by Admin | Jun 6, 2023 | Orthopaedic Updates
Shoulder dislocation accounts for 50% of all major joint dislocations seen in clinics and emergency rooms.
The primary shoulder joint has the greatest range of motion than any joint in the body due to its ball-and-socket design. A network of muscles, tendons, and ligaments, in particular the rotator cuff (a ring of tendons that encircles the shoulder joint and the joint capsule), keep this joint, the glenohumeral joint, in place.
The cost of shoulder joint flexibility is the possibility of instability. The humeral head may become displaced because the glenoid, or socket, is shallow and flat, especially at the front (anterior) of the joint.
There are various ways that a shoulder dislocation can happen. The most typical type of shoulder dislocation is an anterior one. Anterior dislocation occurs when the humeral head shifts forward. Almost 90% of dislocated shoulders are anterior dislocations. A fall on an extended arm or participation in contact sports can also result in this injury.
Another dislocation direction is the posterior dislocation, when the humeral head shifts toward the rear of the body (backward). It occurs for 2 to 4% of shoulder dislocations and is typically because of a blow during physical activity. Yet, athletes like offensive linemen and weightlifters frequently suffer from posterior dislocations.
Inferior (downward) dislocation, in which the humeral head moves downward, is the least common, accounting for only 0.5% of shoulder dislocations. This type of dislocation can happen when you apply weight or force to an extended arm that is away from your body.
Knowing the direction of the dislocation, and the potential soft tissue damage help the orthopaedic surgeon develop a diagnosis and treatment plan.
Orthopaedic surgeons usually apply nonsurgical treatment for first-time shoulder dislocations, and surgeons do not consider surgery until the shoulder shows signs of persistent instability. Physical therapy is the first step in the conservative approach since it will help to strengthen the muscles that keep the shoulder’s humeral head firmly in its socket. To compensate for the fact that the labrum, the cartilage that surrounds your shoulder, may not always heal in its natural position, the patient can strengthen the muscles surrounding the shoulder. Using this method, the patient may be able to restore their shoulder’s normal range of motion. Age and participation in contact sports both increase the risk of recurring shoulder dislocation, with young athletes participating in contact sports having a 90% higher risk of a second dislocation. As a result, when an anterior shoulder dislocation due to trauma occurs in a young athlete for the first time, surgeons are increasingly considering doing surgery right away.
Surgery for treating a dislocated shoulder can be either open or arthroscopically (meaning with small incisions and devices to guide the surgeon).
The orthopaedic surgeon typically performs a Bankart repair on patients who have anterior dislocations, or dislocations that point toward the front of the body. Anterior dislocations have the potential to tear the labrum, which is the cartilage that surrounds the shoulder joint. A Bankart lesion is the medical term for this type of tear. During a Bankart repair, the orthopaedic surgeon repairs and replaces the torn labrum in the shoulder joint. A shoulder dislocation’s most common type of damage is the Bankart tear. As part of a Bankart procedure, reattaching the labrum to the shoulder joint, tightens the ligament that holds the humeral head in place.
If the shoulder socket has lost bone density, the orthopaedic surgeon may recommend Laterjet surgery. The orthopaedic surgeon inserts a small portion of bone from the coracoid (a part of the shoulder blade) in the front of the shoulder socket during a Latarjet procedure. To replace the lost bone in the socket, the surgeon may use bone grafts from a donor or the patient’s iliac crest (a section of pelvic bone).
The recovery period following shoulder dislocation surgery may vary depending on the procedure type and surgical strategy of the orthopaedic surgeon (open versus arthroscopic). Most patients who have surgery undergo physical therapy while wearing a sling for several weeks. It could take several months to fully recover.
Both open and arthroscopic procedures for treating a dislocated shoulder have a high success rate in restoring function and preventing further dislocations.
