Vail Summit Orthopaedics Blog

Ask a Sports Doc Question for Dr. Rick Cunningham:

I am a finish carpenter and recently had immediate pain in my knee after simply standing up from a squatting position. There is now sharp pain at times in my knee especially when I rotate or pivot on the knee. What do you think it is?

Answer:

This is the last part of a series where we talk with Dr. Rick Cunningham about new trends in ACL tears and how to prevent one.

VSO: What can women do to help prevent an ACL tear?

Dr. Cunningham: Keeping strong but more importantly preventing imbalances in your musculature. In a lot my athletic patients, they do activities that are quadriceps dominant, but they neglect their gluteal and hamstring strengthening. Gluteal (=buttock) strengthening is critical as these muscle prevent your knee from falling into that knockneed (=valgus) alignment which places increases stresses across the ACL. Core strengthening is also critical so that athletes land directly over their feet and not land in the back seat which again stresses the ACL.

VSO recently interviewed Dr. Cunningham on the topic of ACL tears. We continue the discussion here:

VSO: Are there other injuries you see that differ from male to female? 

Dr. Cunningham: Because women's tissues tend to be more lax (with men having stiffer ligaments), I see women have more shoulder instability as well (ie. shoulder subluxations). I probably see more males who dislocate their shoulders but this is traumatic (ie. major wreck in the terrain park) whereas a young female athlete (ie. volleyball player) may present with a shoulder that can slide partially out of the socket (=subluxation) but they have not had any major injury that caused it.

VSO recently interviewed Dr. Cunningham on the topic of ACL tears. We continue the discussion here:

VSO: Why are women more at risk for an ACL tear?

VSO recently interviewed Dr. Cunningham on the topic of ACL tears. Here is part of that interview:

VSO: What percentage of female patients vs. male patients do you see with ACL tears? Have you noticed an increase in female patients in your office?

Dr. Cunningham gives biking tips on TV8 Interview with Seth Ehrlich from SOS Outreach.

Knee pain is a frequent complaint among cyclists. Knee pain is usually associated with a seat position that is too high, too low, too far forward or too far backward.

• Back angle = 45º (smaller angle for more aggressive riding)
• Shoulder to trunk angle = 90º (larger angle for more aggressive riding)
• Elbow angle = 15º to 25º
• Wrists in a neutral position
• Height usually 1-4” below top of saddle
• Width = shoulder tip to shoulder tip in centimeters
• Distance from saddle tip to bars within an inch of elbow tip to middle finger tip

The length of your stem will give you either more reach or more of an upright feel. If the handlebars are too high, too low, too close, or too far away, you may have neck, shoulder, back, and hand pain. You should be able to comfortably use all the positions on the handlebars and bend your elbows while riding.

In regards to available treatment options for meniscus tears, here are my thoughts on meniscus transplantation.

Just as we transplant solid organs (i.e. kidneys), some patients are candidates for meniscus transplants. I recently had a 28 year old man who lost most of his lateral meniscus due to a bad injury. Given his age and activity level, he underwent a lateral meniscus transplant. This should alleviate his pain and more importantly, protect his cartilage from early degradation and arthritis.

Continuing our look at meniscus tears and the available treatment options, today I will focus on arthroscopic meniscal repair:

Arthroscopic Meniscal Repair
If the meniscus tissue is torn in the peripheral 1/3 where there is blood supply, the meniscus can be repaired and preserved. Repairing the meniscus is always my preference. So called “bucket handle tears” where the meniscus tears longitudinally along the outer rim and then flips into the center of the knee like a bucket handle, are amenable to repair. The alternative to repairing these bucket handle tears is to remove 50% or more of the meniscus. Removing this amount of the meniscus, which is the “shock absorber” cartilage, is known to predispose the knee to early arthritis and this should be avoided if possible.