East Tennessee Orthopedics & Sports

Reconstruction of the ACL and repair of a torn meniscus are among the most commonly performed arthroscopic surgeries. Our surgeon performs reconstruction surgery and uses a graft to replace the ligament. Autografts are harvested from the patient’s body, typically from the middle third of their involved leg patellar tendon or hamstring in place of the torn ligament. Another choice is allograft tissue, which is harvested from donor tissue that has passed the highest and most advanced measures of testing and screening.

During ACL surgery, other injured parts of the knee may be repaired too, such as menisci, other knee ligaments, cartilage, or broken bones.

Revision Reconstruction Surgery

After a primary reconstruction surgery there is always a chance that the reconstructed ACL could be injured. If the reconstructed ACL is injured or torn, it may take either one or two additional surgical procedures to complete the ACL revision reconstruction. Revision reconstruction consists of debriding and removing the primary ACL graft along with the screws that held the previous reconstructed ACL in place. Removing this hardware might leave holes in the bone that are too loose and/or too wide for the new screws and grafts to securely fixate in the second reconstruction. Under these circumstances a bone grafting process is necessary in order for the fixation tunnels to heal to accommodate the revision graft. The bone grafting allows the widened holes from the prior surgery to be filled so that when the revision reconstruction is performed the screws have a tight fit. Following bone grafting, the revision reconstruction can be performed approximately three months later. Our surgeon does perform many revision reconstructions using a single stage process. Your options will be intimately discussed prior to surgery.

Knee replacement, also called arthroplasty, is a surgical procedure to resurface a knee damaged by arthritis. This surgery may be considered for someone who has severe arthritis or a severe knee injury.

Musculoskeletal ultrasound is an advanced imaging technique that uses sound waves to help visualize an area of the body and diagnose the cause of pain. This imaging method also can be used to guide injections for pain, especially in locations that are difficult to access.

This imaging technique is useful in diagnosing a wide variety of problems in muscles, ligaments,
nerves and tendons.

Some of the conditions easily diagnosed include:

• Bursitis of the Hip
• Cubital Tunnel
• Ganglion Cysts
• Impingement
• Ligament Tears of the Ankle
• MCL/PCL Tears of the Knee
• Patellar Tendonitis
• Rotator Cuff Tears
• Tennis Elbow

Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can cause this condition. But several other sports and activities can also put you at risk.

Tennis elbow is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. The forearm muscles and tendons become damaged from overuse — repeating the same motions again and again. This leads to pain and tenderness on the outside of the elbow.

Cause of Tennis Elbow

Overuse

Recent studies show that tennis elbow is often due to damage to a specific forearm muscle. The extensor carpi radialis brevis (ECRB) muscle helps stabilize the wrist when the elbow is straight. This occurs during a tennis groundstroke, for example. When the ECRB is weakened from overuse, microscopic tears form in the tendon where it attaches to the lateral epicondyle. This leads to inflammation and pain.

The ECRB may also be at increased risk for damage because of its position. As the elbow bends and straightens, the muscle rubs against bony bumps. This can cause gradual wear and tear of the muscle over time.

Activities

Athletes are not the only people who get tennis elbow. Many people with tennis elbow participate in work or recreational activities that require repetitive and vigorous use of the forearm muscle.

Painters, plumbers, and carpenters are particularly prone to developing tennis elbow. Studies have shown that auto workers, cooks, and even butchers get tennis elbow more often than the rest of the population. It is thought that the repetition and weight lifting required in these occupations leads to injury.

Age

Most people who get tennis elbow are between the ages of 30 and 50, although anyone can get tennis elbow if they have the risk factors. In racquet sports like tennis, improper stroke technique and improper equipment may be risk factors.

Unknown

Lateral epicondylitis can occur without any recognized repetitive injury. This occurrence is called “insidious” or of an unknown cause.

The symptoms of tennis elbow develop gradually. In most cases, the pain begins as mild and slowly worsens over weeks and months. There is usually no specific injury associated with the start of symptoms.

Common Signs and Symptoms of Tennis Elbow

• Pain or burning on the outer part of your elbow
• Weak grip strength

The symptoms are often worsened with forearm activity, such as holding a racquet, turning a wrench, or shaking hands. Your dominant arm is most often affected; however both arms can be affected.

Treatments

Tests. Your doctor may recommend additional tests to rule out other causes of your problem.

X-rays. These may be taken to rule out arthritis of the elbow.

Diagnostic Ultrasound. Using an in-office ultrasound machine, your doctor can quickly diagnosis tennis elbow.

Magnetic Resonance Imaging (MRI). If your doctor thinks your symptoms are related to a neck problem, an MRI scan may be ordered. This will help your doctor see if you have a possible herniated disk or arthritis in your neck. Both of these conditions often produce arm pain.

