CONDITIONS TREATED
Knee
Anterior cruciate ligament injury
Arthritis
Posterior cruciate ligament injury
Collateral ligament injury
Bursitis
Patellar dislocation
Sports Medicine
Sports injuries occur when playing sports or while exercising. They can result from accidents, inadequate training, or insufficient stretching or warm-up exercises.The most common sports injuries are sprains and strains, fractures and dislocations.
CONDITIONS TREATED
AC Joint Injury
The acromioclavicular (AC) joint is located where the clavicle (collarbone) meets the highest point of the acromion (shoulder blade). The AC joint is held closely together by multiple ligaments and wrapped in cartilage at the end of each bone. An AC joint injury is a common shoulder condition generally caused by a hard fall or blunt force to the joint. Dr. Yehia Bedeir can help alleviate acromioclavicular joint pain after an injury and return patients to an active, healthy lifestyle.
The most common cause of an AC joint injury is a direct contact force impacting the top of the shoulder. The fall can cause the joint to experience a mild sprain or, in cases of a particularly forceful impact, a complete joint separation. An AC joint injury is measured in multiple grades, spanning from grade 1 to grade 6 depending on the severity of ligament disruption and direction of separation.
The hallmark sign of an AC joint injury is pain at the AC joint. Acromioclavicular joint pain ranges from mild tenderness to sharp, intense pain following injury. The pain is commonly felt at the top of the shoulder. Patients may also experience bruising, swelling, a visible deformity and a popping sensation in higher grade injuries.
A complete physical examination of the shoulder performed by Dr. Bedeir and a series of x-rays will lead to a confirmed AC joint injury diagnosis. An x-ray can also help rule out any additional injuries to the bone, such as a fracture of the end of the collarbone.
Ultimately, treatment of an AC joint injury is based on injury grade, level of acromioclavicular joint pain and patient’s functional level.
Lower grade AC joint injuries are commonly treated with a non-surgical approach that includes rest, joint stabilization in a sling, medications, and a detailed physical therapy program. The combination of these non-surgical measures decrease acromioclavicular joint pain and return patients to normal activities within 1-6 weeks.
A surgical procedure may be recommended by Dr. Bedeir in higher grade injuries. In acute injuries, an arthroscopic AC joint stabilization procedure is generally performed by Dr. Bedeir to stabilize the joint and decrease and correct the separation between the acromion and clavicle. In chronic cases, the AC joint is reconstructed by utilizing a tendon graft harvested from the leg in order to restore full joint stability and function. Dr. Bedeir will evaluate a patient’s AC joint injury on a case-by-case basis through physical examination and acquired imaging to determine the proper surgical technique needed to reconstruct damaged surrounding ligaments and resolve the AC joint injury.
Biceps Tendon Injury
Located at the front of the arm, the biceps muscle is responsible for rotating the wrist and flexing the elbow. The muscle has two tendons that attach it to the shoulder bones, as well as one tendon that attaches it to the elbow bone. The tendons are quite tough but are susceptible tearing. Injury to biceps tendon may be inflammation, partial tear or complete tear.
Two tendons are responsible for attaching the biceps muscle to the shoulder. The “long head” tendon attaches the muscle to the top of the shoulder socket and the “short head” attaches to the shoulder blade. A biceps tendon injury is more likely to occur in the long head tendon. The short head tendon may allow patients to continue using the biceps muscle even in cases of a complete tear of the long head tendon.
Repetitive shoulder movement and overuse are the main causes of biceps tendonitis, and possible subsequent tear, but the shoulder condition may also affect active individuals and athletes as they age and the shoulder joint begins to wear out. Other common shoulder injuries can cause biceps pain and inflammation, including a rotator cuff injury, bone spurs, shoulder trauma, shoulder arthritis, and multi-directional instability.
As the long head biceps tendon becomes damaged from overuse or aging, it displays several warning signs, such as intermittent or constant biceps pain located at the front of the shoulder joint that radiates down to the biceps muscle. Many patients experience the biceps pain more intensely when the arm is moved in front of the body or raised above the shoulder. Other common biceps tendonitis symptoms include sensitivity in the injured area, local redness, and a snapping sensation during shoulder movement.
