andrew – Dr. Nolan Horner

ACL Reconstruction Surgery FAQ

Posted on January 10, 2023January 10, 2023 by andrew

ACL reconstruction surgery is one of the most common procedures I perform. The primary reason patients require ACL reconstruction surgery is due to a near complete or complete tear of the ACL. Below is a list of the most common questions patients ask me about ACL reconstruction surgery.

Q: What is the ACL, and what does it do?

A: The Anterior Cruciate Ligament (ACL) is a cable-like structure that attaches the thigh bone (femur) to the shin bone (tibia) through the middle of the knee joint. The ACL stabilizes the knee joint by preventing the tibia from moving too far forward with respect to the femur as well as providing rotational support to the knee.

Q: Will I need any tests done before I am ready for surgery?
A: An MRI will be necessary prior to surgery to confirm the diagnosis and look for the existence of other simultaneous injuries to the knee, such as meniscal tears. After the decision has been made to proceed with ACL Reconstruction surgery, the patient may require pre-operative clearance from a primary care physician to ensure that there are no underlying medical conditions that would make undergoing ACL reconstruction surgery unsafe.

Q: How long is the surgery?

A: The length of the surgery can vary depending on the level of damage within the knee, but on average it takes approximately 1 hour to complete.

Q: What is the difference between ACL reconstruction with and without meniscus repair?

A: Injuries to the ACL are often associated with tears in the meniscus, the cartilage cushion between the femur and tibia. During ACL reconstruction surgery, if the meniscus is torn, I will either repair or remove the damaged meniscus tissue. The decision of repair versus removal is determined based on the location and severity of the tear. If the meniscus is able to be repaired, the patient will have a longer non-weightbearing period immediately after surgery to allow the meniscus to heal. The detailed rehab protocol for each operation can be found on the rehabilitation section of this website.

Q: What is the recovery like after ACL reconstruction surgery?

A: The initial recovery after an ACL reconstruction surgery varies depending on the patient’s associated meniscus procedure. If the meniscus is repaired, the patient will be restricted to toe touch weightbearing only for 2-6 weeks with no range of motion past 90 degrees for the first 4 weeks. Crutches will be necessary until 6 weeks after ACL reconstruction with meniscus repair. If there is no meniscus injury or the damaged meniscus tissue is removed, the patient can begin weightbearing and range of motion exercises up to 90 degrees as tolerated immediately after surgery. Crutches may be used as needed for the first 2 weeks after ACL reconstruction without meniscus repair.

Physical therapy for progressive strengthening and range of motion will be an essential part of ACL reconstruction recovery and should start as soon as possible after surgery. Regardless of the accompanying meniscus procedure, the earliest a patient may begin running after ACL reconstruction surgery is 3.5 months, and the earliest they may return to sports is 6 months. The detailed rehabilitation protocol for ACL reconstruction can be found on the rehabilitation section of the website.

Q: What are the benefits of ACL reconstruction surgery?

A: The ACL is necessary to provide stability during jumping, cutting, and pivoting. Once the knee has recovered from surgery, patients will experience a return to pre-injury levels of stability during these movements. The stability in the knee provided by ACL reconstruction also helps to prevent further injury to other knee structures and may to delay the onset of osteoarthritis.

Q: Will I have to stay in hospital over night after my ACL reconstruction surgery?

A: Most patients I treat with ACL reconstructions go home within a couple hours after the surgery is complete. In some rare cases, depending on a patient’s medical history and functional status, I may ask them to stay in hospital overnight for observation.

Q: What kinds of grafts can be used in ACL reconstruction surgery?

A: There are two categories of grafts that I use in ACL reconstruction surgery: Autografts and Allografts. Autograft tissue is harvested from another part of the patient’s own body, and allograft tissue is harvested from a donor. In either category, the most common graft I use in ACL reconstruction surgery is the patellar tendon, though I may use other grafts depending on the patient’s unique circumstances. Generally, younger or more active patients will receive autografts while older or less active patients will receive allografts.

Q: How do I know if I need ACL Reconstruction Surgery?

A: The necessity of ACL reconstruction surgery varies depending on the individual patient. Generally, ACL reconstruction surgery is recommended for all younger patients, especially if they are physically active. ACL reconstruction surgery in older patients is generally recommended if they wish to return to a high level of physical activity, everyday activities are impacted by the injury, or if there are other associated injuries in the knee.

Q: What are the risks associated with ACL Reconstruction surgery?

A: Overall ACL reconstruction surgery is safe with low risks of complications for most patients. However, with any surgical procedures there are risks. Risks include (but are not limited to) risk of graft failure after returning to sport, tendinitis, persistent pain, stiffness, infection, wound complications, medical complications, risks of anesthetic, as well as others.

Q: What type of anesthetic is used?

A: All of the ACL reconstruction surgeries I do are typically done with both a general anesthetic and regional nerve block. The general anesthetic means that you will be completely asleep during the procedure and that you will not remember any parts of the operation. The regional nerve block helps to reduce pain during the initial 24 hours after the operation. This is highly effective at controlling pain during the first day after the surgery, which is typically the most painful part of the procedure.

