Category Archives: Knee

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Robert Williams Bone Contusion

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On July 6th, 2018 Boston Celtics rookie Robert Williams had a knee to knee collision in the first game of the Summer League. Williams left the game and did not return.

The diagnosis was a bone bruise (contusion).  We’ve all had bruises before. This is just one that goes deeper than the skin and muscle and down to the bone. This is the reason that the knee is sore. A bone contusion requires significantly less sideline time than a ligament injury or fracture.

There is no timeline for Robert Williams’ return.  The leg is structurally sound and people usually return to play when they are comfortable enough to be effective.

This blog was written by Paul Bonilla and David Ring.

All Blogs, Basketball, Knee

Lonzo Ball’s Meniscal Tear

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Los Angeles Lakers point guard Lonzo Ball, was diagnosed with left knee meniscus at the end of the 2017- 2018 season.

The knee meniscus is a piece of cartilage that acts as a “shock absorber” between the thigh bone and shinbone. They are strong enough to help cushion the joint and keep it stable. The cushion is sometimes torn by an awkward and forceful twist of the knee. It’s important to distinguish traumatic injury of the meniscus from the types of changes and fraying that occur with normal aging (part of arthritis). Both types of problems are described as “tears” so it can be confusing.

A torn meniscus might be felt as a sudden pop or just a sore knee after playing. Although x-rays do not show meniscus tears, they can rule out other knee problems that cause similar symptoms. Magnetic resonance imaging (MRI)–a way to image the non-bone structures in the joint is used to diagnose this injury.

Treatment for a traumatic meniscus tear in a young adult athlete depends on the size and location of the tear. It’s possible to treat this injury non-surgically with stretches and pain relievers. Many feel better with time and non-specific supportive measures (e.g. ibuprofen).  Exercises help keep the knee flexible and the muscles conditioned. Surgery is considered when there is a large loose fragment of meniscus that is getting stuck between the bones of the knee joint.  The knee may get stuck or pop with movement–sometimes referred to as “mechanical symptoms.” Surgery usually just removes these fragments. Once in a while, a very large tear of the meniscus as it’s the thickest part near the edge of the knee joint is repaired and protected so that it might heal.

With or without surgery to resect a fragment, players usually feel well enough to return to play after about 4 to 6 weeks. If the meniscus is repaired it needs to be protected for 6 to 12 months. Lonzo Ball chose to have an injection of platelet-rich plasma. This is an experimental treatment based on the rationale that this type of plasma is loaded with growth factors that aid recovery. There is no evidence that this actually occurs. There is much more marketing than evidence behind these types of shots. If you have a problem with your meniscus, you should be cautious about having this type of shot or any other type of experimental treatment. It’s not clear that they are better than your body’s natural healing. There is definitely risk, discomfort, cost, and inconvenience. Lonzo Ball is expected to play when season starts.

This blog was written by Ramla Kiyar and David Ring.

 

ACL Injuries, All Blogs, Knee

Manuel Lanzini’s ACL Tear

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Manuel Lanzini from Argentina’s national team tore his anterior cruciate ligament (ACL) during practice on June 8, 2018.

The ACL runs through the center of the knee joint. It stabilizes the knee when a player plants the foot and turns.  That maneuver is often referred to “pivoting.” One forceful pivot can tear the ligament.  This is one of the few ligaments in the body that don’t heal when they rupture.

There is often a pop that is heard or felt.  The knee usually fills with blood and the effusion can be detected on examination.  Specific examination techniques can look for the greater laxity that tends to occur after ACL rupture.  Because pain and guarding may mask that exam, and an x-ray only shows fractures, an MRI is typically used to confirm ACL tear. The MRI might also show injury to other ligament, the meniscus, or bone.  That information would mostly affect prognosis.

ACL tears are nearly always complete.  The body cannot heal an ACL tear.  The first step is to regain motion in the knee.  That usually takes a few weeks of stretching.  People with ACL tears are offered surgery to reconstruct the ACL with a tendon or ligament taken from another part of the body or from a tissue bank is offered.  High-level athletes in sports with a lot of pivoting usually choose surgery if they want to their sport. People that do very little pivoting or who are willing to limit those activities often choose to leave the ACL unrepaired.

Lanzini will have surgery to reconstruct the ACL.  Return to play takes about a year, because the graft needs to be solidly healed and the muscles strong in order to limit the risk of reinjuring.

This blog was written by Paul Bonilla and David Ring.