ACL repair has long been considered an operation that will fail. In recent years there has been a renewed interest in repairing the ACL. Based upon new information, a revisiting of old research articles and newer devices has identified tears that may be amenable for repair. Success with repair in the proper patient can be achieved reliably and the native ACL can be saved.
The BEAR technique utilizes a recently FDA approved device to “bridge” the gap in the repair and enhance healing by promoting healing through the use of the patients own blood and growth factors, providing a scaffold for repair and blocking the synovial (joint) fluid from disrupting the repair process. This now allows for an even wider array of tear patterns to be amenable to repair.
This is particularly exciting for younger, pediatric patients that are still growing. This technique avoids the need to use the patient own tissue and allows for safe repair without as much risk to the growth plate. Dr. Rizio is accepting new patients interested in this technique and also many other sports related injuries. Dr. Rizio sees sports injuries in adult and pediatric patients.
To learn more about the actual device, clink the link below for the company website:
Breaking the clavicle or “collarbone” occurs from a fall or direct blow to the area. Contact sports like football, rugby and ice hockey are common high risk sports. Falls while cycling, skiing and motor vehicle accidents are other common ways to fracture the clavicle. Immediately following the injury patients experience pain, swelling and limited use of the arm. X-rays are usually sufficient to make the diagnosis and initial treatment involves immobilization in a sling and use of ice and over the counter pain medications.
X-ray showing a clavicle fracture that is displaced and in multiple pieces
Treatment can be surgical or non- surgical. Non-surgical management simply lets the fracture heal in the position it is in and includes a period of immobilization. The immobilization period is typically 3-4 weeks until sufficient healing occurs so therapy can begin and pain is decreased. Non-surgical management has been the norm for a long time, however, surgical fixation or repair is gaining popularity for certain injuries.
X-ray showing clavicle plate
Surgical repair can be accomplished with a variety of devices, but usually a plate and screws has some advantages. Repair can align very displaced fractures. When the fracture is very displaced and when fragments shorten or ride over each other patients who are active tend to complain of shoulder pain and sometimes weakness or dysfunction. This can be alleviated with surgical repair. In addition, fracture healing time is shortened with surgical repair and risk of fracture not healing is lessened by surgical fixation. Use of the upper extremity is allowed much sooner following surgical repair.
In summary, clavicle fractures can be managed with or without surgery. Treatment decision is made based on fracture type, displacement and shortening. Patients activity level, age and other risk factors are taken into consideration as well. Below is a short presentation on a clavicle fracture I treated utilizing sutures and a plate to restore the anatomy and fix the fracture anatomically.
Presentation of clavicle fracture treated surgically
Tennis elbow is a common problem for patients who play tennis or not. The #Tenex device offers a minimally invasive solution for patients not improving with typical treatments and those who do not want to wait any longer to return to activity. I combine this with PRP at time of the procedure.
Shoulder pain is one of the most common complaints that patients come to my office for on a daily basis. There are many causes of shoulder pain including: bursitis, rotator cuff tendonitis, rotator cuff tears, labral tears, fractures of the shoulder, adhesive capsulitis ( frozen shoulder ) and many others. In this post I am going to focus on calcific tendinitis of the shoulder.
Calcific tendinitis is a common painful condition of the shoulder that results from calcium deposits within the rotator cuff. The calcific material is actually calcium hydroxyapatite. The calcium hydroxyapatite can be present in as many as 10% of people that her asymptomatic, although approximately half of these people will become symptomatic or painful from the calcium deposit. This is a more common condition in women. It commonly occurs in patients between 30 and 60 years of age and can be in both shoulders. There is no known definite cause calcific tendinitis, but the res include degeneration of the rotator cuff, repetitive trauma and injury. Patients with diabetes and hypothyroidism may be at higher risk for the development of calcium deposits in the rotator cuff.
The symptoms can include pain which is often severe and constant, limited motion and difficulty with lifting and reaching away from the body or behind the back. Almost all patients have no history of injury to the shoulder. The symptoms often come on abruptly and the pain seems out of proportion to the lack of trauma. The pain is often on the outside part of the shoulder and can radiate down to the mid arm or lower. However, pain can be more diffuse and poorly localized. An x-ray is usually diagnostic and rarely is an MRI, CT scan or other imaging modality necessary to make the diagnosis. An MRI may be indicated when symptoms are not resolving with proper treatment to look for additional pathology such as a rotator cuff tear.
