We recently sat down with Scott Arthur, M.D., sports medicine specialist at the Bone and Joint Institute of Tennessee to discuss innovations in the treatment of ACL (anterior cruciate ligament) tears.
Williamson Source: What is an ACL tear?
Dr. Arthur: ACL stands for Anterior Cruciate Ligament and is one of the two major ligaments in the center of the knee. The ligament stabilizes the knee during rotational or pivoting movements.
ACL tears are frequently non-contact injuries caused by being off balance while planting the foot and pivoting. This motion puts excessive stress on the joint, resulting in a tear. It’s most commonly an athletic injury, but can also result from daily activities.
WS: What can athletes do to prevent ACL tears?
Dr. Arthur: They are largely unpreventable, but there are some behaviors that we can attempt to modify in athletes––for example, the way you land from a jump or position yourself while changing direction. Hip, leg, and core strength as well as good flexibility can help support the joint.
There are some programs we recommend, especially for female athletes, that help recondition the athlete’s hip and knee position during athletic maneuvers and protect the knee. Female soccer players have a rate of ACL tears up to four times that of male soccer players. We know from studies that we can close the gap with functional training.
WS: What technological advancements in ACL repair surgery have there been in recent years?
Dr. Arthur: Our goal is to perfect ideal techniques to place the ACL graft in an anatomic position and continue to improve fixation devices.
Graft options are also being explored and there has been more recent enthusiasm about using the quadriceps tendon as an additional graft option. We have started to learn more about possible involvement of a capsular ligament on the outside of the knee called the ALL or Anterolateral Ligament of the knee. In certain at-risk patients and in revision settings, we can improve stability with reconstructing this ligament as well as the ACL.
There is also continued interest in possible uses of biologics at the time of ACL surgery. The goal is to research possible ways to ramp up the body’s ability to recover from injury and surgery. This is an exciting field but still in its infancy. Right now we have a lot more questions than answers.
WS: Can you describe the rehabilitation process following ACL reconstruction?
Dr. Arthur: At Bone and Joint Institute of Tennessee, we excel in the rehab and recovery process. Surgery is typically delayed until after the patient recovers for a few weeks from the initial injury. This allows for muscle tone to return and the knee to recover from trauma. Then, we will often start rehab on the same day of the surgery.
WS: How long does it take to recover?
Dr. Arthur: An ACL reconstruction is about a 45-minute surgery. As far as recovery, patients are on crutches for about three weeks until their gait pattern normalizes. After 10-12 weeks, the patient may start jogging. Then it’s typically 6-8 months before a return to sports.
During the latter part of rehabilitation, the focus is on agility training and sports specific exercises.
The last several years we have also utilized a return-to-play assessment tool called DorsaVi. We place sensors on the patient and have them perform different agility drills such as jumping and cutting. This gives information as to whether the athlete has the strength and coordination to maintain a safe knee position during sports. I think we’re doing a better job assessing when someone is safe to go back to play with these tools.
While recovery can be lengthy, we have to fix these injuries in active patients. An ACL tear can affect your knee long-term. If we don’t reconstruct the ACL, there’s a high likelihood of the knee giving way again, and that can cause more long-term knee damage, especially to the meniscus.
Advanced Orthopaedic Care at The Bone and Joint Institute
For more information about sports medicine or to schedule an appointment with a physician at The Bone and Joint Institute of Tennessee, call (615) 791-2630. New and returning patients may also schedule an appointment online.
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