This blog post was authored by Jack Felkner BSPh and Dr. Nolan Horner MD.

Dr. Nolan Horner is an orthopedic surgeon with a specialization in sports and shoulder surgery. He works in the Chicagoland area and has offices in Chicago, Oak Park, Oak Brook and St. Charles.

Meniscal Surgery FAQ

Posted on January 3, 2023January 3, 2023 by andrew

Arthroscopic meniscal surgery is a surgical procedure that is used to repair or remove damaged meniscal tissue in the knee. Here are some common questions I get asked about the procedure:

1. What is the purpose of arthroscopic meniscal surgery?

The purpose of arthroscopic meniscal surgery is to repair or remove damaged meniscal tissue in the knee joint. The meniscus is a C-shaped piece of cartilage that cushions and stabilizes the knee joint. When the meniscus is damaged, it can cause pain, stiffness, and difficulty with movement.

2. How is arthroscopic meniscal surgery performed?

Arthroscopic meniscal surgery is usually performed under general anesthesia. During the procedure, the surgeon makes two small incisions around the knee and inserts a small camera, called an arthroscope, into the joint. The camera allows the surgeon to view the inside of the knee on a monitor, and small surgical instruments can be inserted through the other incisions to repair or remove the damaged tissue.

3. What is the difference between meniscal repair and partial meniscectomy?

Meniscal repair refers to a surgical procedure in which the damaged portion of the meniscus is repaired using suture type material. The goal of meniscal repair is to preserve as much of the meniscus as possible since the meniscus plays an important role in the stability and function of the knee joint.

Partial meniscectomy, also known as partial meniscal resection, refers to a surgical procedure in which a portion of the damaged meniscus is removed. This is typically done when the damage to the meniscus is too extensive to repair, or when the patient has significant degenerative changes in the knee joint. In these cases, as little of the meniscus is removed as possible to alleviate the patient’s symptoms while maintaining as much of the integrity of the meniscus as possible.

The decision to perform meniscal repair or partial meniscectomy will depend on the extent and location of the damage to the meniscus, as well as the patient’s age, overall health, and the presence of any other knee problems. In some cases, a combination of both procedures may be necessary.

4. How long does the recovery process take after arthroscopic meniscal surgery?

In general, for a partial meniscectomy, patients do not require a brace or crutches after surgery and can begin fully weightbearing from the same day after surgery. Patients will begin physical therapy within 1 week after surgery and continue therapy for 6-10 weeks. Full clearance for return to all sports is typically 6-10 weeks from surgery. Many patients return to work just a few days after surgery

For a meniscal repair, patients will require use of a brace and crutches for 4-6 weeks after surgery. Physical therapy will begin 2 weeks after surgery.

My specific and more detailed rehabilitation protocols can be found under the rehabilitation portion of my website.

5. Is arthroscopic meniscal surgery effective?

Arthroscopic meniscal surgery is effective for relieving pain and improving function in people with damaged meniscus tissue. However, the long-term success of the surgery can depend on the extent of the meniscal damage, the amount of osteoarthritis in patient’s knee, the patient’s age and overall health, and their commitment to the rehabilitation process.

6. How long does the surgery take?

Meniscal surgery is typically performed on an outpatient basis, which means that the patient can go home the same day as the procedure. The length of the surgery will depend on the extent of the damage to the meniscus and the specific type of surgery being performed. In general, meniscal surgery is a relatively quick procedure and can usually be completed in 30 minutes to an hour.

7. When can I drive again after meniscal surgery?

In general, it is usually safe to drive when you are no longer taking pain medication and your knee is strong enough to support the weight of your body. Generally, for partial meniscectomy patients this is 1-2 weeks after surgery. For patients with a meniscal repair, it may take 4-6 weeks to be able to drive if their right knee is the surgical side, for left knee meniscal repairs it can be as soon as 1 week after surgery.

Before you start driving again, it is important to make sure that you have full control of the pedals, can easily reach the steering wheel and other controls, and have the physical strength and mobility to safely operate the vehicle. You should also be able to safely enter and exit the vehicle and perform an emergency stop if necessary.

It is always a good idea to check with your doctor before starting to drive again after meniscal repair surgery, to ensure that you are ready and that it is safe for you to do so.

8. What are the risks of arthroscopic meniscal surgery?

As with any surgery, there are risks associated with arthroscopic meniscal surgery. These risks include infection, bleeding, and reactions to the anesthesia. There is also a risk of injury to the blood vessels, nerves, or other structures in the knee. However, due to the minimally invasive nature of arthroscopic meniscal surgery the rates of complications are generally very low.

Dr. Nolan Horner is an orthopedic surgeon with a specialization in sports and shoulder surgery. He works in the Chicagoland area and has offices in Chicago, Oak Park, Oak Brook and St. Charles.

