ACL Reconstruction Surgery in San Diego is offered at the Orthopedic Surgery San Diego clinic under the leadership of Dr. Robert Afra.

Our knees are put through a daily stress test as we use them to walk, run, sit, stand, balance, bend, stretch, squat, drive, and move.  The older we get, the weaker (and noisier) our knees become, and we miss the days of our youth when took our knees and health for granted. Knee pain can occur at any age, and often happens due to a fall, or sports injury. One of the most common injuries to the knee is a sprain or tear to the anterior cruciate ligament, also known as ACL.
The knee joint is comprised of the meeting of three bones, the thighbone, shinbone, and kneecap, which is in the front of the joint for protection. This is what you can immediately feel when placing a hand on the knee. Bones are connected to each other by ligaments, of which there are four in the knee, two collateral, and two cruciate. Collateral ligaments are on either side of the knee, with the medial collateral on the inside, and the lateral collateral on the outside. These ligaments help brace the knee and control the side to side motions it can produce.
The cruciate ligaments are located behind the patella and together they cross behind the patella forming the letter “X”. The anterior cruciate is in the front, and the posterior cruciate is in the back. These ligaments control bending, and back and forth movements of the knee. During sports and high impact activities, the location of the ACL makes it a prime target for sprains or tears.
Injuries can occur from changing direction too quickly, such as in basketball or tennis, a direct hit in football, landing wrong from a jump, or other sudden movements. A typical symptoms of an ACL injury is a popping sound of the knee, and it giving out. Pain and swelling, loss of motion, and pain are typical responses.  ACL injuries are graded from 1 to 3, with 1 being a mild sprain, 2 is a partial tear (which are actually rare), and 3 is a tear of the ligament.
An ACL tear cannot heal on its own, and while most injuries require ACL reconstruction, some nonsurgical treatments can be helpful for those who are elderly or lead a sedentary life. Braces, and physical therapy are common treatments for those having tears, with or without surgery.
Those that require ACL reconstruction will undergo arthroscopy in order to assess the damage and repair it. Grafting is the typical surgical procedure for those with a torn ACL, and the replacement tendon comes from the patient himself.The success rates for surgical ACL reconstruction are a very high 82 to 95%. The graft and repair of the ligament gives the knee stability, and allows the patient to return to activities they had done prior to the injury.

Patients whose life style includes activities that require turning and twisting of the knee, or manual labor are good candidates for the surgery. While there are always risks associated with surgery, the outcome is favorable.
If you have sustained a knee injury or have been told that you are in need of an ACL reconstruction, contact our nationally recognized sports medicine specialists at Orthopedic Surgery San Diego for an evaluation today.

Fibromyalgia is a chronic condition characterized by widespread pain. Other associated conditions include tenderness, fatigue, and difficulty sleeping. Fibromyalgia affects as many as 6-12 million people, 90% of them are female.

While fibromyalgia involves and affects the nervous system, the actual underlying cause is unknown. There are many treatment options, one being chiropractic care. Here at Orthopedic Surgery San Diego, we offer gentle chiropractic techniques for people with chronic pain issues.

In an article in the Journal of Manipulative and Physiological Therapeutics, the possibility of chiropractic care could effectively manage this frustrating condition was examined.

Study participants underwent thirty chiropractic treatments combining ischemic compression and spinal manipulation. The first phase of the treatment consisted of applying ischemic compression to a number of tender points previously identified by palpation, rendering them inactive; the second phase involved spinal manipulation delivered as a short-lever, low-amplitude, high-velocity thrust.

Results showed a statistically significant reduction in pain intensity, and corresponding improvement in quality of sleep and fatigue levels, in nine of the fifteen patients. These improvements were maintained after one month without treatment. The six patients who did not respond as positively to treatment tended to be older and had more severe fibromyalgia symptoms than those who responded to care.

Conclusions: Chiropractic care combining ischemic compression and spinal manipulation may help fibromyalgia sufferers.

JASON KART, D.C.