Electromyography (EMG). Your doctor may order an EMG to rule out nerve compression. Many nerves travel around the elbow, and the symptoms of nerve compression are similar to those of tennis elbow.

Nonsurgical Treatment

Approximately 80% to 95% of patients have success with nonsurgical treatment.

Rest. The first step toward recovery is to give your arm proper rest. This means that you will have to stop participation in sports or heavy work activities for several weeks.

Non-steroidal anti-inflammatory medicines. Drugs like aspirin or ibuprofen reduce pain and swelling.

Equipment check. If you participate in a racquet sport, your doctor may encourage you to have your equipment checked for proper fit. Stiffer racquets and looser-strung racquets often can reduce the stress on the forearm, which means that the forearm muscles do not have to work as hard. If you use an oversized racquet, changing to a smaller head may help prevent symptoms from recurring.

Physical therapy. Specific exercises are helpful for strengthening the muscles of the forearm. Your therapist may also perform ultrasound, ice massage, or muscle-stimulating techniques to improve muscle healing.

Brace. Using a brace centered over the back of your forearm may also help relieve symptoms of tennis elbow. This can reduce symptoms by resting the muscles and tendons.

Surgical Treatment

If your symptoms do not respond after 6 to 12 months of nonsurgical treatments, you may need surgery. Most surgical procedures for tennis elbow involve removing diseased muscle and reattaching healthy muscle back to bone.

F.A.S.T. Procedure. The innovative FAST procedure—Focused Aspiration of Scar Tissue—is based on advanced technology developed in collaboration with the Mayo Clinic. FAST is a minimally invasive procedure designed to remove tendon scar tissue quickly and safely, without disturbing your surrounding healthy tendon tissue.

View the F.A.S.T Procedure Video

Arthroscopic Surgery. Tennis elbow can also be repaired using tiny instruments and small incisions. Arthroscopic elbow surgery is often called “scoping the elbow.” This procedure is often used to release scar tissue, remove loose bodies or resurface the bone to decrease pain and improve range of motion.

Elbow arthroscopy has been performed since the 1980s. It has made diagnosis, treatment, and recovery from surgery easier and faster than was once thought possible. Improvements to elbow arthroscopy occur every year as new instruments and techniques are developed.

Interventional orthopedic treatments include platelet-rich plasma (PRP) injections and bone marrow concentrate.

Meniscus surgery is a common surgery to remove or repair a torn meniscus, a piece of cartilage in the knee.

Knee Arthroscopy

This minimally invasive surgery involves making two or more small incisions in the knee. A camera mounted on a thin, flexible tube—a tool called an arthroscope—is used to visualize the interior of the joint.

Knee arthroscopy is commonly used for:

• ACL tear reconstruction
• Meniscal tear repair or trimming
• Loose body removal
• Removal of inflamed synovium

Hip Arthroscopy

During this minimally invasive procedure, an arthroscope is inserted into the hip joint through a small incision, while surgical tools are inserted through other incisions. Hip arthroscopy can help relieve painful symptoms of many problems impacting the labrum, articular cartilage, or other soft tissues surrounding the hip joint.

Hip arthroscopy is commonly used for:

• Hip injuries
• Hip dysplasia
• Femoroacetabular impingement
• Loose bodies in joint
• Synovitis
• Hip joint infection

Shoulder Arthroscopy

A common minimally invasive surgery, shoulder arthroscopy also uses an arthroscope and specialized tools to visualize the joint and perform repairs. It is used to relieve painful symptoms caused by damage to the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.

Shoulder arthroscopy is commonly used for:

• Rotator cuff repair
• Bone spur removal
• Shoulder instability repair
• Labral repair or removal
• Removal of inflamed tissue

Wrist Arthroscopy

Although not as common as some other types of arthroscopic surgery, wrist arthroscopy may be a viable alternative to conventional surgery for wrist injuries and other painful wrist conditions.

Wrist arthroscopy is commonly used for:

• Carpal tunnel release procedures
• Fracture repair
• Ligament/TFCC tear repair
• Diagnosing or treating chronic wrist pain

Minimally Invasive Total Joint Replacement

Many different types of joint replacement—including hip, knee, and shoulder—can now be performed through minimally invasive surgery. In a total joint replacement, the damaged or worn surfaces of the joint are removed and replaced with artificial joint components that are cemented or screwed into place.

Not all patients who are considering a joint replacement are candidates for a minimally invasive joint replacement.

Orthobiologics are organic and synthetic materials that help in the cure of musculo-skeletal problems that uses the body’s own cells and healing factors to potentially reverse debilitating effects of osteoarthritis and accelerate healing of tendon and/or ligament injuries.

A tear of the rotator cuff is a common injury in which the tendons are pulled off their insertion on the humerus. Most tears occur in the supraspinatus muscle and tendon, but other parts of the rotator cuff may also be involved. In many cases, torn tendons begin by fraying. As the damage progresses, the tendon can completely tear, sometimes with lifting a heavy object.

