A little ACL education

[WestWYOPoke]

Given the abrupt introduction of ACL injuries into our discussion I wanted to give you guys just a quick note on some ACL vocab. I know this sounds nit picking but it's one of those things that drives me crazy, plus I think it's good for the general public to know.

When discussing ligaments (ACL, PCL, MCL, etc.) there are no such thing as strains. When ligaments are injured they are sprains. Sprains are graded 1-3 depending on severity. Grade 1 is mild, typically just a slight stretching of the ligament. Grade 2 is moderate, typically a significant stretching or a partial tear. Grade 3 is severe; complete tear or rupture of the ligament. So when I hear someone say "hopefully it's just a sprain, not a tear," I cringe because tear=sprain.

Further info, when dealing specifically with ACLs, a Grade 1 sprain is typically immobilized with rehab for re-strengthening. Grade 2 sprains can go either way, rehab or surgery. Grade 3 are always surgically repaired.

Sorry for the "grammar police"-like post but just thought a little info couldn't hurt.

If you have any ACL-related (or other sports-related injury) questions, let me know. There's a few of us on here that deal with this type of stuff on the regular as well.

[whyoh]

fantastic info, thanks

[bladerunnr]

Given the abrupt introduction of ACL injuries into our discussion I wanted to give you guys just a quick note on some ACL vocab. I know this sounds nit picking but it's one of those things that drives me crazy, plus I think it's good for the general public to know.

When discussing ligaments (ACL, PCL, MCL, etc.) there are no such thing as strains. When ligaments are injured they are sprains. Sprains are graded 1-3 depending on severity. Grade 1 is mild, typically just a slight stretching of the ligament. Grade 2 is moderate, typically a significant stretching or a partial tear. Grade 3 is severe; complete tear or rupture of the ligament. So when I hear someone say "hopefully it's just a sprain, not a tear," I cringe because tear=sprain.

Further info, when dealing specifically with ACLs, a Grade 1 sprain is typically immobilized with rehab for re-strengthening. Grade 2 sprains can go either way, rehab or surgery. Grade 3 are always surgically repaired.

Sorry for the "grammar police"-like post but just thought a little info couldn't hurt.

If you have any ACL-related (or other sports-related injury) questions, let me know. There's a few of us on here that deal with this type of stuff on the regular as well.

So, a couple of questions: How are they surgically repaired? Do they use artificial tendon or just reattach what was torn?
What causes it? Since Larry was injured in an earlier game, could the tendon have already been compromised and a serious injury was just around the corner? As a distance runner (an aging one) I'm curious as to how effective strengthening exercises and stretching can prevent tendon and ligament injuries.

[WYO1016]

Given the abrupt introduction of ACL injuries into our discussion I wanted to give you guys just a quick note on some ACL vocab. I know this sounds nit picking but it's one of those things that drives me crazy, plus I think it's good for the general public to know.

When discussing ligaments (ACL, PCL, MCL, etc.) there are no such thing as strains. When ligaments are injured they are sprains. Sprains are graded 1-3 depending on severity. Grade 1 is mild, typically just a slight stretching of the ligament. Grade 2 is moderate, typically a significant stretching or a partial tear. Grade 3 is severe; complete tear or rupture of the ligament. So when I hear someone say "hopefully it's just a sprain, not a tear," I cringe because tear=sprain.

Further info, when dealing specifically with ACLs, a Grade 1 sprain is typically immobilized with rehab for re-strengthening. Grade 2 sprains can go either way, rehab or surgery. Grade 3 are always surgically repaired.

Sorry for the "grammar police"-like post but just thought a little info couldn't hurt.

If you have any ACL-related (or other sports-related injury) questions, let me know. There's a few of us on here that deal with this type of stuff on the regular as well.

WestWYOPoke - The "Dean" of sports medicine on wyonation

[CowboyNV]

Hey WestWyoPoke, have you worked with anyone who used stem cell injection instead of surgery to repair the ACL? I know they claim it is effective in all but the complete retracted tears, but just wondering if that is true or not.

[Wyovanian]

Given the abrupt introduction of ACL injuries into our discussion I wanted to give you guys just a quick note on some ACL vocab. I know this sounds nit picking but it's one of those things that drives me crazy, plus I think it's good for the general public to know.

When discussing ligaments (ACL, PCL, MCL, etc.) there are no such thing as strains. When ligaments are injured they are sprains. Sprains are graded 1-3 depending on severity. Grade 1 is mild, typically just a slight stretching of the ligament. Grade 2 is moderate, typically a significant stretching or a partial tear. Grade 3 is severe; complete tear or rupture of the ligament. So when I hear someone say "hopefully it's just a sprain, not a tear," I cringe because tear=sprain.

