the&overall&stability&of&the&knee,&and&they&can&be&injured&during&activity.&!
It&is&important&to&avoid&excessive&twisting&to&the&knee&in&order&to&maintain&the&health&of&the&stabilizing&ligaments.
35
KNEE PROCEDURES
Dr.&Meier&performs&the&following&surgical&knee&procedures:&!
•&Cartilage&restoration&•&Arthroscopic&knee&surgery&•&Arthroscopic&ligament&reconstruction/repair&•&Arthroscopic&meniscus&repair/shaping/smoothing&•&Fracture&[ixation
36
KNEE PROCEDURES
When&surgery&is&required,&Dr.&Meier&uses&the&latest&minimally&invasive&techniques&to&treat&his&patients.&!
The&utilization&of&minimally&invasive&techniques&allows&patients&to&be&back&on&their&feet&and&doing&the&things&they&love&in&less&time&than&traditional&surgical&techniques.
37
KNEE ARTHROSCOPY
Arthroscopic&surgery&is&a&minimally&invasive&surgical&technique&where&small&incisions&are&made&into&the&tissue&surrounding&the&knee.&!
Dr.&Meier&inserts&a&light&and&camera&through&one&portal&and&an&extremely&specialized&instrument&through&another&portal.&!
Knee&arthroscopy&can&be&used&to&treat&many&different&knee&conditions.
38
KNEE ARTHROSCOPYCompared&to&open&procedures,&in&which&the&surgical&work&is&done&through&one&big&incision,&knee&arthroscopy&is:&!
•&Less&invasive&•&Carries&fewer&risks&of&complications&•&Has&a&quicker&healing&time&•&Causes&less&blood&loss
39
ACL INJURY
Injuries&to&the&anterior&cruciate&ligament&(ACL)&can&be&very&common&among&professional&and&recreational&athletes.&!
ACL&injuries&are&often&caused&by:&!
•&Sudden&increase&or&decrease&in&intensity&of&activity&•&Rapid&deceleration&while&in&motion&•&Twisting&the&knee&&•&Impact&to&the&knee&•&Landing&improperly&on&the&leg
40
ACL INJURY
Treatment&for&an&ACL&injury&depends&on&the&severity&of&the&injury.&!
If&the&ACL&is&completely&torn,&then&it&will&usually&have&to&be&reconstructed.&!
If&the&ACL&is¬&torn,&then&rest&and&ice&will&be&used&in&conjunction&with&rehabilitation&in&order&to&help&restore&the&knee&to&proper&function.&&!
Dr.&Meier&uses&the&latest&advances&in&orthopedic&surgery&to&reconstruct&a&torn&ACL.
41
PCL INJURY
The&posterior&cruciate&ligament&(PCL)&is&one&of&the&two&cruciate&ligaments&that&maintain&stability&of&the&knee&and&correct&alignment&of&the&femur&and&tibia&bones.
42
Did&you&know?&!
•&The&posterior&cruciate&ligament&is&the&strongest&ligament&in&the&knee.&&•&A&PCL&injury&often&occurs&with&other&ligament&injuries.&&•&PCL&injuries&are&commonly&found&after&major&trauma&to&the&knee&(i.e.&in&a&car&accident).
PCL INJURY
The&treatment&for&a&PCL&injury&is&determined&on&an&individual&basis.&!
Some&patients&do¬&require&surgery&and&can&bene[it&from&physical&therapy&rehabilitation&and&strength&training&alone.&!
Dr.&Meier&will&perform&an&examination&to&determine&the&best&therapy&for&any&patient&who&has&an&injury&of&the&PCL.&
43
ARTHROSCOPIC LIGAMENT RECONSTRUCTION & REPAIR
Some&ligament&injuries&are&unable&to&heal&without&surgical&repair.&A&complete&ACL&tear,&for&instance,&cannot&heal&properly&without&surgery.&!
There&is&more&than&one&way&to&reconstruct&an&ACL.&!
If&a&patient&is&a&candidate&for&ACL&reconstruction,&Dr.&Meier&will&discuss&the&best&techniques&for&that&person&speci[ically&to&[ind&the&best&choice&for&them.
44
MCL INJURY
The&medial&collateral&ligament&(MCL)&is&the&ligament&that&attaches&from&the&inner&side&of&the&femur&to&the&inner&side&of&the&shin&bone.&!
The&MCL&is&a&stabilizer&of&the&knee&against&lateral&forces&traveling&from&the&outside&toward&the&inside&of&the&knee.
