New ACL Technique

The anterior cruciate ligament (ACL) is the prime stabilizer of the knee to prevent anterior instability. Ligaments are the “ropes” of the knee which connect bone-to-bone and stabilize the knee. When ligaments tear the two ends spring apart like a “torn guitarstring” and the ligament loses its blood supply and it dissolves. The patient will have an unstable knee without an ACL which can lead to a meniscus tear and early degenerative arthritis of the knee.
The reconstruction of an ACL tear utilizing the patients own tendons  (structures which connect muscle to bone) or a allograft (cadaver donor) is a successful procedure but one that, unfortunately, does not prevent and may accelerate the development of early degenerative arthritis. The reason for this is that in the past we have used a Trans-Tibial technique to perform our drill holes in the bone to stabilize the ligament. This technique cannot put the ACL graft back to its “Anatomic Footprint Position” and will change the function (kinematics) of the knee which will lead to early arthritis.
A new technique has been devised to create our bone tunnels in the femur and tibia at the “Anatomic Footprint Position” which enhances stability and restores the normal kinematics of the knee and prevents the development of early arthritis.
We routinely use this new “Anatomic” ACL reconstruction and our results have been fantastic! If you have an ACL tear, ask your surgeon if they use the new “Anatomic reconstruction technique” and if they do not, get a second opinion with us to discuss the new technique and how it will improve the long-term outcome of you surgical result!

Keep moving!
Dr. Sisto

What Is “PRP”?

Kobe Bryant has just traveled to Germany to have a “PRP” injection and everyone wants to know what this is about. PRP stands for Platelet Rich Plasma which is a new injectible, non-surgical technique to stimulate healing of chronic soft-tissue injuries of the knee, shoulder, elbow and ankle joints. The technique is perfomed in thw office and a small amount of blood is taken from the patient and this is placed in a special machine which concentrates the “healing portion” of the blood into a concentrated healing “super fluid.” It is than injected into the patient’s joint under ultrasonic visualization.
  The early results for lateral epicondylitis (Tennis elobw), patellar tendonitis (Jumping knee) and rotator cuff tendonitis have been great. We are the team physicians for Cal-State Northridge (CSUN) and have performed PRP successfully for these problems. The role of PRP in the treatment of degenerative arthritis (Kobe’s diagnosis) is very controversial and is unknown at this time.
  Schedule an appointment if you have a chronic soft-tissue injury or degenerative arthritis and we can discuss whether PRP is an option for you.

Stay young!
Dr. Sisto

Meniscus Transplantation

I performed a lateral meniscus allograft transplantation today and this procedure reminded me of the amazing technological advances that knee injuries have made recently.

A meniscus allograft transplantation is performed when a patient has had a previous removal of the majority of the medial or lateral meniscus.

The meniscus is the cartilage soft tissue shock absorber of the knee which is located between the femur (thigh bone) and tibia (shin bone). There are two menisci in each knee. One on the inside which is the medial meniscus and one on the outside which is the lateral meniscus.

A twisting injury with a combined compressive force across the knee can tear the meniscus and lead to pain and locking of the knee
.

The meniscus has a poor blood supply and rarely heals when it is torn. The treatment of a meniscus tear is arthroscopic surgery. “Arthro” is the greek work for joint and “scope” is to look inside so we put a small camera in the knee to visualize the joint. The ideal treatment of a meniscus tear is to surgically repair the meniscus with multiple sutures. Unfortunately, many meniscus tears are not able to be repaired and require a meniscectomy or a removal of the torn portion preserving as much of the normal meniscus as possible. Rarely, the entire meniscus is removed and these unfortunate patients are now at risk for early degenerative arthritis because the normal shock absorber between the femur and tibia is absent.

A relatively new technique is now performed which transplants a “cadaver” meniscus (a young person who has died and donates their meniscus) to give the patient a brand new meniscus. The success rate is high and the early results following this surgery eliminate knee pain and, hopefully, prevent or delay the onset of degenerative arthritis.

We perform meniscus transplantation as well as many “new age” procedures to repair cartilage to keep the knee “young” and maximize the patients’ ability to return to sports and a high level of physical activity. Our goal is to avoid or significantly delay the need for a joint replacement surgery.

Please contact us if another surgeon has told you that there is “nothing else to be done” for your knee or a joint replacement has been recommended for you. Our advanced techniques may keep you and your “own” knee at a high level of function.

Have a great summer!
Dr. Sisto