Shoulder Replacement Surgery FAQ

Posted on December 20, 2022December 20, 2022 by andrew

Shoulder Replacement Surgery FAQ

Shoulder replacement surgery is one of the most common procedures I perform. The most common reasons patients require shoulder replacement surgery is due to osteoarthritis of the shoulder, however it may also be indicated in patients with large rotator cuff tears and/or fractures of the shoulder. Below is a list of the most common questions patients ask me about shoulder replacement surgery.

Q: Will I need any tests done before I am ready for surgery?

A: After the decision has been made to proceed with shoulder replacement surgery, typically two things are required prior to your surgical date.

A CT scan of the shoulder – I use the CT scan of the shoulder to plan each patient’s surgery to determine which shoulder replacement components will best fit an individual patient’s anatomy. Also, in many cases I use the CT scan to have custom patient specific instrumentation made to ensure that the implants are placed in an optimal position.
Pre-operative clearance from your primary care physician to ensure that there are no medical conditions that would make undergoing shoulder replacement surgery unsafe.

Q: How long is the surgery?

A: The length of the surgery can vary significantly depending on the patient’s anatomy, but on average it takes approximately 1.5-2 hours to complete.

Q: What is the recovery like after shoulder replacement surgery?

A: Typically, patient will have to be in a sling for 4-6 weeks after the surgery. After the sling is discontinued patients can move the shoulder as they tolerate, however I will ask patients to limit heavy lifting until ~10-12 weeks after the surgery. Patients should begin physical therapy 2-4 weeks after surgery and will continue until about 3-4 months after the surgery.

Q: What are the benefits of shoulder replacement surgery?

A: Most patients will experience resolution of most of their pain with activities of daily living. Most patients will experience significant improvements in their range of motion after surgery as well. Depending on patients’ pre-operative limitations, patients are often able to perform activities that they were unable to perform prior to the surgery.

Q: Will I have to stay in hospital over night after my shoulder replacement surgery?

A: Most patients I treat with shoulder replacements go home only a couple hours after the surgery is complete. In some cases, depending on a patient’s medical history and functional status, I may ask them to stay in hospital overnight for observation.

Q: What is the difference between an anatomic total shoulder replacement and a reverse total shoulder replacement?

A: The shoulder is a ball and socket joint, with the glenoid forming the socket and the humeral head making up the ball portion of the joint. In an anatomic shoulder replacement the humeral head is replaced with a new ball shaped prosthesis and a new prosthetic cup is placed where the glenoid was previously located. In a reverse total shoulder replacement, the anatomy is flipped, and the prosthetic cup is placed where the humeral head was, and the new ball of the shoulder is placed on the glenoid. A reverse total shoulder arthroplasty is more ideal in patients with issues with their rotator cuff as the change in anatomy allows for the deltoid to perform many of the functions of the rotator cuff.

Q: How do I know when I am “ready” for shoulder replacement surgery

A: The timing of shoulder replacement varies depending on the individual patient. Generally once patients reach the point that they feel their shoulder is affecting their everyday life, despite having tried non-operative treatment options such as therapy, anti-inflammatory medications, and cortisone injections. Patients who choose to undergo shoulder replacement surgery often will state that they must restrict some activities that they do as a result of their shoulder and/or that their shoulder affects their sleep.

Q: What are the risks associated with shoulder replacement surgery?

A: Overall shoulder replacement surgery is safe with low risks of complications for most patients. However, with any surgical procedures there are risks. Risks include (but are not limited to) risk of fracture of the bone, dislocation of the prosthesis, persistent pain, stiffness, infection, wound complications, medical complications, risks of anesthetic, as well as others.

Q: What type of anesthetic is used?

A: The majority of shoulder replacements I do are done with both a general anesthetic and a nerve block. The general anesthetic means that you will be completely asleep during the procedure and that you will not remember any parts of the operation. The nerve block means that your arm will be numb for approximately 24 hours after the operation. This is highly effective at controlling pain during the first day after the surgery, which is typically the most painful portion of the procedure.

Q: Am I too young for shoulder replacement surgery?

A: There is no specific age cut-off for shoulder replacement surgery. The decision to proceed with shoulder replacement surgery in younger patients is based off several factors including the age of the patient, the severity of symptoms and the appropriateness of alternative treatment options. More modern shoulder replacement implants that I use in my practice are bone preserving and therefore more suitable for younger patients who many require a revision in their lifetime, as more of the native bone stock is maintained in the initial operation.

**Newer stemless anatomic total shoulder replacement which preserves bone stock compared to older stemmed implants.**

**Stemmed anatomic shoulder replacement**

Dr. Nolan Horner is an orthopedic surgeon with a specialization in sports and shoulder surgery. He works in the Chicagoland area and has offices in Chicago, Oak Park, Oak Brook and St. Charles.

Dr. Nolan Horner

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Author: andrew

ACL Reconstruction Surgery FAQ

Meniscal Surgery FAQ

Shoulder Replacement Surgery FAQ

Shoulder Replacement Surgery FAQ

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