45
Quick&Fact:&an&MCL&injury&may&occur&along&with&an&ACL&or&meniscus&injury.
MCL INJURY
There&are&three&grades&of&MCL&injury:&!
Grade&1:&The&MCL&is&partially&torn.&The&injury&is¬&severe&and&will&heal&in&152&weeks.&&!
Grade&2:&The&MCL&is&partially&torn,&but&more&severe&than&grade&1.&Surgery&is¬&required,&but&will&take&between&354&weeks&to&fully&heal.&&!
Grade&3:&The&MCL&is&fully&torn.&A&knee&brace&will&be&worn&to&allow&the&MCL&to&heal&properly.&It&will&take&6+&weeks&for&the&ligament&to&fully&heal,&or&surgical&intervention&might&be&indicated.
46
MENISCUS INJURYThe&menisci&are&C5shaped&discs&that&provide&shock&absorption&for&the&knee&joint&and&are&often&prone&to&tearing&or&“fraying”.&!
Twisting&the&knee&while&the&foot&is&planted&on&the&ground&can&cause&the&meniscus&to&tear.&!
Additionally,&as&we&age,&the&meniscus&wears&down&and&becomes&more&prone&to&tearing&and&injury.
47
MENISCUS INJURY
The&treatment&for&a&meniscus&injury¬&only&depends&on&the&severity&of&the&injury,&but&the&location&of&the&injury&on&the&meniscus.&!
If&the&injury&is&minor&to&moderate,&and&in&an&area&of&good&blood&[low,&then&the&tear&may&be&able&to&heal&on&its&own&with&time&and&rest.&!
However,&if&the&tear&is&in&an&area&of&the&meniscus&that&receives&poor&blood&supply,&the&meniscus&will¬&be&able&to&heal&on&its&own&even&given&time&and&rest.&!
The&meniscus&and&may&continue&to&cause&pain&and&discomfort&until&it&is&surgically&repaired.
48
ARTHROSCOPIC MENISCUS REPAIR
Dr.&Meier&uses&arthroscopic&knee&surgery&to&treat&some&meniscus&tears.&Dr.&Meier&can&trim&or&repair&the&meniscus&depending&on&how&it&is&damaged.
49
CARTILAGE RESTORATION
Dr.&Meier&is&one&of&a&few&orthopedic&surgeons&on&the&West&Coast&to&perform&a&technique&known&as&Autologous&Chondrocyte&Implantation&(ACI).&!
This&procedure&restores&cartilage&to&areas&of&the&knee&that&are&seriously&damaged.&This&procedure&can&replace&damaged&cartilage&due&to:&!
•&Injury/overuse/trauma&•&Osteoarthritis
50
CARTILAGE RESTORATION
ACI&is&a&cutting5edge&treatment&that&helps&to&repair&damaged&articular&cartilage&by&[illing&in&large&gaps&and&lesions&of&the&joint&cartilage&using&the&patient’s&own&cartilage&cells.&!
Dr.&Meier&will&determine&if&this&procedure&is&an&option&during&your&consultation.
51
FRACTURES
When&a&bone&is&cracked&or&split,&it&is&called&a&break&or&a&fracture.&!
There&are&many&different&types&of&bone&fractures,&and&they&are&classi[ied&by&how&the&bone&is&broken.&!
The&treatment&for&fractures&depends&on&the&severity&and&location&of&the&broken&bone.&!
In&severe&cases,&surgery&is&required&to&set&the&bone&and&ensure&the&surrounding&tissues&are¬&damaged.
52
FRACTURES
Did&you&know?&!
•&The&average&adult&has&two&fractures&in&their&lifetime.&•&Women&can&be&more&prone&to&stress&fractures&than&men.&•&Fractures&commonly&occur&in&children&and&seniors.&•&After&radiation&therapy,&the&bones&in&the&affected&area&are&weakened&and&become&more&susceptible&to&fractures.
53
FRACTURE FIXATION
Surgical&repair&is&sometimes&necessary&for&a&fracture&that&is&out&of&place.&!
If&that&is&the&case&then&pins,&rods,&and&screws&can&be&utilized&to&properly&set&a&fracture&and&ensure&that&it&heals&well.
54
PATELLAR TENDINITIS
Patellar&tendinitis&is&a&condition&where&the&patellar&tendon&just&under&the&knee&cap&becomes&in[lamed&and&irritated&due&to&overuse.&!
The&treatment&for&patellar&tendinitis,&often&called&Jumper’s&Knee,&rarely&involves&surgery.&!
