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CLASSIC LIST

30/Sep/2014

ACL injuries or Knee ligament injuries are seen commonly by the best orthopedists in town, as these injuries often times occur in aggressive or elite level San Diego athletes that yearn to return to play.

acl-injury-sports

Anterior Cruciate Ligament (ACL) injuries or simply ACL injuries happen to hundreds of thousands of people every year.  ACL  injuries usually end play and can be extraordinarily painful. Although debilitating, they are treatable. You just have to make sure you know how severe your injury is and what you can do to treat the problem.bruised-knee-contusion

ACL injuries are actually quite common among people who participate in high action cutting sports, such as:

  • Soccer
  • Football
  • Basketball
  • Lacrosse

Levels of Severity with ACL Injuries

There are three categories of injuries based on what kind of damage has been done to the ACL:

  1. Grade 1 ACL injuries: This is the easiest ACL injury to heal. A grade one ACL injury is the result of the ligament stretching slightly. It does not cause the knee joint to become unstable.
  2. Grade 2 ACL injuries: This grade of injury is in the middle, and the least common of all knee injuries. A grade two type of injury happens when the ligament stretches to the point where it is unstable. It is more commonly known as a partial tear.
  3. Grade 3 ACL injuries: This ACL injury is the most severe. A grade three injury is labeled when the ligament is completely torn in half. This can cause the knee to become extremely unstable. Severe knee pain and an almost impossible time walking are common symptoms.

acl-tear-grades

At the end of the day, the grade doesn’t really matter.  To an orthopedist this injury boils down to those athletes that are able to compensate (ie, their knee is functionally stable) and those that can’t (ie, their knee is functionally unstable). Having a functionally stable knee means that that athlete is able to return to his/her level of customary play in cutting sports without the knee giving out.  Generally speaking, one third of athletes will be able to return to play despite their injury with little to no intervention; one third of athletes will be able to return to play after engaging in directed physical therapy without surgery; one third will require surgery in order to return to play due to continued knee instability despite physical therapy.

Treatments for ACL injuries

Non-Severe ACL Injuries

If you only have a mild injury, you can, usually, use physical therapy to treat your injuries. Your physical therapist will have you go through a series of exercises and motions to help you regain full control of your knee again. It can take some time to heal completely, depending on the injury type.

Since this is so common with sports athletes, there are specialists who work specifically with athletes. The goal is to help them get back into their sport of choice as quickly as possible.

Severe ACL Injuries (ie, unstable knee)

One third of the athletes will require surgery to regain a stable knee, despite having engaged in physical therapy.  With a physical examination and an MRI scan, a well-trained sports medicine surgeon can anticipate the need for treatment of various concomitant injuries: cartilage damage, meniscus tears, etc.  severe-acl-tear

ACL reconstruction can be done in a variety of ways.  First decision to be made is whether a patient chooses to use their own tissue or donor tissue to reconstruct the ligament.  If a patient chooses their own tissue, the options are bone-patellar tendon-bone, or hamstring tendon, or quadriceps tendon.  Although some surgeons may argue that one type of tissue is superior to the other, many studies have looked at this and there is little to no clinical difference.

If you have been told that you have an ACL tear or are concerned about a knee injury, contact our award winning sports medicine doctors at San Diego Orthopedic Surgery Clinic.

 


26/Sep/2014

ACL injuries or Knee ligament injuries are seen commonly by the best orthopedists in town, as these injuries often times occur in aggressive or elite level San Diego athletes that yearn to return to play.

acl-injuries-nfl

Anterior Cruciate Ligament or ACL injuries happen to hundreds of thousands of people every year. This knee ligament injury usually ends play and can be extraordinarily painful. Although debilitating, they are treatable. You just have to make sure you know how severe your injury is and what you can do to treat the problem.

ACL injuries are actually quite common among people who participate in high action cutting sports, such as:

  • Soccer
  • Football
  • Basketball
  • Lacrosse

Levels of Severity with ACL Injuries

There are three categories of injuries based on what kind of damage has been done to the ACL:

  1. Grade 1: This is the easiest ACL injury to heal. A grade one ACL injury is the result of the ligament stretching slightly. It does not cause the knee joint to become unstable.
  2. Grade 2: This grade of injury is in the middle, and the least common of all knee injuries. A grade two type of injury happens when the ligament stretches to the point where it is unstable. It is more commonly known as a partial tear.
  3. Grade 3: This ACL injury is the most severe. A grade three injury is labeled when the ligament is completely torn in half. This can cause the knee to become extremely unstable. Severe knee pain and an almost impossible time walking are common symptoms.

At the end of the day, the grade doesn’t really matter.  To an orthopedist this injury boils down to those athletes that are able to compensate (ie, their knee is functionally stable) and those that can’t (ie, their knee is functionally unstable). Having a functionally stable knee means that that athlete is able to return to his/her level of customary play in cutting sports without the knee giving out.  Generally speaking, one third of athletes will be able to return to play despite their injury with little to no intervention; one third of athletes will be able to return to play after engaging in directed physical therapy; one third will require surgery in order to return to play due to continued knee instability.

Treatments for ACL injuries

Non-Severe ACL Injuries

If you only have a mild injury, you can, usually, use physical therapy to treat your injuries. Your physical therapist will have you go through a series of exercises and motions to help you regain full control of your knee again. It can take some time to heal completely, depending on the injury type.

Since this is so common with sports athletes, there are specialists who work specifically with athletes. The goal is to help them get back into their sport of choice as quickly as possible.

acl-injury

Severe ACL Injuries (ie, unstable knee)

One third of the athletes will require surgery to regain a stable knee, despite having engaged in physical therapy.  With a physical examination and an MRI scan, a well-trained sports medicine surgeon can anticipate the need for treatment of various concomitant injuries: cartilage damage, meniscus tears, etc.

ACL reconstruction can be done in a variety of ways.  First decision to be made is whether a patient chooses to use their own tissue or donor tissue to reconstruct the ligament.  If a patient chooses their own tissue, the options are bone-patellar tendon-bone, or hamstring tendon, or quadriceps tendon.  Although some surgeons may argue that one type of tissue is superior to the other, many studies have looked at this and there is little to no clinical difference.

If you have been told that you have an ACL tear or are concerned about a knee injury, contact our award winning sports medicine doctors at San Diego Orthopedic Surgery Clinic.


06/Aug/2014

Some people wonder what happened to the Tennessee Titans RB Chris Johnson (CJ2K)Did you know that CJ2K played a majority of the season on a torn meniscus last year? Yup, it’s true, since week 3 on the NFL season, CJ2K played on a meniscus tear. If his silver-plated teeth weren’t a dead give away, then playing on a symptomatic torn meniscus does Mr. Johnson is the real deal…he is as tough as they come.

To understand toughness that it would take to play on a torn meniscus, you must first understand the meniscus itself. The meniscus is essentially a wedge of cartilage in your knee. This tough and rubbery meniscus acts as a shock absorber between the femur and the tibia. In layman’s terms, the meniscus is a cushion between the thighbone and the leg bone. An intact meniscus is essential for proper cushioning and stability. When the meniscus is torn, there will be significant pain and swelling.  It can cause a sharp searing pain that will bring you to your knees…literally.  It can cause instability which can lead an athlete to fall. One of the worst feelings when dealing with a torn meniscus is the feeling you get when you place the brunt of your weight on that knee. It almost instantaneously does one of two things, locks up or gives out. Now imagine running for 1,000 yards and 6 touchdowns against an NFL defense on one of those bad boys. Gives you a new respect for CJ2K, doesn’t it?

 

There are two real ways to treat a torn meniscus and neither of them involves continuing to use your knee the way that Chris Johnson did. Non-surgical treatment involves the age-old acronym RICE. Rest, ice, compression, and elevation. This is pretty standard protocol for any inflammatory process.  Measures like these can work for what is called a “degenerative tear”.  Much of the scientific studies today talking about how arthroscopies aren’t helpful are targeting treatment of degenerative tears.  However, acute meniscal tears that occurs in relatively younger athletes usually happens as a result of a twisting or pivoting maneuver.  The tears usually require an arthroscopy for symptom relief. Knee arthroscopy is one of the most common orthopedic procedures involves the use of miniature cameras and surgical instruments to repair and/or clean away the tear. After a successful surgery comes a tremendous amount of rehabilitation.  Rarely, meniscus tears are actually repairable.  This is a special kind of tear that can actually be repaired.  We can use platelet rich plasma (PRP) clots to augment the healing.  The rehabilitation process for repairs takes longer but is well worth it.  After a meniscus repair, the athlete will need a month on crutches followed by range of motion and strength exercises. The total rehabilitation time is approximately 3 to 4 months.

 

So what does this all mean for our 2009 fantasy football MVP, Chris Johnson? He had a successful meniscus repair surgery at the end of January and was completely rehabilitated by training camp.  He gets a change of scenery as he heads to the run-happy New York Jets. To expect another 2,000-yard season would be foolish, but to think that he will bounce back to be the back we all thought he was, is not completely out the realm of possibilities

 


24/Jul/2014

ACL tears that undergo delayed intervention can lead to further cartilage and meniscus damage. Although many such injuries eventually earn a referral for orthopedic knee surgery, it’s not unusual for kids and their parents to wait several weeks to see how the healing process is going on its own.  ACL tears don’t heal.  The inflammation that is caused by an injury may improve.  But the athlete remains indefinitely vulnerable to recurrent episodes of knee instability.  The knee repeatedly giving out puts the young athlete at risk of further damage with meniscus tears and cartilage loss.

Now researchers think too much caution may be unwise:

Compared to children who had surgery within six weeks, those who had surgery six to 12 weeks after their ACL injury were 45 percent more likely to have a lateral meniscus injury – on the outside of the knee – and those waiting more than 12 weeks were almost three times more likely to have a lateral meniscus tear.

Children who waited at least six weeks for surgery were about four times more likely to have a medial meniscus tear – on the inside of the knee – than those who had prompt treatment, Anderson said.

It is a stark finding, but one which makes sense on its surface: when trauma occurs, often the best chance to reverse its potentially ongoing damage is to hasten the repair process right away.

If you or your child has suffered an ACL tear, I recommend seeing an expert San Diego orthopedic surgeon sooner rather than later.  The longevity of your knee may be at risk.


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow