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Dr. Harlan Selesnick is in private practice in orthopedic surgery and sports medicine at Doctors Hospital in Coral Gables. He serves as team physician for the Miami Heat, Miami and Dania Jai Alai, Miami Dade College, the USTA, and the Sony Ericcson tennis championships. He also is director of the ACGME accredited Miami Sports Medicine fellowship.
Submitted by Anonymous from Pembroke Pines, FL
Q: Hello, I am a 32 year old female who, about a month ago, tore her ACL playing kickball. My doctor states that having surgery would depend on my level of activity prior to the injury. I am pretty active, especially with a 1 year old and a 4 yeard old. I have being doing rehab to strengthen my leg and prepare myself for possible surgery (which once scheduled will not take place until May.) What are your thoughts on "autograft vs allograft"? Also, is the surgery completely necessary? Please let me know. Thank you in advance.
Answered 03/07/08 03:37:10 by Dr. Harlan Selesnick
A: Not everyone who tears an ACL(anterior cruciate ligament) needs surgery to reconstruct the acl. It depends upon the age of the patient, the activity level, the degree of instability, and the other damage the knee has sustained. If after rehab your knee feels unstable then surgery is indicated. There are multiple techniques for acl reconstruction. Most involve your own tissue( hamstrings or patellar tendon) autograft. The other popular method involves the use of cadaver tissue(allograft). The advantages of your own tissue include no risk of disease transmission, easier to size the graft, and posssibly earlier revascularization of the graft. The advantages of the allograft include less pain, smaller scar, no weakening of your hamstrings or patellar tendon, and easier and faster rehab. The risk of disease transmission (HIV, Hepatitis, Infection is likely less than 1 in a million. Recent studies suggest that both autografts and allografts have similar success rates in terms of stability and function. I suggest you discuss this further with your orthopedic surgeon. Good luck. Harlan SelesnickSubmitted by John k from Bremerton WA
Q: Hello, My 15 year old Son hurt his back last year playing football. After a positive straight leg raise test our Doctor ordered and MRI which revealed a 2-3mm central posterior disc protrusion at L5-S1 with mild indentation of epidural fat.The Doctor who read the MRI said his back actually looks pretty good. He has had no symptoms at all since a week or so after he hurt his back. He has been doing side bridges, bird dog's and a form of crunches that does not flex the lower back for core strength. He is 5' 10" and 190lbs and a star athlete in football and wrestling. My question is should he be doing squats at any weight? Would a low weight like 100lbs be ok if form was perfect? So far I haven't allowed him to do any. Thanks
Answered 03/01/08 18:26:28 by Dr. Harlan Selesnick
A: Full squats may put your son's back at risk. Heavy weights and full squats may also result in kneecap or meniscal injuries. Therefore I don't really recommend this exercise. Your spine specialist who treated your son may be more helpful in having a therapist design a conditioning program for your son to help prevent new injuries. Good luck. Harlan SelesnickSubmitted by AL from augusta,ga
Q: hello, i'm a 44 year old retired army soldier. about 5 weeks ago i fell off my father's 4 step porch. 2-3 days later my left knee started to swell and hurt. i applied ice and took pain medicine. later i went to the doctor they took x-rays no broken bones. The pain is still there hard to walk and can not bend my knee, will have mri soon. What could be the problem?
Answered 02/11/08 21:39:29 by Dr. Harlan Selesnick
A: It is possible you sustained a meniscal cartilage tear, a ligament tear or a bone contusion. Depending upon what you injured will determine whether rehab, bracing, rest or surgery will be needed. The mri scan should be helpful in establishing the diagnosis. Good luck. Harlan SelesnickSubmitted by Gary from Mingo Junction, Oh
Q: Hello, I was told by my chiropractor that i have intevertebral foraminal encroachment at the 5th lumbar. If chiropractic care does not eventually help can you tell me if there has been any other areas of success for treating this problem such as maybe surgery?? thanks Gary
Answered 01/29/08 20:55:15 by Dr. Harlan Selesnick
A: Many patients as they get older develop narrowing of the spinal canal or where the nerve roots exit the spine(foramen). Many of this conditions are long standing and get better with a variety of non surgical treatments. If these fail then surgery may be an option. I recommend you see a neurosurgeon or orthopedic spine specialist if you don't get better from your chiropractor. Harlan SelesnickSubmitted by Anonymous from Vestal, N.Y
Q: I am post L1 compression fracture, no disc problems. I have had a lot of stomach problems since.. slight neusea, gas, gastro pain..What's up with that? I'm trying to take as little pain meds as possible.. mostly motrin. Also I'm 10 days post injury, (not an osteo fracture),, can I start to use my stationary bike with no resistance.. will it help in healing?
Answered 01/29/08 20:52:02 by Dr. Harlan Selesnick
A: Occasionally bowel problems can develop post lumbar fractures or spine surgery. You should discuss this with your spine specialist. I think it is too early to return to cycling and your physician should outline when it is safe for rehab and sports activity. Good luck. Harlan SelesnickSubmitted by richie from davie fl
Q: hi there last may i hurt my back i went to see a chiropractor he seen me 4 0r 5 times and referred me to a orthopedic which sent me to have a nerve block which did nothing then i started physical therapy which helped my cardio but did nothing for my back i was then sent to see a back surgeon which told me that i needed a level 2 fusion but said i was not in bad enough shape for him to do it iam still in pain i have pain real bad in my hips can you please give me advice thankyou
Answered 01/22/08 20:57:52 by Dr. Harlan Selesnick
A: You may want to get another opinion from a back surgeon. Please bring copies of your x rays and scans with you for the opinion. If all non surgical treatment fails(rest, rehab, meds, blocks,etc.)then surgery might be an option. Good luck. Harlan SelesnickSubmitted by Barry from Fort Pierce, FL
Q: Hello Dr. Selesnick, I am currently obtaining my bachelors degree and would like some advice on how to get to the position that you are.Please any info from one of the elite NBA doctors would be apprecitated.thanks.
Answered 12/24/07 21:16:27 by Dr. Harlan Selesnick
A: I have been fortunate that I have a nice orthopedic surgery practice and the opportunity to treat many elite athletes. For you it starts with doing well in college particularly in the pre med requirements. A good MCAT score and some exposure to medicine will also help your application to medical school. After 4 years in medical school you will need a 5 year orthopedic surgery residency followed by a 1 year long sports medicine fellowship. after fellowship hopefully you can join a medical practice with a sports medicne following. Then hard work, good results and timing will hopefully allow you to fulfill your professional goals. Good luck. Harlan SelesnickSubmitted by stephanie from queen creek az
Q: I am 27 years old, have had a car accident, went to a chiropractor, 6 months (give or take) the middle of my back was aching all the time, like I had to stretch it. Then I would get shooting pain down my right leg, and it would go "dead" now I still have those, getting worse and a horrible dull aching pain in my lower back, my emg turned normal, my neurologist prescribed voltaren and neurontin, didn't do anything and made me sick, so I stopped them. As of now I am still hurting, especially after about 3, 4pm it gets REALLY bad, I have nothing for the pain and I am about to tear out my hair. What should I do? I am waiting for my insurance to approve an MRI but what do I do in the meantime??? I have been taking Ibuprofen like candy fo over a year, I TOLD my dr this, and she prescribed me IBU 800's.... duh! what was she thinking?????
Answered 12/24/07 21:01:12 by Dr. Harlan Selesnick
A: It is unfortunate that you have not been able to get your mri scan. It may show why you are having such back and leg pain. The medications you are taking may be helpful. However, an accurate diagnosis is most important so an effective treatment plan can be implimented. I would push your insurance company to be more responsive. Good luck. Harlan SelesnickSubmitted by Marianne from Salt Lake City, UT
Q: Can you tell me some figures (or where I would go to find some figures) on MCL tears in the knee in the major sports (like Hockey, Soccer, Football, Basketball, Baseball, etc.)?
Answered 11/30/07 18:54:52 by Dr. Harlan Selesnick
A: The american college of sports medicine(ACSM.org) and the american orthopedic society of sports medicine(AOSSM.org) have websites that can tell you about injury rates in sports. However, these are not ususally broken down by specific injury(such as MCL) tears. Medial collateral(MCL) injuries are common in football, soccer, hockey, and skiing.Submitted by Bill from hemet
Q: Question: 27 years old, I recently had an MRI done on my middle and lower back. I had been experiancing a lot of pain in my middle back. Here our my results: L3-L4 2 to 3 MM Posterior disc protrusion, Disc dessication present L4-L5 2 MM Posterior disc protrusion, Disc dessication present L5-S1 2 to 3 MM Posterior disc protrusion T11-T12 1 to 2 MM Posterior disc protrusion The doctor that I am seeing said these results are normal and that everyone has pain and to just deal with it. I have been doing physical therapy for 2 months and my middle back still hurts all the time. It is hard for me to stand for more than 30 minutes. What do you think my options are at this point.
Answered 11/19/07 15:55:51 by Dr. Harlan Selesnick
A: It is true that many people have disc protrusions or herniations without pain or other back symptoms. However, it is not normal to have chronic pain which may or may not be related to your disc abnormalities. I recommend you get a second opinion from a spine specialist in your area as there are other treatments that may be effective in relieving your pain. Good luck. Harlan SelesnickSubmitted by Anonymous from No location specified
Q: Not a question, just happened on this web page and saw your name. I was a patient several years ago with a broken wrist, a pretty bad break, and you fixed it. I was in a Masters program at the time. Just want to say thanks again. I can't even tell it was ever broken and never had any problems with it once therapy was finished. You spent time explaining everything to me. I came in scared about finishing school and you really made a bad experience, not so bad. Thanks for the wonderful care you gave me.
Answered 10/24/07 21:16:31 by Dr. Harlan Selesnick
A: Thank you for your kind words. I am glad it turned out so well. Good luck. Harlan SelesnickSubmitted by Joe from Nassau, Bahamas
Q: I'm 42, 150 lbs. I had an MRI after severe left leg pain. It showed herniated disks (L4-5 &L5-S1) which I'm told requires surgery because of "ventral thecal indentation & bilateral neural foraminal encroachment". I would prefer non-surgical alternatives. Also, I am very anxious to resume participation in weightbearing activity, which the orthopedic surgeon, acupuncturist and chiropractor say is a no-no. Is my preference for no surgery a realistic one? Thanks so much for any attention you can give.
Answered 10/08/07 01:54:13 by Dr. Harlan Selesnick
A: It is not possible to say whether you have a good alternative to surgery without examining you and reviewing the mri scan. Depending upon the degree of weakness, the size of the spinal canal, the degree of disc herniation and your expectations wpuld factor into the best decision. YOu may want to get a second opinion from another spine surgeon prior to deciding what to do. Good luck. Harlan SelesnickSubmitted by cody from jupiter, florida
Q: i have a full thickness tear of my acl from the frontal attachment, a medial meniscal tear and bone contusion. i am not active in sports right now although I used to be very much. Is it possible for me to avoid surgery and undergo physical therapy or not?
Answered 10/08/07 01:50:40 by Dr. Harlan Selesnick
A: Not everyone who tears an acl needs reconstructive knee surgery. A rehab program and custom acl bracing for pivoting activities may be an option. You should discuss this with your orthopedic surgeon. If conservative treatment fails then surgery can be performed at that time. Harlan SelesnickSubmitted by zeo from Oakland Park FL
Q: My ACL is "near absent in a pattern reflective of prior ACL tear in the substance with secondary ligament atrophy and probable ACL insufficiency." I must have torn it 12 years ago while performing martial arts. My surgeon back then did not order an MRI. He said the cartilage was torn and he repaired arthroscopically. My current surgeon ordered an MRI. It also shwed that I have mild degenerative joint disease and patellofemoral compart chondromalacia along the medial and patellar facets, grade 2 in character with grade 3 pattern change along the central mid to superior aspect of the femoral trochlear groove. He said surgery to repair the ACL would be major. My other option is to stop running. My question is Is the ACL really necessary? I'm passionate about running, but I will stop rather than have major surgery. I'm 39, female.
Answered 10/08/07 01:47:59 by Dr. Harlan Selesnick
A: Not everyone who tears an acl needs surgery. A lot depends upon the degree of instability , age activity level, and the sports you want to play. If your knee is not painful or buckling you may not need surgery to run. I recommend you speak further with your orthopedic surgeon or consider a second opinion. Good luck. Harlan SelesnickSubmitted by sharon from Parker, Colorado
Q: I fell down uncarpeted stairs nearly 2 years ago and got a severe bruise on my shin. X-rays confirmed that it was not broken, however, I still have dark discoration and a large "dent" in the muscle at the sight. I also have obtained a new bruise near the same sight that I don't recall getting, but it is not returning to normal color after about 6 weeks. Should I be concerned?
Answered 10/08/07 01:45:09 by Dr. Harlan Selesnick
A: It is likely the discoloration and dent will be permanent. You can discuss this with a plastic surgeon or dermatologist to know for sure. Harlan Selesnick