If long head of biceps tendon injury is suspected, Dr. Bedeir will perform physical examination tests that are specific for biceps tendon disease. If a torn biceps is suspected, he will order an MRI scan to rule out other shoulder injuries and confirm the diagnosis.
Dr. Bedeir typically recommends non-surgical measures such as ice, rest and anti-inflammatory medications (NSAIDs) for biceps tendon injuries. A corticosteroid injection may be utilized to reduce pain for a longer duration in certain patients. Patients may also need a physical therapy program to increase flexibility and strength. While the inflammation calms down, patients are encouraged to refrain from heavy lifting.
If the biceps tendon injury is severe or does not respond to non-surgical treatment, Dr. Bedeir may recommend surgery. Depending on the patient’s age, activity level and extent of damage to the long head of biceps, surgical treatment of biceps tendon disease may require release, repair or tenodesis (removing the damaged section of the biceps tendon and reattaching the remaining tendon to the upper arm bone). These procedures can be done arthroscopically through tiny incisions around the shoulder.
Clavicle Fracture
The clavicle, more commonly known as the collarbone, is an S-shaped bone that lies horizontally at the top of the thorax. The clavicle functions as a strut, between the sternum and scapula (shoulder blade), designed to oppose forces that would bring the upper limb toward the thorax. The range of motion of the upper limb is reliant on this function of the clavicle. When the shoulder girdle experiences a blunt force trauma, such as a direct blow or a fall onto an outstretched arm, the clavicle can become easily broken. A clavicle fracture is a common condition accounting for 5% of all adult bone fractures. Dr. Yehia Bedeir has the knowledge and understanding, as well as substantial experience in treating patients who have experienced a clavicle fracture.
One of the most common complaints of a clavicle fracture is a sharp pain of the clavicle immediately following an injury. Although symptoms can vary with the severity of the injury, other common symptoms of a clavicle fracture include:
- Pain with arm movement
- Obvious visual deformity of the clavicle
- Difficulty with lifting or rotating the affected arm
- Downward shoulder sag
- Tenderness, inflammation, and bruising of the affected clavicle
Dr. Bedeir will obtain a comprehensive medical history to include the initial injury and any other pertinent medical conditions. A thorough physical examination will also be performed at the office visit. An x-ray will be completed to confirm the clavicle fracture diagnosis. Additional diagnostic imaging, such as CT scan or magnetic resonance imaging (MRI), may be recommended to identify damage to any other structures of the shoulder girdle.
Non-surgical treatment:
When a clavicle fracture does not result in bone displacement, conservative therapies may be sufficient in alleviating symptoms during the healing process. The shoulder will be immobilized with the clavicle in the correct anatomical position. Pain and inflammation can be controlled with a combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). When appropriate, Dr. Bedeir will prescribe a physical rehabilitation program focused on increasing motion and strengthening the shoulder girdle.
Surgical treatment:
Surgical intervention is usually necessary for clavicle fractures with significant displacement, break through the skin, or in the event of failed conservative therapy. A clavicle fracture is surgically repaired using special plates and screws to realign the bone fragments into the correct anatomical configuration.
Proximal Humerus Fracture
Humerus is the upper arm bone and it forms two joints —shoulder joint and elbow joint. The proximal humerus is the upper end of arm bone that forms shoulder joint. Fractures of proximal humerus are common in elderly individuals suffering from osteoporosis. Fractures are caused by traumatic injuries such as a fall on outstretched hand from greater heights or motor vehicle accidents. In younger individuals, a severe trauma can cause these fractures.
Most common complaints of a proximal humerus fracture is a sharp pain and loss of motion in the affected shoulder. Occasionally, numbness over the outside of the upper arm and deltoid muscle weakness may be present, and may indicate nerve injury.
Dr. Bedeir will obtain a comprehensive medical history to include the initial injury and any other pertinent medical conditions. A physical examination will also be performed at the office visit. An x-ray will be completed to confirm the proximal humerus fracture diagnosis. Additional diagnostic imaging, such as CT scan, may be recommended to accurately identify the fracture configuration.