Written by Elmari Snoer, BusinessBrainz
Interview with Orthopaedic Surgeon, Dr Hannes Jonker
by Admin | Feb 14, 2023 | Orthopaedic Updates
A correct understanding of the knee’s anatomy is crucial when choosing the right type of graft for Anterior Cruciate Ligament (ACL) reconstruction. ACL reconstruction relies heavily on the graft type. Statistics show that approximately 20% of teens suffering ACL reconstructions experience re-tears, and 80% develop arthritis after 15 or 20 years of surgery. The type of graft affects a patient’s success rate of the procedures and their recovery timeline. More so if their plans include returning to sports that require pivoting and twisting movements.
The classification of grafts includes autografts (harvesting bone from one’s own body) and allografts or also referred to as donor grafts (that is to harvest bone from another person or cadaver). Another option is Ligament Augmentation and Reconstruction System, or LARS (artificial grafts).
In the first category of the classification, namely autografts, there are three types, namely the patellar tendon, hamstring tendon, and quadriceps tendon.
The second category is the allograft or donor graft. This is for example, when the orthopaedic surgeon uses a graft from a child’s mother or father during paediatric ACL reconstruction.
However, the preferred choice remains harvesting tissue from the patient’s own body (autograft) to create the new ACL graft. Research shows that these options have lower failure rates. Let’s examine each of these types a little closer.
Historically the patella tendon graft is a very popular, reliable and safe graft for ACL reconstruction. This graft involves harvesting a piece of bone from the patient’s own kneecap. “We create a new ACL using a 1cm central portion of the patellar tendon and bone from the tibia. We then drill into the femur and tibia where the ACL anatomically attaches, and pulls the graft into these tunnels to create the knee ligament,” explains orthopaedic surgeon Hannes Jonker. “The patella tendon graft closely resembles a torn ACL, and it is almost the same length as an ACL, which is beneficial to the patient,” confirms Dr Jonker. However, pain may develop at the site where the surgeon harvested the graft (donor site morbidity).
It is also possible to reconstruct the ACL using the hamstring tendon (from the back of the thigh). An orthopaedic surgeon removes two of the tendons of the hamstring muscle and bundle it together to create a new ACL graft. “By folding these tendons four to six times over, we create a graft with a 9 to 10mm diameter, just like the original ACL”, says Dr Jonker. Then the orthopaedic surgeon pulls it through the tunnels in the femur and tibia. Orthopaedic surgeons have used hamstring grafts for decades with a high rate of clinical and biomechanical success. The incision is smaller and patients experience less pain after the surgery. An advantage with the newer techniques is to also insert an internal brace with the ligament that allows exhilarated rehabilitation, thus protecting the graft while it heals.
A third option is the quadriceps tendon graft. If you are playing any kicking sports, like soccer or football, you might opt for the quadriceps tendon graft instead of a hamstring tendon graft as you do not want to weaken your hamstrings. Newer graft harvest techniques and instrumentation allow for easy, safe, and reliable graft size harvesting. The quadricep tendon is a thick, strong tendon above the patella (kneecap). The advantages of this graft include the size, firmness, and reliability like that of the patella tendon graft but without the risk of anterior knee pain.
Then there is the option of the second category, namely the allograft (cadaver) or donor tissue (for example tissue from a family member) such as a ligament, bone or tendon which an orthopaedic surgeon surgically implants from one person to another. Some studies show that an allograft may not be as strong as a patient’s own tissue and may lead to an increased risk of re-tear. Orthopaedic surgeons may recommend this graft type for lower demand patients or senior patients. A slightly shorter surgery time and a reduction in pain after surgery are examples of the benefits of using an allograft tendon. It is evident in some donor graft cases that the patient’s body rejects the tissue, requiring revision surgery.
The Ligament Augmentation and Reconstruction System, or LARS involves the use of artificial polyester material to replace an injured ACL graft. Although LARS significantly reduces the recovery time of ACL, which allows athletes to return to sport sooner, there are concerns regarding the failure rates of LARS which increases the popularity of patella tendon and hamstring tendon autografts.
“By reconstructing the ACL, we aim to produce a structure that is close to that of the original ligament, The preferred choice remains harvesting tissue from the patient’s own body (autograft) to create the new ACL graft. Research shows that the autografts have higher success rates. This includes the patella-, hamstring- and quadriceps tendons, ” says orthopaedic surgeon, Dr Hannes Jonker.
It is vital that you visit an orthopaedic surgeon after suffering an ACL injury. Only your orthopaedic surgeon can diagnose the severity of the tear and determine the right treatment plan for you. By obtaining the right information from your doctor and following their recommendations, you can determine what graft is the right fit for you.
Written by Elmari Snoer, BusinessBrainz
Interview with Orthopaedic Surgeon, Dr Hannes Jonker
by Admin | Jan 12, 2023 | Orthopaedic Updates
May 17th, 2022
You might be reluctant to undergo surgery, but the reward of a total knee replacement that offers: pain relief, improved mobility, and quality of life over the long term, is invaluable.
This blog post focuses on what to expect after a total knee reconstruction when performed by Dr. Hannes Jonker, orthopaedic surgeon in Potchefstroom, North West. In general, about six weeks after surgery, most patients can resume normal activities and drive. Dr. Jonker applies the kinematic technique, a patient-specific total knee reconstruction approach, and together with his multi-disciplinary team’s treatment programme after surgery, you can expect results within six to eight weeks after surgery. Initially, the immediate symptoms after surgery include soreness, tenderness, warmth, and irritability. The scar may take time to heal because the front of the knee is sensitive. In the beginning, kneeling is painful; however, this becomes easier, but the ability to kneel will vary from patient to patient after a knee replacement.
DIRECTLY AFTER SURGERY – IN HOSPITAL
Directly after surgery, you will be in the recovery room, where you will move to the general ward. Nowadays hospital stays have decreased and depending on your condition, you will most likely not stay longer than two to three days. During the postoperative period, you will receive pain medication, and make use of an ice pack to reduce the swelling. On the same day as the surgery, you move your foot and ankle, which improves the flow of blood to your leg muscles and helps prevent swelling and blood clots. Also, four to six hours after surgery Dr. Jonker starts mobilising his patients, which is moving around the bed area with the assistance of a physiotherapist. Further protection against swelling and clotting is the use of compression socks or boots and blood thinners. You will continue to increase your activity level. The physiotherapist will show you how to further exercise your new knee. Mobilisation and collaboration with the physiotherapist are extremely important to ensure a successful outcome. Traditionally on day 2, the blues would appear. But, with Dr. Jonker’s treatment, progress in mobility shows each day, you walk longer distances, and your pain gradually fades.
LEAVING HOSPITAL TO TWO WEEKS AFTER SURGERY
Before you leave for home, you will receive exercise instructions that you can do at home to help you recover more quickly after surgery. Two weeks after surgery you will have to go for physiotherapy and biokinetic sessions when treatment will include massage, manipulation, and range of motion (ROM) techniques to decrease pain and increase motion. The general swelling after surgery may peak between seven and ten days after a knee reconstruction. Keep to your exercise programme at home and balance your activity with rest. Eat healthy meals and snacks. Make sure to drink six to eight glasses of liquids each day and include protein (meat, poultry, fish, beans, nuts, and seeds) in your meals which will help your body to heal. You should remember that every person’s pain level differs. During recovery, ice and elevation continue to be ways that help in addition to medications. Continue with your prescribed exercises regularly and include some walking each day. You may also try ways other than medicine to relieve pain such as: relaxing, listening to music, changing sleeping positions, walking distractions, (reading, watching television, have visitors).
THREE TO SIX WEEKS AFTER SURGERY
As before, your focus should be to continue with your home exercise program. While pain, discomfort, stiffness, and swelling are still common, they will gradually lessen day by day. Continue treating your knee with elevation, ice, and other non-medication approaches. In six weeks after surgery, you’ll have your incision checked and discussed physical activity.