The symptoms can include pain which is often severe and constant, limited motion and difficulty with lifting and reaching away from the body or behind the back. Almost all patients have no history of injury to the shoulder. The symptoms often come on abruptly and the pain seems out of proportion to the lack of trauma. The pain is often on the outside part of the shoulder and can radiate down to the mid arm or lower. However, pain can be more diffuse and poorly localized. An x-ray is usually diagnostic and rarely is an MRI, CT scan or other imaging modality necessary to make the diagnosis. An MRI may be indicated when symptoms are not resolving with proper treatment to look for additional pathology such as a rotator cuff tear.
X-RAY of the shoulder showing a calcium deposit in the rotator cuff
X-RAY of Calcium deposit in the rotator cuff on the left and an MRI image on the right
Treatment of calcific tendinitis includes rest from painful activities, anti-inflammatory medications such as Aleve or Advil or could be a prescribed anti-inflammatory. In addition, ice or and physical therapy/home exercises are often helpful. A cortisone or steroid injection into the shoulder can also be performed to ease pain and improve function. On occasion, more than one injection may be necessary over a several week period to alleviate symptoms. When these methods fail to resolve symptoms there are other methods to try and break up or dissolve the calcium deposit. The methods vary in invasiveness and include ultrasound-guided needle decompression/debridement, shockwave therapy, ultrasound-guided percutaneous micro debridement with a TENEX device and arthroscopic debridement of the calcium deposit. Most patients recover with the need for surgery, below is a video of a calcium deposit removal I performed arthroscopically.
Shoulder pain is one of the most common complaints seen in the orthopedic surgeon’s office. There are many causes for shoulder pain, but one common cause is disorders of the rotator cuff. The rotator cuff is a group of 4 muscles called the “SITS” muscles, this stands for Supraspinatus, Infraspinatus, Teres Minor and Subscapularis muscles. These 4 muscles work in coordination with each other to provide fine tuning for shoulder stability, motion and strength. Disorders of the rotator cuff could range from bursitis to complete tears. Symptoms can develop due to aging, overuse or acute trauma. The most common cause of rotator cuff damage is due to age-related degenerative changes of the rotator cuff tendons. The incidence of age-related degenerative tearing of the rotator cuff increases every decade of life beginning in the 30s to 40s.
Symptoms of rotator cuff injury can include pain, weakness and loss of motion. Frequently patients complain of pain with lifting the arm above shoulder level, reaching behind her back, reaching to their side and lifting objects away from their body. Pain at night is a frequent symptom and often keeps people awake. After a traumatic event, patients can often have a loss of active motion and strength.
Diagnosing rotator cuff tears begins with a thorough history, physical exam and diagnostic x-rays. While x-rays may not show soft tissue damage, the x-rays will show if there is underlying arthritis, calcific deposits or other bone lesions that could be responsible for the symptoms. The history and physical exam often gives the orthopedic surgeon an idea of the severity of symptoms, duration of symptoms and amount of physical dysfunction from motion loss or weakness. When appropriate, an MRI may be necessary to confirm the presence or absence of a tear.
Treatment of rotator cuff tears ranges from non operative to surgical management depending upon the duration a symptoms, level of dysfunction and pain. Initial treatment with physical therapy or home exercises, possible injection and activity modification is usually the first line treatment for atraumatic rotator cuff symptoms. With these modalities fail to resolve symptoms and a rotator cuff tear is identified, surgical management with an arthroscopic rotator cuff repair and possibly open repair is an option. While many patients with known rotator cuff tears have minimal or no symptoms and normal function, it is generally accepted that approximately half of patients will develop rotator cuff tear enlargement or progression over time. It is important to follow these tears on a regular basis for tear progression even in the absence of symptoms, which could indicate the need for operative repair. It has also been shown that earlier repair of rotator cuff tears has higher healing rates from surgery. The treatment of each patient’s rotator cuff problem should be individualized based upon the patient’s overall activity level, level of symptoms, level of weakness or loss of motion and underlying health of the shoulder joint. Below is a short video of a rotator cuff repair I performed. The video shows an arthroscopic double row rotator cuff repair. I welcome comments and questions and will do my best to answer them for you here!
Dr. Louis Rizio 