With many advances in orthopedic sports medicine, it seems amazing that we have not seen a decrease in the incidence of ACL injuries. It’s true that we have not witnessed a downward trend of these injuries in spite of increased awareness and programs designed to strengthen muscles around the knee and improve neuromuscular control.
More athletes, particularly more female athletes, may fuel the more than 200,000 ACL injuries that occur in this country each year. Improved accuracy of the physical exam and MRIs ordered may also play a small role in the increasing numbers.
Last year I blogged about the value of “prehab," the rehabilitation which is done before ACL surgery. This remains a very important practice. Surgery is the mainstay of treatment for athletes with ACL ruptures.
As surgeons, we remove the torn ACL and start from scratch, reconstructing the ACL utilizing hamstring tendon or patella tendon tissues from the athlete’s knee, or rarely using allograft (cadaver tissue). Studies show that in high-level athletes, cadaver tissue has a higher incidence of eventual graft failure. Occasionally we will combine an athlete’s own tendon with an allograft tendon to give it larger bulk in the joint.
Associated cartilage injuries may have the greatest impact of future knee function of all the compounding factors. If we need to resect or repair a large meniscus tear, or smooth a large area of surface cartilage damage, this statistically plays a role in the eventual knee function.
Drs Buck, Warme and Greenwald work together in all ACL surgery as we strive to prove the best state-of-the-art treatment for our athletes. It is a big team effort including the athlete, athletic trainer, physical therapist, parents, coach and surgical staff. The team approach is important to foster a positive rehab experience and a better chance of return to full function for the athlete.
More later this year.