Derek L. Hill, D.O.

Fellowship-Trained Orthopedic Surgeon and Specialist

ACL Tears in Children

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Young group of friends hanging out in the cityThe anterior cruciate ligament (ACL) is one of the main stabilizing ligaments of the knee joint. Though ACL tears have been reported in children as young as two years, they are more likely to occur in teenage girls when compared to boys involved in similar sporting activities.

According to Seattle Children’s Hospital, ACL injuries are harder to treat in children due to the presence of epiphyses or growth plates in their leg bones (tibia) and thigh bones (femur). As a result, non-surgical measures are usually used to treat these injuries in order to avoid the leg length inequality and angulatory deformities that may arise if the growth plate is injured.

These non-operative measures usually involve bracing and strengthening exercises. The children are also advised to avoid sporting activities like basketball, volleyball and soccer which involve changing directions suddenly and knee twisting motions.

If these conservative measures fail, surgical options can be considered. According to the American Academy of Orthopedic Surgeons, the orthopedic surgeon can modify the traditional ACL surgery technique to reduce the risk of growth plate injury.

These modifications can include placing the tendon graft in a non-anatomic position or wrapping the graft around the bone to avoid drilling holes through the growth plates. These non-standard measures are designed to temporarily control the symptoms until the patient reaches skeletal maturity when a traditional reconstruction can be done.

After the modified ACL reconstruction surgery, Cincinnati Children’s Hospital states that children should be admitted into a rehabilitation program that includes regular physical therapy to help them recover their range of motion, rebuild strength, restore balance and regain confidence in using their knee.

Parents of children with anterior cruciate ligament tears should therefore ask their orthopedic surgeon if the mode of treatment they choose will effect their child’s growth plates and lead to growth abnormalities.

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Hip Fracture Cause & Recovery

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PixmacPreview000087901002A hip fracture, which is often the result of osteoporosis, is a serious femoral fracture that occurs at the proximal end of the femur near the hip. This type of fracture is serious, especially for adults over 65, resulting in life-threatening complications. Your bones tend to weaken (osteoporosis) as you get older, which is why older people are more susceptible to hip fractures. Younger people can also suffer from hip fractures, but the cause is usually the result of car or cycling accidents.

There are signs and symptoms of a hip fracture to look for. These may include the inability to move after a fall, severe hip or groin pain, inability to bear weight on the leg of your injured hip, stiffness/bruising/swelling surrounding your hip area and shortness of the leg of your injured hip.

Not all hip fractures are readily visible on an x-ray, therefore an MRI is the next test option. In cases where the patient cannot afford an MRI or cannot fit in the scanner, a CT may be substituted. MRI sensitivity for fractures usually are greater than a CT. Once a fracture is identified it is determined if the patient will require orthopedic surgery. If an operation is necessary a full pre-operative general investigation including blood labs, ECG and a chest x-ray will be obtained. The surgery is a stress on the patient, especially if elderly due to the prolonged immobilization.

According to Mayo Clinic Staff (2012), “A hip fracture almost always requires surgical repair or replacement, followed by months of physical therapy. Taking steps to maintain bone density and prevent falls can help prevent hip fracture.” Occupational therapy and/or physical therapy is a very important process in rehabilitation, as it has been known to increase daily function for a healthy recovery. About 2% of hip surgery recipients experience a deep or superficial wound infection. If the infection is superficial it could lead to a deep infection including the healing bone. It could also contaminate the implants, which requires implant removal once the infection has been treated and clears up.

Medical Disclaimer: Always talk to a medical consultant before starting a new exercise routine, returning to exercise after injury or surgery, or if you have any health care-related questions.

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Vitamin D’s Role in Muscle & Post-Surgery Recovery

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aaaaaBy now most of us know that an adequate intake of vitamin D is necessary for our bodies to absorb the calcium we need to build and keep strong bones, but now there’s evidence that vitamin D is a much more interesting and versatile little vitamin than previously thought.

According to an article on the website www.vitalchoice.com, (“Vitamin D Aids Muscle Strength, Resiliency, and Recovery”), the role this vitamin plays may be much more than just helping us to absorb our calcium. According to this article, vitamin D may play a major part in helping our muscles recover after strenuous exercise or even muscle injury.

Vitamin D is a multi-talented vitamin. It boosts blood levels quickly and efficiently and regulates certain processes that help muscles move, repair, and grow. According to the article, a study conducted at the Orthopedic Specialty Hospital in Utah found that leg strength was recovered more quickly in a group of adults who had higher levels of the vitamin in their systems than in those with a lower amount, as tested before and after a strenuous workout. The doctors performing this study concluded that higher vitamin D levels appear to protect against muscle weakness caused by muscle damage. In another study, doctors in Britain found that ballet dancers showed greater strength, higher vertical jumps, and less injuries than a control group after being put on a 2000 UI regimen of D3 for a period of 4 months.

It also seems that vitamin D’s benefits extend beyond that of muscle repair after a tough workout. According to the article “What Vitamins Should You Take Before Surgery?” (www.huffingtonpost.com), vitamin D assists the cellular repair and growth required after any type of surgery.

In another study, Professor of Orthopedic Surgery and Chief of the Metabolic Bone Disease Service at New York’s Hospital for Special Surgery Joseph Lane, MD and colleagues reviewed the charts of 723 men and women scheduled for orthopedic surgery from January, 2007 to March, 2008. Their conclusion was that a vitamin D deficiency in people scheduled for orthopedic surgery occurs 50% of the time. This condition is fixable, and according to the doctors involved in the study, “We recommend that people undergoing a procedure that involves the bone or the muscle should collect their vitamin D if they want to have better results, with an earlier, faster recovery. What we are saying is “wake up guys, smell the coffee; half of your patients have a problem, measure it, and if they are low, then fix it.'”

Vitamin D is interesting in that not only can it be absorbed from outside food & supplement sources, but the body can also manufacture it from sunlight. But no matter how we get it into our bodies, there seems to be plenty of evidence to suggest that not only is vitamin D important to daily bone health, but to muscle recovery after strenuous exercise, and bone and muscle repair after injury and/or surgery.

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