Further info, when dealing specifically with ACLs, a Grade 1 sprain is typically immobilized with rehab for re-strengthening. Grade 2 sprains can go either way, rehab or surgery. Grade 3 are always surgically repaired.

Sorry for the "grammar police"-like post but just thought a little info couldn't hurt.

If you have any ACL-related (or other sports-related injury) questions, let me know. There's a few of us on here that deal with this type of stuff on the regular as well.

So, a couple of questions: How are they surgically repaired? Do they use artificial tendon or just reattach what was torn?
What causes it? Since Larry was injured in an earlier game, could the tendon have already been compromised and a serious injury was just around the corner? As a distance runner (an aging one) I'm curious as to how effective strengthening exercises and stretching can prevent tendon and ligament injuries.

Not to tread on WestWyo's ground, but I know a few things about ACL injuries, having had one and having been a ski patrolman for five years. It's a very common injury in skiing due to the relative inability of skiers' feet to turn with torsion from the leg above. I knew as soon as I saw the replay what had just happened. He planted his right foot and his sneakers, apparently, are really, really good, because his foot did not move as he began to fall backward and his thigh rotated outward. His foot held fast to the court surface and didn't allow his lower leg to twist along with the upper leg. This hyper-extended the ACL to the point it tore. People down low might have actually heard the "pop" as it came apart. I've heard them pop from over thirty yards in gusty wind.

Think "backward, twisting fall"- that's the most common motion that leads to an ACL injury. It's why you shouldn't crank the DIN settings on your bindings up to where they wouldn't release Rosanne Barr wearing a suit of armor after a breakfast buffet.

[PokeOLoco]

WestWYO you a doc? Have some OT questions for you if so.

[WestWYOPoke]

So, a couple of questions: How are they surgically repaired? Do they use artificial tendon or just reattach what was torn?

When an ACL is completely torn or torn enough to be considered non-viable (usually a tear >50%) it will be replaced. A machine will be inserted arthroscopically that will essentially grind up the remaining tissue and suck it out like a vacuum. After this, the surgeon will replace the ACL with 1 of 3 options: A) a graft from the patient's patellar tendon, B) a graft from the patient's hamstring tendon, or C) an ACL from a cadaver body. (NOTE: since Larry plays basketball they will probably stay away from option A as you don't want to weaken the patellar tendon in a jumping athlete.)
The surgeon will insert the new ligament with its bony ends up through a (freshly drilled) hole in the tibia and into the femur (another fresh hole). He will then anchor both ends in place.

What causes it?

While there are always exceptions to the rule, the vast majority of ACL injuries are caused by trauma. The most common mechanism is called a valgus motion, where the knee moves inward while the hip and foot move outward or stay stationary. Other mechanisms that can cause an injury are a rotation of the lower leg (tibia; this is what it looked like Larry did to me) or an anterior and/or lateral movement of the tibia.

Since Larry was injured in an earlier game, could the tendon have already been compromised and a serious injury was just around the corner?

It is definitely possible that Larry had some prior trauma to the ACL which could have cause some stretching, micro-tearing or even small noticeable tears of the ligament. Any of these would weaken the ligament and make it more susceptible to rupture. If any of this were the case, he would probably have been experiencing pain and possible instability. However with the mechanism Larry had, even a healthy ACL would have stood little chance.

As a distance runner (an aging one) I'm curious as to how effective strengthening exercises and stretching can prevent tendon and ligament injuries

While no amount of stretching or strengthening can completely remove the risk of an ACL injury, there are things you can do to decrease your likelihood. Flexible muscles will allow more elasticity in the event you "tweak" something the wrong way. In this event, it would be much more ideal for a muscle to take the brunt force than your joints and ligaments. Quadricep and hamstring strengthening are also very good as they will add stability to the knee joint and in the event of an injury will (hopefully) flex and protect the joint before a ligament is damaged. Examples of things you could do would be hamstring curls or light-weight straight leg dead lifts. IMO, the most important muscle to strengthen, however, is the Vastus Medialis Oblique (VMO) muscle. This can be done by working on the last 20° of knee extension, an easy way to do this is stand with one foot on a step or small box and lower your other foot down until it barely touches the floor and then stand back up using only the elevated leg.

[WestWYOPoke]

Hey WestWyoPoke, have you worked with anyone who used stem cell injection instead of surgery to repair the ACL? I know they claim it is effective in all but the complete retracted tears, but just wondering if that is true or not.

I've never worked with anyone using stem cells for an ACL repair. Typically all of the surgeons I have worked with are very black and white with ACLs, either it is minimally torn and can be rehabbed or it is torn and must be replaced. Theoretically I could see how it might work, just don't have any personal experience with it.

