Monday Medical: Navigating an ACL tear
For Steamboat Pilot & Today
Tearing your ACL is a fairly common injury. But it’s also an intense one.
“It can be a life-altering injury,” said Dr. Michael Sisk, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “It causes not only a physical injury, but creates a mental wound as well. Suddenly, people lose confidence about their ability to get outside and do what they want to do.”
But with proper treatment and rehabilitation, it can heal. Below, Sisk describes how to prevent an ACL tear and heal from it when the worst happens.
What is the ACL and why does it tear?
The ACL, or anterior cruciate ligament, runs through the knee joint, connecting the thighbone to the shinbone. It provides stability to the knee, but because of its position, it can snap if the knee encounters a sudden force.
That force may be caused by stopping suddenly or changing direction quickly, by a collision or fall, or by landing from a jump incorrectly, which means sports such as football, lacrosse, basketball and skiing are prime opportunities for injuring the ACL.
Can an ACL tear be prevented?
“Probably the most important factor is being physically fit,” Sisk said. “Having a strong quad is one of your best weapons as far as preventing an ACL injury.”
Another precaution: try not to put yourself into harm’s way. While that can be difficult when going all-out in a football game, there are steps you can take when skiing. For instance, ski in good conditions on terrain at your level, stop when you start to fatigue and make sure your skis are adjusted properly, so they release in a fall.
How is it treated?
An ACL tear won’t heal on its own, but ACL reconstruction surgery is elective. Some people forgo surgery and do physical therapy to build up surrounding muscles and wear a brace when needed.
But many people, especially those who are active, go ahead with surgery.
“Most people don’t want to live life in a brace, so proceed to reconstruction of the knee,” Sisk said.
What does surgery involve?
When an ACL is torn, it’s typically shredded and can’t be stitched back together. Instead, the surgeon removes the torn tendon and replaces it with a new one.
It’s a straightforward process that local surgeons have a lot of experience with.
“This is Ski Town USA, and we happen to deal with this injury all the time, so we have local expertise here,” Sisk said.
Patients can choose to use their own tendon for a replacement or a donor tendon, which Sisk typically prefers.
“When you steal a tendon from your own knee, you may weaken it and create a further injury,” Sisk said.
How long does it take to heal?
“It truly is a six-month journey, at minimum,” Sisk said. “Think about it: if you see a Denver Broncos’ player tear his ACL, when do you see the athlete return? It’s the following year.”
Physical therapy is a critical part of any recovery.
“The outcome is, in my opinion, mostly derived from the amount of work and dedication a patient puts into that recovery,” Sisk said. “Physical therapists are so critical to a patient’s recovery. And therapists here in town are some of the best in the world.”
It takes about two months after surgery for the ligament to begin to heal. And then, physical therapy intensifies.
“You’re continually asking the patient to go into the red zone and rebuild fitness,” Sisk said. “My advice to my patients always is, ‘I want you to achieve a level of fitness that is, at the bare minimum, where you were before you tore your knee up. It’d be even better to elevate your fitness level.’”
The good news: with proper focus on physical therapy, the knee can become as good as new.
“I want patients to eliminate the thought that they had their knee rebuilt,” Sisk said. “My goal is that, at a dinner a couple of years later, somehow ACL reconstruction comes up, and they say, ‘I had ACL surgery. Now, which knee was it?’”
Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at firstname.lastname@example.org.
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