Non-surgical treatment:
When a proximal humerus fracture is minimally displaced, conservative therapies may be sufficient in alleviating symptoms and achieving a satisfactory outcome. The shoulder will be immobilized in a sling for 1-2 months. Pain and inflammation can be controlled with a combination of rest, ice, and non-steroidal anti-inflammatory medications (NSAIDs). When appropriate, Dr. Bedeir will prescribe a physical rehabilitation program focused on increasing motion and strengthening the shoulder girdle.
Surgical treatment:
Surgical intervention is usually necessary for proximal humerus fractures with significant displacement, or fractures that are associated with dislocation of the shoulder. Surgical treatment options included fixation by plate and screws, hemiarthroplasty (replacement of the proximal humerus bone), or reverse shoulder arthroplasty (replacement of proximal humerus and the glenoid). Choice of surgical treatment depends on multiple factors including patient age, fracture configuration and quality of the bones and tendons.
Rotator Cuff Injury
A rotator cuff injury is quite common in both young and older active individuals. The rotator cuff is composed of four muscle-tendon units that surround the shoulder joint and provide overhead arm motion and strength. Rotator cuff injuries, such as a rotator cuff tear, can occur during sports activities, from a fall, from degeneration of a tendon or from repetitive overhead motion of the arm. Dr. Yehia Bedeir is highly trained and experienced in rotator cuff surgery and returning patients to a healthy, active lifestyle.
A rotator cuff tear occurs by separation of the tendon attachment off of the humerus (upper arm bone).
Several factors can damage the rotator cuff, including:
- Acute injury- The rotator cuff sustains damage due to a sports injury, automobile accident, fall, or other traumatic event.
- Chronic overuse- The rotator cuff sustains damage from continuous, repetitive movements, such as throwing, swimming, tennis or other sports activity.
- Degeneration- The rotator cuff sustains damage from natural wear and tear associated with aging.
Shoulder impingement and tendonitis are also associated with certain rotator cuff tears.
The hallmark symptom of a rotator cuff tear is pain over the top of the shoulder joint and arm. The pain may travel down the arm and towards the elbow joint in some patients. The shoulder pain may also interfere with rest and sleep if the patient sleeps on the affected shoulder.
Other common rotator cuff injury symptoms include shoulder weakness and tenderness caused from the inflammation that accompanies the muscle-tendon damage.
If a patient believes they have experienced a rotator cuff tear from a traumatic event, from overuse, or from natural degeneration, Dr. Yehia Bedeir will perform a thorough physical examination. During the examination, he will assess the affected shoulder’s range of motion and strength, and compare it to the other side. He will also manipulate the muscles and bones to find any areas of pain and tenderness. A number of tests, such as x-rays and an MRI, may also be performed to confirm the diagnosis.
Many cases of a rotator cuff injury will improve without rotator cuff surgery. The success of non-surgical treatment is influenced by many factors including patient age, activity level, size of the tear and examination findings.
Dr. Bedeir’s goal with non-surgical treatment involves the reduction of inflammation, as well as strengthening the shoulder muscles that were not damaged to compensate for the torn muscle-tendon unit. Non-surgical treatment commonly includes rest, physical therapy, medication and cortisone injections to reduce inflammation and relieve pain.
Patients with reparable rotator cuff tears who will benefit from surgery are treated by Dr. Bedeir with an arthroscopic approach. During the procedure, tiny incisions are created in the injured area so Dr. Provencher can insert a small camera, and view the damaged area in great detail. After viewing the injured muscle-tendon unit, he will insert small, special surgical instruments, and repair the damaged area. Arthroscopic rotator cuff surgery provides numerous benefits to patients, including less pain, and a quicker return to activities.
Shoulder Arthritis
Arthritis of the shoulder causes patients to feel chronic shoulder joint pain, stiffness, and weakness. Patients living in or around Alexandria, Egypt who are suffering from shoulder arthritis are encouraged to contact Dr. Yehia Bedeir. Dr. Bedeir is dedicated to treating patients afflicted with this debilitating disease and returning them to an active, pain-free lifestyle.