I have, however, worked with a doctor that was using platelet replacement therapy on individuals with chronic tendonitis (usually patellar or achilles). While most studies are showing mixed results, he seemed to be having success with reduction in symptoms and better quality of life activities. So that is something that will be interesting to see coming forward in the future.

[WestWYOPoke]

WestWYO you a doc? Have some OT questions for you if so.

No, I'm am an Athletic Trainer, hence my familiarity with sport-related injuries. You can ask if you'd like, not sure how much help I'll be able to provide though.

[PokeOLoco]

Gotcha. Well my soon to be wife is a family medicine resident, and I'm just wondering about practicing in Wyoming. Would love to come back.

[NewYorksCowboy]

How long do you think it usually takes to heal?

[WestWYOPoke]

How long do you think it usually takes to heal?

ACLs are really tricky to pinpoint a timeline. A general range is 6-9 months. However there are extreme exceptions on both sides. Case in point, Terrell Owens had ACL surgery and was back in like 3-4 months. On the flip side, it took Derrick Rose 12-14 months to come back.

Quick timeline looks something like this:
Injury on Tuesday the 18th.
MRI and Dr. Visit Wednesday the 19th.
Allow 1-2 weeks for swelling to reduce.
Surgery around the end of the month.
With that in mind, best case scenario he is starting to run by early September, but more likely it'll be closer to November.

A longer recovery could certainly lead to a medical redshirt possibility.

[whyoh]

a couple of questions

how exactly do they attach the new one? krazy glue?

and how important is it if hines ward has been missing one since he was a child?

[BackHarlowRoad]

a couple of questions

how exactly do they attach the new one? krazy glue?

and how important is it if hines ward has been missing one since he was a child?

They drill small holes in the femur and tibia and then anchor the ACL, which in this case will most likely be made from one of the hamstring tendons on the inside of the leg (semitendinosus) with screws. We are starting to shy away from using cadavers because the body doesn't accept them as well as something from within our own body and like WestWYO said, using the patella tendon in a bball player is a bad idea.

Hines was at greater risk of injuring the cartilage in his knee (meniscus) because without the ACL, the knee joint experiences much more movement (like tectonic plates during an earthquake). He will also probably suffer from osteoarthritis at a younger age than most would for the same reason.

Since he was without one for so long and during his formative years, his body adapted. His quads and especially hamstrings learned to make up for the missing ligament and was able to limit some of the excessive movement. That's why I'm amazed by DeJuan Blair who has to deal with this extra movement in a sport that requires so much jumping and change of direction. His hamstrings have to be amazingly strong.

[stymeman]

does he have to go thru doctors contracted by UW or can he go to other surgeons that his family may seem fit??? There's been discussion that the clinc in Birmingham, Alabama (best in the world) may be in play, just curious

[BackHarlowRoad]

does he have to go thru doctors contracted by UW or can he go to other surgeons that his family may seem fit??? There's been discussion that the clinc in Birmingham, Alabama (best in the world) may be in play, just curious

Most universities strongly encourage the use of their own doctors, and will cover the costs when they do. If an athlete chooses to use a different physician, they are welcome to but they are on their own as far as payment is concerned.

That's just with most universities, I'm too far removed from UW to know their policy anymore.

As far as Dr. James Andrews from Birmingham, Alabama is concerned....I'm sure he's good, real good... but there has to be others comparable. He's a master of PR. He earned a reputation in the 80s and was considered top dog and now every elite athlete is under the impression that if they let anyone else perform their surgery that it will be a failure. Probably not true.

[WYO1016]

does he have to go thru doctors contracted by UW or can he go to other surgeons that his family may seem fit??? There's been discussion that the clinc in Birmingham, Alabama (best in the world) may be in play, just curious

Most universities strongly encourage the use of their own doctors, and will cover the costs when they do. If an athlete chooses to use a different physician, they are welcome to but they are on their own as far as payment is concerned.

That's just with most universities, I'm too far removed from UW to know their policy anymore.

I hope to God that he doesn't use Gem City. He'd be way better off even just going down the road to Orthopedic Center of the Rockies.

[stymeman]

good to know, i just don't want him to rush anything, i forsee a redshirt year next year, which i think could be best...fix him up right!!!!!!! bigger, faster, stronger

[BackHarlowRoad]

good to know, i just don't want him to rush anything, i forsee a redshirt year next year, which i think could be best...fix him up right!!!!!!! bigger, faster, stronger

Oh he'll rush into it, I guarantee you haha. Larry and his family will want to be back as soon as possible. All athletes do, even when it lacks common sense.