SIX WEEKS AFTER SURGERY
After six to eight weeks, though your knee may still be warm and somewhat red, pain is usually less than before the surgery, and it will be easier for you to visualise the result. By now you will have finished your formal physiotherapy and you will have transitioned to an unsupervised exercise programme. In most cases, you should be able to resume your regular activities. As you recover, the level of pain will fade away until you have completely recovered. Each individual experiences recovery differently, and the speed of recovery will also differ from person to person. Therefore, it is relevant to follow a patient-specific approach and personalised treatment plan in total knee reconstruction. For a consultation with Dr. Hannes Jonker contact 018 293 3474
written by Elmari Snoer BusinessBrainz
Resources:
Dr Hannes Jonker, Orthopaedic Surgeon, Potchefstroom
by Admin | Jan 12, 2023 | Orthopaedic Updates
June 17th, 2022
“We work in a Sport Centre with physiotherapists and Biokineticists and we treat the bulk of injuries and arthritis complaints conservatively. Only if conservative treatment is not successful, we revert to surgery” says orthopaedic surgeon, Dr Hannes Jonker.
From Dr. Jonker’s quote, it is evident that he is keen to treat many knee injuries or minor strains of the knee conservatively when appropriate. This week we find out when conservative treatment of the knee is relevant.
Runners often present overuse injuries of the knee, and it is common for the orthopaedic surgeon to treat jumper’s knee, ITB, and quadriceps strains, conservatively.
A soft tissue injury of the knee will result in bruising (or contusion in medical terms) in and around the knee area. Normally the bruising will heal within five to seven days and one should be able to return to normal play. However, if the bruising fails to improve or swells a lot within these five to seven days, it is crucial to make an appointment with an orthopaedic surgeon.
People who are inactive for a long time, start training, and then develop knee pain is another overuse injury of the knee that receives conservative treatment. Dr Jonker advises conservative treatment by means of strengthening exercises guided by a biokineticist, combined with some symptomatic remedy.
Dr. Jonker will consider knee reconstruction when conservative treatments have failed to relieve pain and when the pain impairs one’s quality of life. If conservative treatment is effective for the patient to maintain his or her level of activity and quality of life, surgery is not necessary. However, if a patient feels that despite conservative treatments, he or she wants to reduce pain, and improve quality of life, Dr. Jonker may consider surgery.
There are also conservative treatment options for osteoarthritis, which can include over-the-counter medication, supplements, anti-inflammatory drugs, and even painkillers and analgesics prescribed by general practitioners. While cortisone infiltrations are still the gold standard, other options, such as growth factor or PRP infiltrations and even stem cells have shown promising results in the last few years. Many patients also get relief from peri-articular or intra-articular injections. These injections will last from two weeks to about six to eight weeks and is not a permanent solution to the problem.
Dr Jonker explains that there is a rise in patient requests for a “gel” that the doctor infiltrates into their knee or knees. “There is such a product available in the market. Only, patients have the misconception that you inject something that is in a gel form into the knee that will fill the space where the arthritis is. But what is important to know, is that the “gel” basically turns into a watery substance within 48 hours after the infiltration. Dr Jonker explains that it is the supplemental active substances in the knee that give them anti-inflammatory pain relief. In this conservative treatment case, it is important to realise that it is an expensive treatment and many medical aid plans in South Africa do not cover this specific product and treatment. Dr Jonker only uses the “gel” infiltration on a selective basis because many of the patients he treats for osteoarthritis are pensioners. He concludes about this treatment option “Yet if the treatment is requested despite my advice, I will provide it. There are very few side effects”.
Then there is the supplemental business for osteoarthritis and joint pain, which is a thriving industry in South Africa. In any retail pharmacy, you will find a wide variety of supplements to choose from. Many patients do get relief from supplemental treatment but the treatment is expensive if used over a long period of time, and many patients do not experience relief from the supplemental treatment. Nevertheless, if supplements are effective for you, use them.
For a consultation with Dr Hannes Jonker contact 018 293 3474
written by Elmari Snoer BusinessBrainz
RESOURCES: INTERVIEW WITH DR. HANNES JONKER
by Admin | Oct 4, 2022 | Orthopaedic Updates
The management of meniscus injuries
Gracefully moving on ice and spinning in the air, then landing perfectly with one leg bent. The motion seems effortless. As with ice skaters, professional netball and soccer players also display incredible agility. These athletes sprint, jump and swerve, but these seemingly effortless twists and turns will come at a high cost if one move goes wrong.
These types of movements may cause an injury to the meniscus in the knee. As a result, a meniscus injury is sudden and traumatic. Despite the high risk of a torn meniscus among athletes, especially those involved in contact sports, a torn meniscus is common amongst people of all ages and occupations regardless of their level of activity, and a large proportion of people over 40 will have a torn meniscus without symptoms. A meniscal injury, for them, is more a sign of degeneration than a distinct injury.
There are two types of meniscus injuries, acute tears and degenerative tears. Acute tears happen through bending and twisting the knee with force while in a weight bearing position. Often when the injury is a result of a trauma while playing sports, in addition to the meniscus being torn, there tend to be other knee injuries as well, like an ACL tear. Degenerative tears are more typical with older people as the meniscus weakens and becomes less elastic over time.
Common symptoms of a meniscus tear include pain, swelling, catching of the knee, locking of the knee, instability of the knee and the incapability to use full range of motion. Pain to the touch of the meniscus is also a sign of a meniscus tear. Sometimes, you may still be able to stand and walk after the initial injury with only a bit of pain depending on the severity of the tear. This is however not an indication that the meniscus tear is a minor injury and that treatment can wait. It will not be wise to play through the pain.
If left untreated, part of the meniscus can slip into the joint and you may need surgery to restore your full knee function. Untreated meniscus tears can increase in size and lead to complications, such as arthritis over time.
Untreated, a meniscus tear can limit your ADL and ability to participate in exercise and sports. In serious cases, it can develop into long-term knee problems, like arthritis. In addition, moving around with a torn meniscus could pull fragments of the cartilage into the joint causing more serious knee issues which could require more significant surgery in the future.
Endurance is an important part of sports. For some athletes, playing through a little pain is a badge of honour. In the case of meniscus tears, some people think the injury will heal over time on its own. But the truth is that there are different types of meniscus tears — and some tears will not heal without treatment. If your tear is on the outer one-third of the meniscus, it may heal on its own or require surgical repair. This is because this area has blood supply and blood cells can heal meniscus tissue — or help it heal after surgical repair.
But if the tear is in the inner two-thirds, which lack blood flow, the tear cannot be repaired and may need to be trimmed or removed surgically. The first step in treating a torn meniscus is getting the injury examined by an orthopaedic surgeon. During the exam, the orthopaedic surgeon may check the tenderness of your knee joint and move your leg to get a measure of your knee’s range of motion. The surgeon may also order imaging tests, such as a MRI or X-ray, to determine the exact location and severity of the tear.
The best course of treatment will be determined based on the location, degree, and type of tear, as well as your age and activity level.
Non-surgical treatment for tears that can heal on their own may include: physiotherapy; RICE: Rest, Ice, Compression, Elevation and anti-inflammatory medications.
For more severe tears, surgery is typically the best course of treatment. The goal of surgery is to preserve the meniscus by repairing or removing the torn part. During arthroscopic surgery, the orthopaedic surgeon inserts a camera into a small incision in the knee (keyhole surgery), which guides the surgeon in repairing or removing the tear with instruments inserted through another small incision. Following surgery, you will need to undergo physiotherapy to strengthen your knee, regain your range of motion, and get back to your daily activities.
Knee pain should not keep you from participating in your favourite sport and activities. Among the best places to treat knee injuries and meniscus tears is Dr. Hannes Jonker and the Centre for Sport Medicine and Orthopaedics.
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