Rest,&ice,&anti5in[lammatory&medication,&a&brace,&and&stretching&can&be&used&to&help&alleviate&the&pain&from&patellar&tendinitis.
55
PATELLAR TENDINITIS
Those&who&are&prone&to&this&condition&tend&to&participate&in&activities&in&which&there&is&a&considerable&amount&of&jumping.&!
These&activities&include:&!
•&Volleyball&•&Basketball&•&Running&•&Soccer
56
PATELLOFEMORAL INSTABILITY
Patellofemoral&instability&is&a&condition&where&patients&feel&as&though&their&patella&(knee&cap)&is&“slipping&out&of&place”.&!
This&condition&can&be&caused&by&either&laxity&or&tearing&of&the&ligaments&and&tendons&around&the&knee.&!
The&treatment&for&patellofemoral&instability&may&utilize&non5surgical&techniques&to&strengthen&the&muscles&and&ligaments&that&support&the&knee.&!
If&the&ligament&is&torn,&or&too&stretched&to&provide&support,&then&surgical&intervention&may&be&required.
57
PATELLOFEMORAL PAIN SYNDROME
Patellofemoral&pain&syndrome&(PFPS)&is&a&very&common&sports&condition&characterized&by&pain&or&discomfort&originating&from&the&underside&of&the&patella&(knee&cap).&!
Who&is&prone&to&PFPS?&!
•&Women&•&Basketball&players&•&Runners&•&People&who&have&“knock&knees”&!
The&treatments&for&PFPS&often&include&exercise&programs,&activity&modi[ications,&and&rest.
58
PATELLOFEMORAL PAIN SYNDROME
PFPS&is&often&caused&by&prolonged&running&and&jumping,&as&well&as&knee&trauma&or&dislocation&of&the&knee&cap.&!
Over&time,&these&repetitive&forces&acting&on&the&patella&thin&the&cartilage&attached&to&the&undersurface&of&the&knee&cap,&which&articulates&with&the&femur.&!
This&thinning&causes&pain&from&decreased&smoothness&of&tracking,&and&increased&friction&of&the&patella&as&it&moves&over&the&femur.
59
BAKER’S CYST
Baker’s&cyst&is&a&condition&where&joint&[luid&builds&up&behind&the&knee.&!
This&condition&may&be&caused&by&excessive&swelling&of&the&knee,&and&is&often&correlated&with&other&knee&conditions&including:&!
•&Meniscus&tears&•&Osteoarthritis&of&the&knee&•&Rheumatoid&arthritis
60
CONTUSIONS
Contusions,&also&known&as&tissue&bruises,&occur&when&the&capillaries&or&blood&vessels&are&damaged&by&trauma,&and&blood&seeps&into&the&surrounding&tissues.&!
Typically,&contusions&are¬&serious&and&heal&on&their&own.&!
However,&an&injury&involving&a&contusion&can&be&life&threatening&when&a&fracture&results&from&a&high5impact&contusion.
61
OSTEOARTHRITIS
Osteoarthritis,&also&referred&to&as&age5related&arthritis,&is&a&common&condition&that&may&occur&with&age&in&which&joint&cartilage&wears&down&over&time.&!
There&are&many&forms&of&arthritis,&which&all&require&different&forms&of&treatment.&Osteoarthritis&can&be&common&among:&!
•&Older&adults&•&Overweight&individuals&•&People&who&have&jobs&that&require&movement&and&heavy&lifting
62
OSTEOARTHRITIS
Many&patients&with&osteoarthritis&experience&decreased&mobility&of&the&joints,&decreased&joint&[lexibility,&pain,&and&swelling.&!
The&diminishing&cartilage&can&often&lead&to&painful&bone&spurs&as&the&movements&of&the&bone&are¬&cushioned&by&suf[icient&cartilage&between&them,&and&bones&may&rub&directly&against&each&other&to&cause&pain.&!
While&osteoarthritis&cannot&be&cured,&there&exist&many&techniques&that&can&increase&mobility&and&reduce&pain.
63
RICE
What&is&RICE?&&!
•&Rest&•&Ice&•&Compression&•&Elevation&!
RICE&is&often&used&as&a&[irst5line&method&to&treat&sports&injuries&including:&!
•&Sprains&•&Ligament&tears&•&In[lammation&•&Patellar&tendinitis&•&Other&knee&and&shoulder&injuries
64
CARTILAGE RESTORATION
65
WHAT IS ARTICULAR CARTILAGE?
Articular&joint&cartilage&is&the&smooth&tissue&that&covers&the&articulating&surfaces&of&bones&inside&the&joints.&!
Cartilage&allows&you&to&move&your&joints&easily&with&minimal&friction.&It&also&provides&cushioning&between&the&bones&so&that&movement&may&be&pain&free.
66
CARTILAGE DAMAGE
What&causes&cartilage&damage?&There&are&three&things&that&can&wear&down&cartilage:&!
•&Traumatic&injury&•&Overuse&•&Normal&wear&and&tear&with&activity&and&age
67
AUTOLOGOUS CHONDROCYTE IMPLANTATION (ACI)
ACI&is&an&extremely&promising&technique&which&has&the&ultimate&goal&of&restoring&new&cartilage&to&an&area&inside&a&joint&that&has&been&torn&away&or&worn&down&over&time.
68
The&goal&of&any&articular&cartilage&restoration&procedure&is&to&stimulate&and/or&encourage&new&hyaline&cartilage&growth.
THE PROCEDURES
This&procedure,&which&ultimately&results&in&cartilage&restoration,&will&require&two&surgeries&to&complete.&!
The&[irst&procedure&is&arthroscopic,&while&the&second&procedure&is&traditional&"open"&surgery.
69
ABOUT ACI THE FIRST PROCEDURE
The&[irst&procedure&will&be&done&through&knee&arthroscopy.&!
Dr.&Meier&will&go&into&your&joint&with&arthroscopic&instruments&to&take&a&biopsy&(small&piece)&of&your&healthy&cartilage&cells&out.&At&the&same&time,&he&will&also&address&and&take&care&of&any&other&surgical&issues&that&might&be&causing&pain&within&the&knee&joint.
70
The&cells&are&then&sent&to&a&lab&to&be&cultivated.&!
Over&the&next&several&weeks,&the&cells&multiply&and&grow&to&a&point&where&they&can&be&surgically&implanted.
ABOUT ACI THE SECOND PROCEDURE
The&next&step&is&the&implantation&of&the&new,&healthy&cartilage&cells.&!
To&implant&the&newly&grown&cells,&Dr.&Meier&will&perform&an&open&surgical&procedure.
71
ABOUT ACI THE SECOND PROCEDURE
Once&the&incision&has&been&made,&the&area&that&will&receive&the&new&cells&will&be&prepared.&!
Then,&a&layer&of&tissue&matrix&is&seeded&with&the&cultured&cartilage&cells,&sewn&over&the&defect&(the&area&that&needs&new&cartilage),&and&then&sealed&into&place&with&[ibrin&glue.&!
Dr.&Meier&will&then&inject&the&new&cartilage&cells&into&the&defect&under&the&cover,&where&the&new&cartilage&will&grow&into&the&de[ined&area&and&[ill&in&the&hole&of&the&defect&until&it&has&become&like&the&surrounding&healthy&cartilage.
72
THE IMPORTANCE OF PROPER REHABILITATION
Rehabilitation&is&essential&to&the&success&of&cartilage&restoration.&!
It#is#critical#that#any#potential#ACI#patients#commit#to#6412#months#of#physical#therapy#and#rehabilitation#in#order#to#achieve#the#best#results#and#hopefully#return#to#a#condition#of#low#to#absent#pain#levels.
73
REHABILITATION
Dr.&Meier&strongly&recommends&this&extensive&course&of&physical&therapy&to&help&ensure&that&the&joint&heals&properly&and&mobility&returns.&!
Additionally,&the&new&cartilage&must&be&protected&and&allowed&to&grow&without&interference&and&pain&resulting&from&a&poorly&rehabilitated&joint.&!
If&the&patient&does¬&comply&with&the&physical&therapy&and&rehabilitation&program,&then&the&improvement&outcome&of&the&cartilage&restoration&will¬&be&as&dramatic&and&promising&as&expected.
74
QUESTIONS?
If&you&have&any&questions,&comments,&or&concerns&based&upon&anything&you&just&read&in&this&book,&feel&free&to&talk&to&Dr.&Meier&or&a&member&of&his&staff.&!
Contact&us&today&to&schedule&a&consultation!&!
Of[ice&Address:&8641&Wilshire&Blvd,&Suite&215&Beverly&Hills,&CA&90211&!
PHONE:&(310)&77757845&EMAIL:&[email protected]
75
MEIER ORTHOPEDIC SPORTS MEDICINE
Follow&us&on&Facebook:&www.Facebook.com/MeierOrthopedic&!
www.MOSM.com
76