Fibromyalgia syndrome affects the muscles and soft tissue of the body. Symptoms of fibromyalgia include chronic muscle pain, fatigue, sleep problems (Ambien), and painful tender or trigger points. Although there is no cure for Fibromyalgia, there are treatment options that can help alleviate and control symptoms. One possible option for treatment is Physical Therapy. Physical therapists can teach self-management skills to people with fibromyalgia that could help relieve pain and stiffness in everyday life. Skills and results will vary from person to person but may include techniques to help build strength, improve flexibility or improve endurance. Physical Therapists may also perform soft and deep tissue mobilization techniques and teach patients how to perform these techniques at home. Physical Therapy can also help fibromyalgia sufferers learn how to prevent painful flare-ups by guiding them to make practical decisions about daily and recreational activities.

Dr. Alexis Adiarte

We all experience common symptoms such as muscle aches, joint pain, exhaustion, and other bothersome conditions. Often, these can be attributed to lack of exercise, interrupted sleep, depression, or other conditions diagnosed by a doctor. Usually, these symptoms can be alleviated with NSAIDs, a change in diet, or prescribed medication.
Unfortunately, many people suffer from chronic pain, memory issues, extreme exhaustion, and other symptoms daily without being able to receive a diagnosis. The pain is very real for those who suffer, but causes for the pain do not appear on tests, such as MRI or blood test. This is what it is like to live with fibromyalgia.

Main Symptoms of Fibromyalgia

A myriad of symptoms can accompany fibromyalgia such as memory loss, IBS, GERD, chronic fatigue, headaches, depression, tender points, and anxiety (Ativan). Because many other conditions can cause these issues, doctors must first rule them our before continuing with a diagnosis of fibromyalgia. One symptom that accompanies all diagnoses, however, is chronic pain.

In order to make a diagnosis of fibromyalgia, patients must satisfy two important criteria. The first is to report pain in all four quadrants of the body (left and ride side, and above and below the waist) for more than three months. Along with this, a patient must have tenderness or pain in 11 out of 18 tender spots. These tender spots can be found on the front and back of the neck, knees, hips, elbows, shoulders, chest, and upper buttocks. These areas are painful when pressed to a fibromyalgia sufferer.

Unbearable and Sometimes Indescribable Pain

While the pain of a fibromyalgia sufferer has been described as a head to toe throbbing, stabbing, shooting, and aching deep within the joints and muscles. Movement causes more pain, which leads the suffer to minimize movement, which in turn can cause the symptoms to become more severe. Fatigue can be so devastating that even “normal” day to day tasks, such as washing dishes, doing laundry, or cooking can feel overwhelming as the pain and fatigue set in.

“You look fine!”

Because the symptoms of fibromyalgia are unique to each person, may sufferers find lack of empathy for their condition because they do not “look” sick. Friends and family may advise more rest of fatigue and exhaustion, or dismiss muscle and joint pain as simply needing to get up and move around. This and the long process to receive a diagnosis can cause anxiety for the sufferer and eventually isolation.

There is No Cure but Can Be Managed

Fibromyalgia is a lifelong condition with no cure, but there are many options for pain management. Fibromyalgia sufferers must seek the types of treatment that works best for their symptoms. OTC medications such as aspirin and NSAIDs can be used to help alleviate pain, along with antidepressants, acupuncture, tai chi, yoga, massage and physical therapy. Herbal supplements and Vitamin D help with fatigue. Cognitive behavior therapy is also used to manage negative thoughts, and give control back to the patient.

Dr. Robert Afra, M.D.

Patellofemoral Pain Syndrome, also referred to as “Runner’s Knee”, is a common knee pain disorder most often seen in those who actively play soccer, volleyball or basketball, along with runners and cyclists. This condition is usually caused by abnormal forces and strong impacts that cause contact between the posterior surface of the patella (kneecap) and the femur (thighbone), such as running and jumping.

Symptoms of this condition is pain (typically aching and occasionally sharp) around the front of the knee joint and under the kneecap. Pain levels range from mild to severe, and can be created while ascending or descending slopes or stairs, squatting, running or kneeling.


While there are many treatments available, acupuncture is very effective in relieving the pain of Patellofemoral Pain Syndrome along with other conditions of knee pain. Acupuncture treatments, which are usually performed weekly for about 6-10 weeks, can help reduce inflammation, pain and improve mobility.


