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.


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.


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.


ACL tear can happen to proathletes or the teenage competitive soccer player scrimmaging in a Carlsbad park on a sunny  San Diego Sunday afternoon.Isaiah-Pead-acl-tear

Arguably the most volatile position in the NFL is the running back. Injuries, everyday wear and tear, and age can shorten the career of a running back. For Isaiah Pead, the end could be near. He was a top five running back in the 2012 NFL draft. He has been off and on injured, had some off-the-field issues, and has been overall underwhelming when he is available to play. Unfortunately for Pead, his career outlook just got even bleaker as he has suffered a season ending injury during a preseason kickoff return. Pead was running down field full speed when his feet got tangled and he went down. The result: an ACL Tear.  This knee ligament injury will stop you in your tracks.  Most athletes report hearing and feeling a pop and then they go down.acl-tear-san-diego

The ACL or anterior cruciate ligament connects the front of the shinbone (tibia) to the middle of the kneecap (patella). The main purpose of the ACL is to provide rotational stability and to prevent the shinbone from getting too far ahead of the thighbone (femur).

Sometimes ACL tear can occur as a result of direct contact with the knee, but more times than not, an ACL tear is a non-contact injury such as in the case of Isaiah Pead. The cause of this non-contact injury is often due to rapid direction changes, sudden stops and decelerations, as well as incorrect landing and pivoting. The symptoms of a ACL Tear include knee pain, knee swelling, knee discomfort, knee tenderness, and decreased range of motion in the knee.

If a knee injury has occurred, an orthopedic physician will compare the structures of your injured and your non-injured knee and in most cases this is sufficient enough to diagnose ligament tears. However, the doctor will sometimes schedule an x-ray and an MRI in order to dismiss potential confounding problems, to validate the diagnosis, and to determine the degree of the injury.

Treatment for an ACL tear is dependent upon the severity of the injury. Grade I sprains involves overly stretched but still in tact. Grade I sprains typically require keeping the weight off the affected leg. Once the swelling has subsided, a physical therapy regimen will be prescribed. These exercises are meant to strengthen the leg muscles that support the ACL. Grade II sprains involves the ACL being stretched to the point that it has become loose. Grade II sprains are a little trickier to handle because they may or may not require surgery depending on lifestyle of the patient. The non-surgical approach is similar to that of grade I sprain but generally this is a longer process since these sprains are more severe. The surgical approach involves the rebuilding of the ligament via a tissue graft followed by rest and physical therapy. Grade III sprains occur when the ligament has been completely split into two pieces. In grade III sprains, surgery is required to rebuild the ligament. The recovery time for ACL surgery is often six to nine months. The prognosis for surgical recovery is positive and many athletes are able to return to their respective sport at near pre-injury form.ACL-Tear-Grades

As for Isaiah Pead, there is a very good chance he will make a full recovery, but considering his career thus far, it is doubtful he will ever become the player we once thought he could be. Then again, sometimes a player needs to hit rock bottom before they can really begin to understand what it takes to make it, maybe this, will be his wakeup call.

If you have been told you have an ACL tear or are suffering from knee pain, contact our top sports medicine specialists at Orthopedic Surgery San Diego to obtain a consult and be treated they way you deserve!




Many of our Carlsbad and North County San Diego competitive soccer players sustain ACL tear every year.  Even though, sports medicine specialists take measures to prevent such devastating knee injuries, a twisting injury to the knee suffered by the Arizona Cardinals’ Darnell Dockett is just the latest ACL tear to sideline a professional athlete.acl-tear

ESPN reported that Dockett, a defensive tackle, damaged the knee when his foot caught in the turf during training camp in Tempe, Ariz. Following an examination, doctors scheduled Dockett for surgery. Just a few days earlier, Rams quarterback Sam Bradford sustained an ACL tear  as a result of a hard hit by a defensive lineman. Both players are out for the season.  The risk of sustaining such knee injuries and other ligament tears are somewhat preventable with proper core strengthening.  acl-tear-knee-injury

ACL is short for anterior cruciate ligament, connective tissue that extends from beneath the femur (thigh bone) to the top of the tibia (the large bone in the lower leg). The smallest of the four main ligaments in the knee, it stabilizes the knee for rotational movements. The ACL enables a person to make fast “cuts” while running. It is rarely stressed during activities like jogging that do not involve sudden stops, twists or turns.

ACL tear and sprains were once referred to as “trick knees.” They occur frequently in football, basketball, soccer and tennis because of the pressure and repetitive stress that athletes put on their knees. Most of the 250,000 to 300,000 ACL tear injuries reported in the United States each year involve people who play sports. The odds of an athlete spraining or tearing an ACL reportedly is about 1,000 to 1.

ACL Tear Types:

A Grade 1 ACL tear features a ligament that has been stretched too far. It does not usually prevent normal use of the knee. A Grade 2 sprain results from the ligament being stretched to the point that it is loose. This condition also is called a partial tear. The most serious ACL tear injury, a Grade 3 sprain, is a complete tear, in which the ligament is severed and the knee becomes unstable.acl-tear-grades

The ways that Dockett and Bradford hurt their knees were typical. ACL tears result from changing direction too quickly or stopping suddenly, landing wrong on the knee after jumping, and the blunt-force trauma of a blow to the joint or a collision. When an ACL tear occurs, the person might hear a popping sound in the knee. The joint gives out and quickly becomes inflamed. This causes a great deal of pain, as well as loss of mobility and range of motion.

While a mild sprain sometimes heals without surgery, an ACL tear must be repaired for a patient to regain full use of the knee. It is not possible to merely stitch back together the two pieces of a severed ligament. Orthopedic surgeons reconstruct ACLs by grafting tissue from the patellar tendon (with attaches the kneecap to the shine bone), the hamstring tendons (in the back of the thigh) or the quadriceps tendon (which runs from the kneecap to the thigh). Tissues from cadavers also are used.

The arthroscopic procedure requires only small incisions in the skin. Surgeons insert miniature instruments, which they manipulate to graft the tissues. Patients experience less pain, and recover more quickly, than they would if more invasive surgery were needed. Sometimes, ACL injuries happen in conjunction with damage to other ligaments or cartilage. That can necessitate more extensive surgical procedures.  You don’t have to live with the knee pain and instability.  Contact our Orthopedic Surgery San Diego Sports Medicine specialists to help you regain your mobility and be the best athlete you can be.



One of the most common sports related injuries is a torn ACL (Anterior Cruciate Ligament). Many people think that ACL injuries happen mostly in contact sports but the truth is that a majority of ACL injuries occur without contact. One example of a non-contact ACL injury was during a recent major league baseball game. Los Angeles Dodgers pitcher Paul Maholm ran to cover first base on a relatively routine ground ball. Maholm arrived at first, planted the toes of his right foot on the edge of the bag and then went down riving in pain and reaching for his right knee. After watching the replay about a dozen times it is still hard to say that anything even truly happened. However, within a day it was confirmed that Maholm had a complete ACL tear. A simple misstep and his whole season is over.

The ACL is one of four major ligaments that help to align and stabilize the knee. The knee is the point at which thighbone (femur), shinbone (tibia), and kneecap (patella) meet. The ACL attaches the center of the kneecap to the front of the shinbone. The function of the ACL is to assure proper alignment of the shinbone and thighbone. In addition, the ACL provides very important rotational stability. Like many other ligament injuries, ACL injuries can be diagnosed by severity. Grade 1 ACL sprains are considered mild and involve the ACL being stretched but not detached. With grade 1 ACL sprains, the ACL is still capable of stabilizing the knee joint. Grade 2 ACL sprains are moderate or partial tears and occurs when the ACL is stretched to the point of becoming loose. Grade 3 ACL sprains are the most severe of the ACL injuries. Grade 3 ACL sprains occur when the ACL is completely torn into two separate pieces making the knee joint very unstable.

Grade 1 and some grade 2 ACL sprains can often be treated without surgery as long as instability symptoms are at a minimum. The process of healing involves a heavy regimen of progressive physical therapy but can often restore the ACL close to its pre-injury form. For a more severe tear or what is called a ‘complete tear’, surgical reconstruction is the only way to achieve pre-injury form if there are symptoms of instability. Instability is when the knee gives away or buckles. The ACL is replaced using a tendon graft typically from the patient’s patellar tendon, hamstring tendon, quadriceps tendon, or from various cadaver tendons. The success rate of ACL replacement is tremendous and many athletes come back after surgery and rehabilitation to perform similar to their pre-injury performance. One such example of this was Minnesota Vikings running back Adrian Peterson. Peterson nearly broke the NFL rushing record just one year after suffering a complete tear of his ACL and MCL.

As for the case of Paul Maholm, his surgery has not yet been scheduled, but should be scheduled soon. Given the recent success of professional athletes on surgically replaced ACLs, I have no doubt that we will see Paul Maholm on the mound for the start of the 2015 season.


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



This interesting piece caught my eye recently: a first-person account of an orthopedic surgeon’s visit to China. Its author relays a great deal about how the sports medicine specialists there accommodate the nation’s high volume of patients and occasionally insufficient supply of tissue:

When it comes to performing biologic orthopedic procedures using human donor tissue, the situation is challenging. Donor tissues are in short supply and the supply chain is not trusted. This has led to high doses of irradiation being used to sterilize the tissues. Unfortunately, the radiation also ruins the quality of the tissue by cooking it. This is possibly one area where we may be able to help by providing an off-the-shelf device solution.

Some feel that using animal tissues might represent at least one solution, although there is no question that improving the medical infrastructure overall would offer some essential relief throughout the nation.

What stands out from the piece is the singular dedication physicians and surgeons around the world bring to their practice, even when limitations render certain best practices difficult to follow.

I am grateful to serve my orthopedic surgery patients in San Diego, and to offer the gold standard in knee surgery and rehabilitation. To learn more about some ways you can relieve knee pain today, please contact a San Diego orthopedic surgeon.


One can’t spend much time in the field of orthopedic surgery without noticing countless mentions across every section of the newspaper. This month alone brought a fine set of case studies in the power of knee surgery and its transformative effect on active lives.

In my last post I covered the NFL, so this week let us take a small detour here into the world of cinematic icons and discuss the case of Dame Judy Dench. The legendary actress underwent knee replacement surgery in September and is already performing live and walking red carpets with aplomb. My favorite recent quote from the notoriously feisty 78-year-old: “I’m not feeling my age at all. I am about 43, a tall willowy blonde 43-year-old with long legs.”

Meanwhile the sports section brings us news of the Magic’s Solomon Jones, whose torn meniscus has left him sidelined and primed for surgery. The most likely option given his injury is arthroscopic knee surgery, which should involve some reconstruction and rehabilitation to help minimize any deleterious and lasting longterm effects of the meniscus tear.

And of course there is this new athletic power couple, who share the dubious honor of having both undergone knee surgery. Tiger Woods returned to form as expected, and Lindsey Vonn is currently enjoying a full complement of races on the way to this winter’s Olympics in Sochi:

Knee surgery is an orthopedic surgical procedure that comes in many forms. It remains a stalwart of our profession and one of the best-studied interventions we have for knee injuries. If you are suffering from impaired movement, comfort or balance due to pain in your knees, contact me at the San Diego Orthopedic Surgery center today to learn about your options to return to play and enjoy your youthfulness.


Orthopedic surgery and sports medicine are demanding disciplines, highlighted by a constant stream of innovative medical technologies. As an experienced orthopedic surgeon here in San Diego, I field a lot of questions from my patients about how to treat sports injuries and musculoskeletal pain. Although I make time to answer questions in person, I have often wished I had a space where I could explore some of these questions in a bit more depth. This blog is that space – a place designed to discover and discuss what’s new, what’s next and what’s best in the field of orthopedic medicine. A brief word about me: I am the former Chief of Sports Medicine at the University of California, San Diego. I have completed fellowships and training at Boston University, Hawaii’s Queen Emma Medical Center, and the world famous O’Brien Microsurgical Institute in Melbourne, Australia. Earlier in my career, I studied at UCLA and conducted research at the Salk Institute on an NIH research stipend. As you look around this site, you’ll see that I offer a wide array of services, including cutting edge procedures in shoulder surgery, knee surgery and hand and elbow surgery. If you are experiencing lasting discomfort and want to consult with the finest team in Southern California, I invite you to visit my orthopedic surgery offices here today. In the meantime: please bookmark this site and check back often! We have lots of fascinating medical studies, news, ideas and developments ahead. Welcome aboard.

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