Shoulder arthritis is caused by wear and tear of the shoulder, leading to a breakdown of articular cartilage. Cartilage is the smooth, white coating on the ends of each bone at the joint area. The coating allows the joint to move smoothly and freely with no pain. As cartilage degenerates from wear and tear, the bones are exposed and rub against each other, causing patients to experience shoulder joint pain.
The two distinct joints within the shoulder that can become affected by arthritis include:
- The acromioclavicular (AC) joint- Located where the clavicle (collarbone) meets the acromion (bony roof of the shoulder joint).
- Chronic overuse- The rotator cuff sustains damage from continuous, repetitive movements, such as throwing, swimming, tennis or other sports activity.
- The glenohumeral joint- Located where the ball of the humerus (upper arm bone) meets the glenoid (socket).
Patients may experience one or more forms of shoulder arthritis, including:
- Osteoarthritis- Osteoarthritis is a gradual degeneration of cartilage from normal wear and tear. This form of arthritis most commonly occurs in highly active athletes and the older population.
- Post-traumatic arthritis- This form of arthritis occurs after an acute or traumatic injury to the joint, such as a hard fall or blunt force. The joint may still experience arthritis after the damage is healed because of mechanical changes within the shoulder joint.
- Rheumatoid arthritis (RA) – RA occurs when the human body’s own immune system attacks and destroys its own cartilage.
The majority of patients report chronic shoulder joint pain, caused by grinding, and rubbing of bone against bone. Patients may also experience stiffness, weakness, a grinding sensation, and difficulty lifting or moving the arm.
Dr. Bedeir will perform a thorough physical examination and medical review to determine if shoulder arthritis is the cause of a patient’s shoulder joint pain. The physical examination is designed to determine the precise area of pain and tenderness. He may also perform a series of x-rays and an MRI to rule out other injuries and confirm the diagnosis.
The main goal of any shoulder arthritis treatment is to alleviate pain, weakness, stiffness, and other troublesome symptoms. Treatment is dependent on arthritis severity, symptom intensity, and the patient’s functional level.
Since shoulder arthritis is so common, many patients live with the condition for years before contacting Dr. Bedeir. Initial treatment includes resting the shoulder, avoiding activities that cause pain and discomfort, applying ice and taking anti-inflammatory medications (NSAIDs). Physical therapy is commonly recommended by Dr. Bedeir to strengthen the joint and return normal function.
In severe cases where non-surgical measures fail, Dr. Bedeir may recommend a total shoulder replacement. This surgical treatment restores joint function by replacing the damaged ball and socket with synthetic surfaces.
Shoulder Dislocation
The shoulder is considered the most mobile joint in the body and has the ability to move and turn in a number of directions. While this high degree of mobility is advantageous, the wide range of motion also causes the shoulder to be highly susceptible to injury. A dislocation occurs when the ball and socket within the shoulder joint separates. The dislocation creates shoulder instability and allows the ball (humeral head) to move beyond the normal constraints placed by the socket (glenoid bone) in a forward, backward and/or downward direction. Dr. Yehia Bedeir is highly skilled in diagnosing and treating patients who have experienced a shoulder dislocation.
A dislocated shoulder is a common injury in athletes, especially athletes involved in football, handball, basketball and other contact sports. If the shoulder dislocates, it is at an elevated risk of experiencing another dislocation. Many patients who have sustained a dislocated shoulder have weaker shoulder ligaments, thereby resulting in ongoing shoulder instability. Shoulder instability occurs when the bones, ligaments, muscles and tendons surrounding the joint do not work properly to secure the ball and socket in place.
Patients who have sustained a shoulder dislocation may experience a variety of symptoms, including:
- Significant shoulder pain that may spread through the arm
- Arm numbness
- Shoulder weakness
- Deformity of the joint
- Difficulty or inability to move the arm
- A popping sensation
- Decreased range of motion
If a patient experiences a shoulder dislocation, or demonstrates severe shoulder instability, prompt medical care should be sought. Medical care will be focused on returning the shoulder joint to its original position, otherwise known as reduction. Certain patients may experience reduction naturally without medical assistance. However, for those that require reduction via medical assistance, a physician will manipulate the dislocated shoulder and place the ball back into the socket.
Once the shoulder is in its proper position, Dr. Bedeir will examine the joint to assess the extent of damage. He will also perform specific tests to determine the severity and direction of shoulder instability. These tests will allow for an accurate diagnosis that will guide treatment decision-making. Aside from physical examination, an MRI and a series of x-rays may also be performed to define the extent of damage.
Treatment of a shoulder dislocation is dependent on the overall injury severity, past shoulder dislocations, patient age and patient’s activity level.
Following the dislocation, Dr. Bedeir will immobilize the joint in a sling or other immobilization device for several weeks in conjunction with a regular schedule of icing and rest. A physical therapy program is commonly suggested in order to strengthen the surrounding muscles, restore range of motion and improve symptoms of shoulder instability.
Dr. Bedeir may recommend a surgical procedure in cases of persistent shoulder instability or in those who are highly likely to have recurrent dislocation. Type of surgical treatment depends mainly on the severity of injury to the surrounding bone and soft tissue. Surgical treatment may be either arthroscopic or open depending on the appropriate type of surgical procedure. Soft tissue repair is performed arthroscopically while bony procedures require open surgery utilizing a 5-cm incision typically in the front of the shoulder.
Frozen Shoulder
Frozen shoulder, otherwise known as adhesive capsulitis, is a painful and troublesome shoulder condition which restricts normal joint movement and causes joint pain. This condition develops when the joint’s soft tissue begins to thicken and contract from scar tissue formation. In some cases, a “stiff shoulder” can cause a patient to lose complete joint function and range of motion. Dr. Yehia Bedeir is trained and highly experienced in treating frozen shoulder.
As the shoulder’s soft tissues begin to thicken and contract, scar tissue (adhesions) is formed. The scar tissue is responsible for creating pain and loss of normal shoulder function. Over an extended period of time, patients begin to move the shoulder less because of pain, leading to increased joint stiffness. The term “frozen shoulder” is used because the more pain a patient feels, the less likely to move the joint, which eventually causes scar tissue to thicken even more and “freeze” in position.
Adhesive capsulitis symptoms are divided into three distinct stages:
- “Freezing” stage- Lasting from six weeks to nine months, the shoulder becomes stiff and painful with loss of motion.
- “Frozen” stage- Lasting two to six months, the shoulder joint remains stiff but the pain level may lessen.
- “Thawing” stage- Lasting six months to two years, pain lessens and the shoulder gradually returns to normal joint function.
After reviewing a patient’s medical history and performing a physical examination, Dr. Bedeir will be able to diagnose adhesive capsulitis. He may also perform an MRI and series of x-rays to determine if loss of joint function and increased pain are associated with another shoulder condition or injury.
Dr. Bedeir begins frozen shoulder treatment with non-surgical measures such as rest, ice and medications in many cases. He may also prescribe a detailed physical therapy program to return full motion and function to the joint.
If non-surgical treatment does not alleviate symptoms, Dr. Bedeir may recommend arthroscopic shoulder surgery. This technique is designed to release tight areas within the joint. After the tight areas are released, scar tissue around the affected area are removed to relieve pressure. An aggressive physical therapy program must be followed after undergoing surgery for frozen shoulder to maintain full motion and joint function.
Anterior Cruciate Ligament (ACL) Injury
The anterior cruciate ligament (ACL) is one of the main ligaments of the knee joint and is responsible for preventing the tibia (shinbone) from sliding out in front of the femur (thighbone). An anterior cruciate ligament injury is quite common in the athletic population, especially athletes involved in sports that require sudden changes in directions and stops. Injuries can range from a simple sprain to a complete ACL tear requiring surgical intervention from Dr. Yehia Bedeir.
The ACL runs through the knee joint from the front of the shinbone to the back of the femur. This ligament plays an important role in anatomy of the knee. It helps maintain stability and provides protection to the knee’s menisci. An anterior cruciate ligament injury typically occurs in active individuals from a direct blow to the joint or from unnatural twisting and pivoting. When the ACL is stretched past its normal range of motion, the shinbone slides out from under the thighbone, causing an ACL tear or stretch. Roughly 50 percent of ACL injuries occur in combination with an additional injury, such as damage to the meniscus, articular cartilage, or other ligaments.
Patients often experience knee pain, swelling and limited range of motion following an anterior cruciate ligament injury. A slight sprain or stretch of the ligament may cause mild to moderate pain along with a slightly unstable sensation when the knee moves. An ACL tear may cause moderate to severe knee pain and swelling, as well as a “popping” sensation when the injury occurred.
If a patient believes they have experienced an injury to the ACL, Dr. Bedeir will begin the diagnosis with a thorough physical examination of the affected joint. He will perform a variety of tests in many cases to help confirm the anterior cruciate ligament injury. A series of x-rays and an MRI scan are usually performed to evaluate the soft tissues and bony structures of the knee joint in great detail. These diagnostic tests will also help Dr. Bedeir determine if additional injuries to the joint are present.
Treatment of an anterior cruciate ligament injury varies based on severity of ligament damage, as well as possible damage to other structures within the knee. The overall goal of treatment is to reduce pain and swelling and to restore stability and full function to the injured joint.
If the injury is not a complete tear and does not cause instability, Dr. Bedeir typically recommends non-surgical measures. Rest and ice are commonly recommended, along with modified activities, bracing and a detailed physical therapy program.
If the ACL is completely torn and causes knee instability, a surgical procedure may be recommended to reconstruct the torn ligament. Dr. Bedeir utilizes an arthroscopic approach to the knee in order to replace the torn native ACL with a tendon graft. Donor tendon grafts are usually harvested from the patient’s own tendons around the knee or around the ankle.
Meniscus Tear
The menisci are critical to the structure of the knee joint, acting like “shock absorbers” for the joint when it is in motion and put under stress. The small “c” shaped structures are located within the knee between the tibia (shinbone) and femur (thighbone). Each knee has two menisci, the medial meniscus and the lateral meniscus, both of which can experience a meniscus tear from a sports injury, a severe fall or a sudden twist of the knee joint. Dr. Yehia Bedeir specializes in the diagnosis and treatment of meniscus injuries to return patients to an active, healthy lifestyle.
The primary functions of the menisci are to distribute forces and prevent knee arthritis, as well as aiding the knee ligaments in providing joint stability.
A meniscus tear can vary in size, location and severity from patient to patient. A medial meniscus tear is a knee cartilage injury to the meniscus located on the inside of the knee. These tears often occur in combination with other knee injuries, such as an ACL or MCL injury. Medial meniscus tears typically occur due to excessive twisting and weight bearing pressure, commonly in sports activities. Lateral meniscus tears are less common than medial tears, but can also occur in combination of other knee injuries.
Depending on severity of the knee meniscus injury, pain will range from mild to severe in both medial and lateral cases of a meniscus tear. Patients also experience stiffness and swelling in many cases, as well as a sensation that the knee is going to lock up or get stuck in a certain position.
In order to diagnose a meniscus tear, Dr. Bedeir will perform a complete medical review and physical examination of the injured knee. During the examination, he will look for any changes in knee appearance or any deformities. He will also perform a variety of tests, including bending the patient’s knee and rotating the leg inward to assess the pain or clicking as the leg is straightened. This is referred to as the McMurray test. X-rays and an MRI scan are also commonly performed to look for additional joint damage and to confirm the knee meniscus injury.
The treatment of a meniscus tear depends on the type, size and location of tear as well the patient’s age and activity level. Dr. Bedeir may recommend nonperative treatment in some patients with meniscus tears such as those associated with arthritis and not associated with locking or a block to knee motion. These cases often improve and become less painful over time with treatment of the underlying arthritis. On the other hand, traumatic tears that cause a block to knee motion usually require surgery.
In cases of a traumatic meniscus tear, arthroscopic knee surgery may be recommended by Dr. Bedeir. During the procedure, two tiny incisions are made in the injured area and an arthroscope is inserted so that the injured area can be examined in great detail. After viewing the damaged area, torn pieces of the meniscus are repaired and/or removed. The decision to repair vs to remove the torn part of the meniscus depends on multiple factors including patient age, in addition to tear type and location.
Multiligament Knee Injury
Four major ligaments compose the knee joint and maintain stability when a patient is performing any athletic activities. The four ligaments all work together to prevent unnatural, excessive motion between the tibia (shinbone) and the femur (thighbone). When one or more of these ligaments experience damage, the joint loses its ability to function. Dr. Yehia Bedeir is highly experienced at treating a variety of torn ligament in the knee cases, such as a multi-ligament knee injury.
Many cases of a torn ligament in the knee involve only one tear, but certain patients may experience a tear in multiple ligaments during the same traumatic event. A multi-ligament knee injury is considered a severe injury and is commonly caused in an automobile accident, a fall from a great height or a direct blow to the joint during sporting activities. If more than one torn ligament in the knee occurs, the joint may become highly unstable and lose all mobility and function. The knee may also move out of its normal position and injure surrounding structures, such as an artery or nerve.
The four major ligaments of the knee include:
- Anterior cruciate ligament (ACL)
- Posterior cruciate ligament (PCL)
- Medial collateral ligament (MCL)
- Lateral collateral ligament (LCL), or fibular collateral ligament (FCL)
A multi-ligament knee injury is a very serious injury marked by pain, swelling, instability and joint deformity. Walking may become difficult, or even impossible, in some patients since the joint is not functioning as intended. Patients may also experience nerve and blood vessel damage during the traumatic event, leading to weakness, numbness and/or inadequate blood flow to the leg.
Patients are strongly encouraged to seek immediate care at a local ER if multiple torn ligaments in the knee occur. If the knee injury caused a dislocation, although a complete dislocation is rare, prompt medical care will allow a physician to reduce the joint, or place back in its normal position. Once the joint is in place, Dr. Bedeir will perform a complete medical review and physical examination of the injured knee. He will also perform a series of x-rays to examine the bony structures, as well as an MRI to examine full injury extent. The MRI scan will allow Dr. Bedeir to observe all of the surrounding soft tissues and determine which ligaments sustained damage, as well as damage severity.
A multi-ligament knee injury is almost always treated with surgery. Dr. Bedeir strives to perform the surgical procedure as quickly as possible to repair the damaged ligaments, to prevent further nerve damage and to improve overall mobility and function of the joint.
The overall goal of the surgical procedure is to repair all torn ligaments in the knee. Dr. Bedeir will utilize a variety of techniques to reattach and reconstruct the ligaments so the knee joint can return to its normal anatomy. Dr. Bedeir will discuss the surgical procedure for this knee injury in great detail at a patient’s first consultation.
Patellofemoral Pain Syndrome
The knee joint, one of the larger and more complex joints in the body, is where the patella (kneecap) meets the femur (thigh bone) and tibia (shin bone). The undersurface of the patella is lined with articular cartilage that allows the patella to painlessly glide up and down the trochlear groove with knee movement. Patellofemoral pain syndrome is a condition in which the nerves of the knee perceive pain within the soft tissues and bone surrounding the patella. This condition, also known as “Runner’s Knee”, is often caused by chronic use of the knee joint in intensive and repetitive physical activities such as running and squatting. Dr. Yehia Bedeir, has the knowledge and understanding, as well as substantial experience in treating patients who have experienced patellofemoral pain syndrome.
The knee joint, with its arrangement of bones, ligaments, tendons, and cartilage, can manage a significant amount of stress during daily and physical activities. Yet, with vigorous and chronic use of this joint, damage to these structures can occur. The following are some of the methods that can result in patellofemoral pain syndrome:
- Sudden changes in exercise routine. This can be a change in frequency, duration, or intensity of physical activities. This can also include changes in footwear or playing surface.
- Patellar malalignment. When the patella is pushed out of the trochlear groove on the femur, the patella and trochlea may experience more pressure causing irritation of the soft tissues. This abnormality can stem from malalignment of the legs, between the hips and ankles, or a high-riding patella (patella alta).
- Muscle weaknesses. The quadriceps muscle and quadriceps tendon are essential to knee movement. Any weaknesses or imbalances can lead to poor tracking of the patella within the trochlear groove.
A common complaint of patellofemoral pain syndrome is dull and diffuse knee pain that has gradually worsened. Pain when sitting with the knees bent for an extended period, or pain that worsens with physical activity, are other common complaints of patellofemoral pain syndrome. Some patients report a “popping” or “crackling” sound with knee movement after sitting for a long period of time.
A comprehensive medical history, including physical activity habits, will be obtained by Dr. Bedeir. A thorough physical examination will also be performed to evaluate the knee joint. Although patellofemoral pain syndrome is typically diagnosed with a physical examination and medical history, diagnostic imaging, such as x-rays, Computer tomography (CT) and magnetic resonance imaging (MRI), are sometimes requested to identify damage to any other structures within the knee joint.
Non-surgical treatment:
Most patients with a confirmed diagnosis of patellofemoral pain syndrome can alleviate symptoms with conservative therapies alone. A combination of RICE (rest, ice, compression, elevation) and non-steroidal anti-inflammatory medications (NSAIDs) are used to control the pain and inflammation associated with this condition. When appropriate, participation in a physical rehabilitation program aimed at strengthening the quadriceps muscle can improve knee range of motion. Taping the patella can also be used to relieve knee pain.
Surgical treatment:
Surgical intervention for patellofemoral pain syndrome is rare and reserved for individuals with severe pain not previously relieved with conservative therapies. One, or more, of the following surgical procedures may be implemented by Dr. Bedeir:
- The damaged fragments of the soft tissues are excised and removed arthroscopically. Any other abnormalities, such as inflamed tissues, bone spurs, or loose bodies, are also removed with this procedure.
- Lateral Retinaculum Release. The lateral retinaculum (fibrous tissue located on the outer patella) is released to help reposition the patella and alleviate tension on the outer knee.
- Tibial Tubercle Osteotomy. The tibial tubercle (bony prominence of the shin bone), with the patellar tendon still attached, is transferred to another position on the tibia. This removes the load off the painful portions of the knee cap and reduces the pain.
Posterior Cruciate Ligament Injury
Located in the center of the knee joint, the posterior cruciate ligament (PCL) is responsible for helping the knee remain stable during normal everyday activities and sporting activities. The PCL prevents the tibia (shinbone) from sliding too far backwards and keeps the tibia and femur (thighbone) in alignment. The PCL is considered the strongest ligament in the knee; therefore a PCL injury is not as common as other knee ligament injuries. Patients, especially those involved in contact sports, are at a higher risk of a posterior cruciate ligament tear since the knee has a higher chance of being hit when the shin is in a backwards position. Dr. Yehia Bedeir specializes in diagnosing and treating PCL injuries.
The cause of a PCL injury is typically when the knee joint is either hyperextended or forced directly backwards with the knee bent (flexed). This type of injury may occur when a basketball player falls on a bent knee or when a patient hits the dashboard in a bent position during an automobile accident.
Many patients who experience a PCL injury, such as a posterior cruciate ligament tear, typically report immediate swelling and pain in the injured knee. Certain patients may also experience decreased range of motion and increased pain when the joint is in movement. Patients may even report a feeling of instability when walking, usually associated with a severe PCL tear.
In order to diagnose a PCL injury, Dr. Bedeir will need to perform a physical examination on the affected knee, as well as a variety of diagnostic tests. A series of x-rays and an MRI scan are usually performed to examine the bony structures and soft tissues in great detail to confirm the grade of the posterior cruciate ligament tear.
Many cases of a PCL injury are treated more conservatively than cases of an ACL injury. In minor, small partial tears, Dr. Bedeir recommends rest and ice along with bracing, anti-inflammatory medications (NSAIDs) and a physical therapy program designed to increase range of motion and to strengthen the surrounding muscles.
If a posterior cruciate ligament tear causes instability of the joint or if symptoms do not improve with nonoperative measures, Dr. Bedeir may recommend surgery. A PCL reconstruction requires Dr. Bedeir to use a tendon graft from the tendons around the knee or ankle to reconstruct the damaged ligament, restoring knee function and stability. Higher level athletes often choose to undergo this procedure in order to continue competing.
Dr. Yehia Bedeir
Consultant of Orthopaedic Surgery
Reach at..
- Location 410 Abukir, Street, Egypt
- Phone 035430030
- Mob 01507509151
- WhatsApp 01507509151
- [email protected]
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