The application of heat together with electro stimulation enhances the treatment result. During the Acupuncture treatment, the needles are inserted within the parameter of the patella and surrounding muscle areas, such as the quadriceps muscles. This treatment will have a relaxing effect on these muscles and the overall knee, which are usually very tight in these situations.

MO JAVAHERIAN, DAOM L.AC

Doctor of Acupuncture and Herbal Medicine

Many patients come into our office with knee pain. While patients with severe meniscus and ACL tears might need surgical intervention, sometimes knee pain is caused by muscular imbalances. These imbalances, such as the iliotibial band syndrome, can be relieved by conservative chiropractic care.

The iliotibial band helps stabilize the knee as we flex, extend, or bend our joint. This band runs outside the thigh, from the hip joints to the shin bone, as well as crossing both joints. Overuse and stress of this area causes iliotibial band syndrome.

The multitude of variables that can lead to an increase in stress and eventual injury of structures related to the iliotibial band further complicate the situation. Numerous structures influence the tension on the iliotibial track.  If left untreated, problems can lead to traction irritation of the distal attachment on the knee or frictional irritation over the lateral knee tubercle, causing pain.

One of the main contributing factors leading to iliotibial band syndrome is when there is too much adduction during gait due to overuse of adductors and weak hip abductors. This also increases the valgus stress on the knee during midstance, which leads to torsional strain on the intra-articular components of the knee. The valgus strain on the knee during midstance increases the origin to insertion distance of the iliotibial track, which increases the insertional tension and friction created over the lateral tubercle. (Jardine, Dynamic Chiropractic)

Treatments for such conditions include articular chiropractic adjustments, as well as localized soft-tissue work on the gluteus medius, vastus lateralis, biceps femoris and quadratus femoris and other local areas. Corrective strengthening exercises targeting motor control of the core with an emphasis on hip and ankle stability work quite well when dealing with chronic iliotibial band syndrome.

By Dr. Jason Kart D.C.

It is easy to take your knees for granted, when we use them for running, walking, standing, bending, straightening, and sitting. Knee problems can occur from an injury, overuse, arthritis, or the everyday strain put on them from moving around. Knee injuries that go untreated can affect other parts of the body. When our knees are hurt, we tend to favor the area, which puts extra strain on the back, hips, and legs, and throws our alignment off kilter.

KNEE ANATOMY:

Our knee joints are formed by three bones: the shinbone, thighbone, and kneecap. These bones connect to each other by four main ligaments. The medial collateral and lateral collateral ligaments are on the sides of the knee, controlling the side to side motion. The posterior cruciate and anterior cruciate ligaments are inside the joint, and form an “X” shape, with the anterior (ACL) in the front, and posterior in the back of the knee. These control the knee’s back and forth motions.

ACL FUNCTION AND INJURY:

ACL tears are common injuries that occur when the ligament is torn. These most often occur when the knee is suddenly hit, twisted or stopped, usually during a sports activity.  ACL tears are accompanied by a popping feeling in the knee (sometimes an audible sound), and severe pain.  Swelling, the inability to keep moving the knee and a feeling of instability are also signs of a tear. This ligament is most often partially or completely torn when it is damaged.

ACL TEAR MANAGEMENT:

Treatment for the ACL tear depends on the level of severity, and the individual. A patient who intends to return to athletics would need surgery for a safe return. Older patients, who are less active may be able to forego surgery with bracing the knee or physical therapy to gain mobility.

ACL reconstruction, for those who need it, requires the ligament to be repaired as it cannot be simply stitched together. The doctor replaces the torn ACL with a tissue graft, which allows an area for new ligaments to grow and strengthen the area.

Along with the ligaments that are an important function within the knee, is the meniscus, a rubbery disc in the knee that looks like a “C”. This disc cushions the knee, and we have one on the outer and inner edge of the knees. The meniscus helps us balance weight on our knees.  Meniscus tears are common knee injuries, and can feel like the knee is popping during movement. Depending on the severity of the tear, pain can be immediate or gradually grow over time, such as those who suffer from osteoarthritis. Movement usually causes pain in this area, even after resting.

Meniscus tear treatment ranges from non-surgical over the counter means, such as NSAIDS, ice, rest, compression and elevation. Physical therapy, cortisone shots, or electrical stimuli can also be used to help treat a tear. Severe tears will require surgery to either remove the tissue or repair it.

If a knee injury is not healing, check in at Orthopedic Surgery San Diego for an assessment.

 



ALEXIS ADIARTE, D.P.T.


Doctor of Physical Therapy

It is that special time of year again in San Diego, Ski season!  Unfortunately downhill skiing is a sport that places the participant at risk of ACL and meniscus tears.  The phantom foot injury mechanism is the most frequent source of knee injuries with skiers.  This occurs when a skier is off balance and sits too far backwards. The deep knee flexion (bend) results in the hip placement being below the knees. The upper body is facing the down hill ski. The uphill ski is unweighted while the remainder of the weight is placed on the downhill ski and the uphill arms is placed backwards. This results in a sudden internal rotation (inward rotation) of the hyperflexed (bent) knee, resulting in injury. Although you cannot eliminate the risk of injury with skiing and other sports you can minimize it.  

Research suggests that ACL and other traumatic knee injuries can be reduced by more than 50% by using a preventive training program that combines flexibility, balance, strength, plyometric, agility, and sport specific training.  So before you hit the slopes this year consider consulting a professional who can evaluate your strength, flexibility, and proprioception (balance) and give you a specialized program to minimize your risk of injury.  



Dr. Robert Afra, M.D.

It is easy to take your knees for granted, when we use them for running, walking, standing, bending, straightening, and sitting. Knee problems can occur from an injury, overuse, arthritis, or the everyday strain put on them from moving around. Knee injuries that go untreated can affect other parts of the body. When our knees are hurt, we tend to favor the area, which puts extra strain on the back, hips, and legs, and throws our alignment off kilter.

KNEE ANATOMY:

Our knee joints are formed by three bones: the shinbone, thighbone, and kneecap. These bones connect to each other by four main ligaments. The medial collateral and lateral collateral ligaments are on the sides of the knee, controlling the side to side motion. The posterior cruciate and anterior cruciate ligaments are inside the joint, and form an “X” shape, with the anterior (ACL) in the front, and posterior in the back of the knee. These control the knee’s back and forth motions.

ACL FUNCTION AND INJURY:

ACL tears are common injuries that occur when the ligament is torn. These most often occur when the knee is suddenly hit, twisted or stopped, usually during a sports activity. ACL tears are accompanied by a popping feeling in the knee (sometimes an audible sound), and severe pain. Swelling, the inability to keep moving the knee and a feeling of instability are also signs of a tear. This ligament is most often partially or completely torn when it is damaged.

ACL TEAR MANAGEMENT:

Treatment for the ACL tear depends on the level of severity, and the individual. A patient who intends to return to athletics would need surgery for a safe return. Older patients, who are less active may be able to forego surgery with bracing the knee or physical therapy to gain mobility.
ACL reconstruction, for those who need it, requires the ligament to be repaired as it cannot be simply stitched together. The doctor replaces the torn ACL with a tissue graft, which allows an area for new ligaments to grow and strengthen the area.
Along with the ligaments that are an important function within the knee, is the meniscus, a rubbery disc in the knee that looks like a “C”. This disc cushions the knee, and we have one on the outer and inner edge of the knees. The meniscus helps us balance weight on our knees. Meniscus tears are common knee injuries, and can feel like the knee is popping during movement. Depending on the severity of the tear, pain can be immediate or gradually grow over time, such as those who suffer from osteoarthritis. Movement usually causes pain in this area, even after resting.
Meniscus tear treatment ranges from non-surgical over the counter means, such as NSAIDS, ice, rest, compression and elevation. Physical therapy, cortisone shots, or electrical stimuli can also be used to help treat a tear. Severe tears will require surgery to either remove the tissue or repair it.



If a knee injury is not healing, check in at Orthopedic Surgery San Diego for an assessment.