Types

Partial Tear. This type of tear damages the soft tissue, but does not completely sever it.

Full-Thickness Tear. This type of tear is also called a complete tear. It splits the soft tissue into two pieces. In many cases, tendons tear off where they attach to the head of the humerus. With a full-thickness tear, there is basically a hole in the tendon.

A rotator cuff tear most often occurs within the tendon.

Causes

Acute Tear. If you fall down on your outstretched arm or lift something too heavy with a jerking motion, you can tear your rotator cuff. This type of tear can occur with other shoulder injuries, such as a broken collarbone or dislocated shoulder.

Degenerative Tear. Most tears are the result of a wearing down of the tendon that occurs slowly over time. This degeneration naturally occurs as we age. Rotator cuff tears are more common in the dominant arm. If you have a degenerative tear in one shoulder, there is a greater risk for a rotator cuff tear in the opposite shoulder — even if you have no pain in that shoulder.

Repairing Tears

All-arthroscopic repair is usually an outpatient procedure and is the least invasive method to repair a torn rotator cuff. Because the arthroscope and surgical instruments are thin, very small incisions (cuts) are used rather than the larger incision needed for standard, open surgery.

Complications

After rotator cuff surgery, a small percentage of patients experience complications. In addition to the risks of surgery in general, such as blood loss or problems related to anesthesia, complications of rotator cuff surgery may include:

• Nerve injury. This typically involves the nerve that activates your shoulder muscle (deltoid).
  Infection. Patients are given antibiotics during the procedure to lessen the risk for infection. If an infection develops, an additional surgery or prolonged antibiotic treatment may be needed.
• Deltoid detachment. During an open repair, this shoulder muscle is detached to provide better access to the rotator cuff. It is stitched back into place at the end of the procedure. It is very important to protect this area after surgery and during rehabilitation to allow it to heal.
• Stiffness. Early rehabilitation lessens the likelihood of permanent stiffness or loss of motion. Most of the time, stiffness will improve with more aggressive therapy and exercise.
• Tendon re-tear. There is a chance for re-tear following all types of repairs. The larger the tear, the higher the risk of re-tear. Patients who re-tear their tendons usually do not have greater pain or decreased shoulder function. Repeat surgery is needed only if there is severe pain or loss of function.

Sports medicine is the treatment and prevention of injuries related to sports and exercise, and the improvement of athletic performance.

Total knee replacement, also known as total knee arthroplasty, is a surgical procedure in which parts of the knee joint are replaced with artificial (prosthetic) parts.

Relieving Joint Pain

Reconstructive arthroscopic surgery is used to diagnose and treat many joint problems. This significant advance in joint care allows for a rapid return to improved activity.  Reconstruction is most commonly used in knees, shoulders and ankles, but the arthroscope can also be used for the spine, hips, wrists, and elbows.

Knee Reconstruction

Our surgeon performs total knee reconstruction and total knee replacement surgery to replace the injured joint and restore function to the knee when joints are injured or deteriorating due to a number of factors, including:

• Anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), and medial collateral ligament (MCL) tears or injuries
• Arthritis, including rheumatoid, post-traumatic, psoriatic, and osteoarthritis
• Avascular bone necrosis (damages blood supply to joint)
• Torn cartilage

Reconstruction Surgery

Many times, in severe ACL tears, the ligaments can’t be sutured back together, so ligament reconstruction surgery is the best treatment option. In a knee ligament reconstruction, our surgeon will replace your torn ligament with a tissue graft from a healthy tendon. The graft acts like scaffolding for a new ligament to grow on.

Total Knee Replacement

In total knee replacement, or total knee arthroplasty, our surgeon resurfaces the end of the thigh bone (femur) and the top of the lower leg bone with metal where the two bones come together to form the knee joint. The original ligaments, tendons, skin, muscle, and most of the bone are left and simply resurfaces the damaged cartilage in the knee with a metal liner.

The space between those two metal surfaces is filled with a plastic spacer. When a patient walks after surgery, metal rubs against plastic instead of bone against bone, improving a patient’s gait and relieving pain.

Partial Knee Replacement Surgery

Partial knee replacement are offered to patients suffering from knee arthritis that is confined to one section of the knee. Partial knee replacement resurfaces the worn-out part of the joint with a metal and plastic liner.

Revision Knee Replacement Surgery

For patients who have had negative outcomes from knee joint replacement surgery, we offer knee revision surgery. Following knee reconstruction and replacement, we offer physical and occupational rehabilitation to help patients return to normal activity quickly and safely.

Shoulder Reconstruction

Arthroscopy is a procedure that orthopedic surgeons use to inspect, diagnose, and repair problems inside a joint. Because the arthroscope and surgical instruments are thin, very small incisions (cuts) occur rather than the larger incision needed for open surgery. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities.