Dr. Miller: Anterior cruciate ligament injury or ACL injury, that happens a lot to knees here in Utah with so many skiers and athletes. We're going to talk about this next on Scope Radio.
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Dr. Miller: I'm here with Dr. Pat Greis. Pat's an orthopedic surgeon, he's professor of orthopedic in the Department of Orthopedics. Pat, what is an ACL injury? How do you get that? I understand it's pretty common. I see a fair percentage of it coming down in sleds off the ski slopes over the ski season.
Dr. Greis: The ACL is one of the main ligaments in the center of the knee. It keeps the knee from sliding forward. Unfortunately, when you tie long boards to the end of your foot
Dr. Miller: With thick boots that weigh 20 pounds?
Dr. Greis: And then go down the ski hill, bad things happen. So, we see a lot of folks who come in had a twisting fall maybe got a toboggan ride down the rest of the ski hill come in with a sore, swollen knee.
Dr. Miller: That happened to a family friend that we took skiing this year. She was, unfortunately, it was last run of the day. Fell. And then pop.
Dr. Greis: First run or last run of the day, it never fails. The knee usually gets twisted. Maybe they feel a pop, tried to get up, tried to ski, a turn or two, the knee feels unstable.
Dr. Miller: Or they can't even stand on it or put weight on it.
Dr. Greis: Certainly those folks who gets put right onto the sled. And then usually managed at the bottom of the hill with a knee mobilizer, maybe got some X-rays, make sure nothing was busted. And then show up in clinic two, three days later to get evaluated.
Dr. Miller: While the ACL is one of the stabilizing ligaments in the knee, but we tend to hear ACL not only in skiing but in other contact sports or even non-contact sports in athletics. So, it's a fairly common injury with the knee?
Dr. Greis: It is one of the higher profile injuries given the level of disability that occurs from it is pretty high. It's difficult for a basketball player, a football player to continue playing after they've torn an ACL because without the ACL in the knee, instability where the knee gives out.
Dr. Miller: So, if you're doing a sport where you pivot a lot - soccer, football, anything with cleats - it's got to be pretty tough to maintain that activity without the ACL.
Dr. Greis: Any jumping, landing, twisting activity is really tough to continue. It's the rare individual who can continue and cope without an ACL. So, we end up rebuilding a lot of these to allow people to get back to these kinds of sports.
Dr. Miller: So, that is to say if you have a complete ACL tear, there's not much in the way of physical therapy that's going to help if you're going to get back into competitive sports. Is that a fair statement?
Dr. Greis: Well, physical therapy alone wouldn't probably get you there. But that is an important part of the overall treatment. ACL injuries, when they happen, result in a pretty sore and swollen knee. And prior to any surgical treatment, physical therapy is a big part of getting ready for surgery. We like to operate and fix knees when they're quiet, when they have full motion, limited swelling. And so therapy, although it's not going to fix the problem, is a big part of treatment.
Dr. Miller: So, this dispels the notion a little bit that when patients have a knee injury, especially the loss of an ACL, they don't need to rush off to the orthopedic surgeon for surgery.
Dr. Greis: Not for surgery but they should see somebody because getting going and doing the right things to get the knee functioning and working again is important.
Dr. Miller: Talk to me about the differences in gender. I understand that women maybe are more prone to ACL ruptures.
Dr. Greis: For sure. Unfortunately, as we've seen more and more young girls and women in cutting sports such as soccer, we've also that their injury rates tend to be four to eight times higher than matched controls with their male counterparts. There's lot of potential reasons for that that's still being worked out. But the fact is, again, young women in soccer are experiencing the same injury quite a bit more often than men.
Dr. Miller: How about the older patient? Do they always need to get their ACL repaired if they're not doing cutting sports?
Dr. Greis: Sure, they don't. Here in the Wasatch Front, given the activity level of many so-called older patients. And I think that that's a question as we all are aging. The activity level is such that many prefer to get their ACL reconstructed so they don't have to modify their activity to fit their knee.
Dr. Miller: So, what do you do? You wait, you do physical therapy, you wait for swelling to subside, you wait for little more motion and then what? I guess there are several techniques that you use top repair the ACL.
Dr. Greis: We usually reconstruct the ACL, so we're replacing it. Actually repairing it, putting sutures in it was something that was done commonly in the '70s and '80s but less so now. So, we're more about replacing the ACL rather than reconstructing it. And the idea there is to put a new ligament where the ACL used to be in the right, anatomic position so that it functions like the native ACL did.
Dr. Miller: And once that's done, I suppose there's a period of fairly enough intense physical therapy to help re-strengthen and reconstruct the knee?
Dr. Greis: For sure. ACL surgery is not something where you wake up from an operation and say, hey . . .
Dr. Miller: Dashing off to the football field.
Dr. Greis: Unfortunately, it's not that quick. There's a period of soreness and swelling just from the surgery. But the rehabilitation occurs in phases. First month might be going to physical therapy, going to the gym, doing simple exercises, spinning on a bike. By two to three months, hiking, playing golf are more reasonable leisure activities.
Dr. Miller: Instead of kick boxing.
Dr. Greis: Kick boxing would not be the first thing you do out of the box. But it's about a 6-month process. And even in six months, many athletes are probably not as good as they're going to be at 9 or 12 months.
Dr. Miller: So physical therapy and follow up is extremely important in coming back with a functional knee that will allow you to participate in high-intensity sports.
Dr. Greis: Without therapy, doing ACL surgery is probably not going to be successful. And it is a big part of that. When you see these athletes who are coming back and six and nine months have to realize that there are probably spending four, five, six days a week in the gym working out. And so, it's a mindset of being injured but then being willing to do the work to get back to where you were.
Dr. Miller: Finally, do you have any tips for the weekend warrior or the visiting vacation skewer handed person who comes out to avoid an ACL injury?
Dr. Greis: Like a lot of sports, keep it upright.
Dr. Miller: Stay on your sticks and don't fall over. I guess, one of my questions was, probably not a good idea to ski until that very of the day when your ligaments and muscles are twitching and not working very well.
Dr. Miller: It's always a little hard to know when to call it. But getting in the back seat, getting behind your skis is certainly one mechanism falls unavoidable. It is what it is. It's a sport that's a lot of fun but comes with certain risks.
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