Dear docsok-ga;
Thank you for allowing me an opportunity to answer your interesting
question. Here are some references I found from notable sources:
?Surgical management is dependent on the presence of a varus
deformity; patients with medial compartment disease and varus
alignment should be considered for high tibial osteotomy (HTO) or
unicondylar or total knee arthroplasty (TKA), depending on their age
and activity level.?
-- J. T. Dearborn, C. L. Eakin, H. B. Skinner, Department of
Orthopaedic Surgery, University of California, San Francisco, USA.
PUB MED
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=96280229
?Those patients who present with a chief complaint of arthritic medial
compartment ache are best treated by a high tibial osteotomy. Those
patients who present with instability as their primary problem will
benefit from an ACL reconstruction accompanied with advice that the
reconstruction will not significantly improve the medial compartment
pain. Those patients who present with both significant instability and
pain will benefit from a combined ACL reconstruction followed by high
tibial osteotomy.?
-- Mervyn J. Cross, North Sydney Orthopaedic and Sports Medicine Centre
ACL INJURIES ? TREATMENT AND REHABILITATION
http://www.sportsci.org/encyc/aclinj/aclinj.html
?This concomitant procedure [valgus high tibial osteotomy] should be
strongly considered in two types of patients: the individual with
varus laxity and medial-compartment loss resulting in varus alignment,
and the individual with a neutrally aligned knee and 3+ varus laxity
accompanied by a varus thrust in gait. The osteotomy should be
performed first; the posterolateral reconstruction may be performed
immediately after the osteotomy. A second option is to perform the
reconstruction as a delayed procedure. Often, the valgus tibial
osteotomy alone, either based medially or laterally, will alleviate
symptoms?
CURRENT CONCEPTS
http://www.indiaorth.org/ijo/Indianjournaloforthopaedics/IJO.July/Acuteandchronic.htm
Not being a medical professional of course I cannot advise you on
medical procedures, nor would I be allowed to per the policy of this
forum, but in researching the issue it appears that professionals in
this area seem to concur that a HIGH TIBIAL OSTEOTOMY may be in order
for the condition you described.
I hope you find that my research exceeds your expectations. If you
have any questions about my research please post a clarification
request prior to rating the answer. Otherwise I welcome your rating
and your final comments and I look forward to working with you again
in the near future. Thank you for bringing your question to us.
Best regards;
Tutuzdad-ga ? Google Answers Researcher
INFORMATION SOURCES
PUB MED
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=96280229
ACL INJURIES ? TREATMENT AND REHABILITATION
http://www.sportsci.org/encyc/aclinj/aclinj.html
CINCINNATI SPORTS MEDICINE
http://www.cincinnatisportsmed.com/pubb.htm
SEARCH STRATEGY
SEARCH ENGINE USED:
Google ://www.google.com
SEARCH TERMS USED:
TIBIAL
OSTEOTOMY
PCL
TEAR
MEDIAL COMPARTMENT |
Clarification of Answer by
tutuzdad-ga
on
25 Mar 2004 17:23 PST
I?m sorry. You are right. I didn?t address that. I?m sorry for that
oversight. Here are more supporting statements in that regard:
In many cases a torn PCL dos not require surgery, however in some
cases surgery is warranted. If the damage due to a chronic tear or
degenerative condition is present the recommendation is sometimes
arthroscopic surgery:
?A damaged PCL will not necessarily require surgery for a full
recovery. Differences in the severity and in the type of injury will
dictate the treatment decisions, as will the degree of athletic
activity that the patient wishes to pursue after treatment. PCL
injuries may range from minor sprains to complete tears of the
ligament, and some patients, even with quite severe injuries, may
choose to not undergo surgery. However, a completely torn PCL cannot
rebuild itself, surgery to reattach or reconstruct the ligament is
usually recommended. Less active patients with a complete tear may not
always require this procedure.
A torn PCL is usually difficult to stitch together after injury
because the torn ends are frayed and difficult to manage. Most often,
the torn ligament is completely replaced with material from the
patellar tendon, though the ligament can also be supplemented with
synthetic material.
Patients with more minor injuries can expect to fully recover after
more than a month of physical therapy. Patients suffering severe
injuries that have resulted in the partial tearing of the PCL will
require a much longer time to rehabilitate, although a full recovery
is still possible with intensive physical therapy. These injuries
typically heal in three or more months.?
OTHOPEDIC CLINIC VALPARAISO
http://www.valpoortho.com/index.php?practiceId=10034&lib=TreatmentPrint&dir=treatment&noheader=y&categoryId=189
You can read more about this here
?Historically, controversy in treatment modalities exists because of
the lack of knowledge of the natural history of this injury; in
addition, reported surgical results are variable. When surgical
reconstruction is considered, graft recommendations include the
following:
Autograft
Patellar tendon
Quadriceps tendon
Hamstring tendons
Medial head of gastrocnemius
Allograft
Achilles tendon
Patellar tendon
Quadriceps tendon
Hamstring tendons
The results of operative reconstruction are variable and may be no
better than nonoperative treatment?
E-MEDICINE
http://www.emedicine.com/sports/topic105.htm
Caution: This source has some graphic photos that may not be suitable
for all viewers.
All sources I read are quick to say that this injury not always
require surgery and most recommend physical therapy or non-operative
procedures before opting for surgery as a last report. Of course, all
of them suggest you consult your physician (I had to throw in that
disclaimer you understand).
I hope this adds significantly to what we?ve already discussed.
Regards;
Tutuzdad-ga
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