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ACL Surgery
The ACL is a ligament in the knee that helps stabilize the joint. Unfortunately, ACL tears are common and they affect your stability and mobility. Listen to Dr. Peter Howard, an orthopedic sports medicine surgeon discuss recent innovations and techniques for treating ACL tears.
Featured Speaker:
Originally from Petoskey, Michigan, Dr. Howard has undergone extensive training in shoulder surgery, sports medicine, minimally invasive arthroscopy, and orthopedics at several prestigious universities and medical centers. Dr. Howard obtained his undergraduate degree with Honors from Michigan State University in East Lansing, Michigan. After his undergraduate education, Dr. Howard completed his medical degree at Wayne State University in Detroit, Michigan in 2008. He then trained in orthopedics at the Western Michigan University Homer Stryker School of Medicine. During his final year, he served as chief resident at Bronson Methodist Hospital and Borgess Medical Center. Seeking additional sub-specialization, he trained in shoulder surgery, sports medicine, and minimally invasive arthroscopy at the Houston Methodist Hospital. During his time there he worked with and cared for the Houston Astros, Texans, Dynamo, Rockets, the Rice University Owls, and many high school teams. Currently Dr. Howard is a team physician for the Toronto Blue Jays during Spring Training, Dunedin Blue Jays, and River Ridge High School.
In his time off Dr. Howard enjoys fishing, boating, going to the beach, cooking, and spending time with his wife and children.
Learn more about Dr. Peter Howard
Peter J. Howard, MD
Dr. Peter Howard is an orthopedic surgeon who specializes in shoulder surgery, sports medicine, and arthroscopy. Dr. Howard’s expertise includes rotator cuff repairs, cartilage transplants, meniscus injuries, ACL injuries, shoulder dislocations, hip impingement, fractures, joint replacement, and arthritis care. Dr. Howard’s areas of interest include the shoulder, elbow, hip, knee, and biologic therapies. Dr. Howard focuses on helping athletes and weekend warriors get back to full activity. Dr. Howard’s offices are in the Palm Harbor and in New Port Richey.Originally from Petoskey, Michigan, Dr. Howard has undergone extensive training in shoulder surgery, sports medicine, minimally invasive arthroscopy, and orthopedics at several prestigious universities and medical centers. Dr. Howard obtained his undergraduate degree with Honors from Michigan State University in East Lansing, Michigan. After his undergraduate education, Dr. Howard completed his medical degree at Wayne State University in Detroit, Michigan in 2008. He then trained in orthopedics at the Western Michigan University Homer Stryker School of Medicine. During his final year, he served as chief resident at Bronson Methodist Hospital and Borgess Medical Center. Seeking additional sub-specialization, he trained in shoulder surgery, sports medicine, and minimally invasive arthroscopy at the Houston Methodist Hospital. During his time there he worked with and cared for the Houston Astros, Texans, Dynamo, Rockets, the Rice University Owls, and many high school teams. Currently Dr. Howard is a team physician for the Toronto Blue Jays during Spring Training, Dunedin Blue Jays, and River Ridge High School.
In his time off Dr. Howard enjoys fishing, boating, going to the beach, cooking, and spending time with his wife and children.
Learn more about Dr. Peter Howard
Transcription:
ACL Surgery
Amanda Wilde (Host): This is BayCare HealthChat. I'm Amanda Wilde. The ACL is a ligament in the knee that helps stabilize the joint. Unfortunately, ACL tears are common and painful and they affect your stability and mobility. We'll talk about recent innovations and techniques for treating ACL tears with fellowship-trained orthopedic sports medicine surgeon Dr. Peter J. Howard. Thanks for being here today, Dr. Howard.
Dr. Peter Howard: Thanks, Amanda. It's a great opportunity.
Amanda Wilde (Host): Let's start with what the ACL is and where is it?
Dr. Peter Howard: The ACL is a ligament inside the knee. It stands for the anterior cruciate ligament. The ACL stabilizes front to back motion of the knee and twisting motions of the knee. The ACL is present in all knees and is commonly injured in sports injuries that are experienced by people of all ages.
Amanda Wilde (Host): And what happens when your ACL tears?
Dr. Peter Howard: When an unfortunate circumstance of an ACL tear happens, oftentimes it's not a direct blow to the knee that tears the ACL. But a sudden shifting or pivoting from side to side. ACL tears are very common in soccer, volleyball, basketball, or football. When the ACL tears, there's a lot of bleeding that happens inside the joint from the torn ligament. The knee fills up with blood and becomes very painful and hard to walk on. It can take several weeks to come back to normal. Often a patient will say that their knee feels like it's going to give way anytime they turn a corner or try to squat or move in a way that isn't walking in just a straight line. Unfortunately, ACL tears tend to affect younger populations, even children. And without an ACL, the knee can remain very unstable.
Amanda Wilde (Host): So what are the different types of ACL repairs?
Dr. Peter Howard: There are many different types of ways to restore stability to the knee. An ACL repair, which was done 20 or 30 years ago differs very, very much from the ACL repair we perform today. The ACL repair is simply stitching the ACL either back together or back to the bone. And this had high failure rates with high retear rates. This was unacceptable to the surgeon community. So we came up with a reconstruction. Which is taking another ligament or tendon from elsewhere in the knee, either the patella tendon, quadricep tendon, or hamstring tendon, and replacing the ACL with that tendon.
That has proven to be an excellent surgery but comes at the cost of removing a healthy piece of tissue and replacing it into where the ACL used to be. The new ACL repair regenerates the ACL within the knee. A special new implant is installed in the knee, which provides a cocoon for the ACL ligament to regrow and not be exposed to joint fluid, which normally would destroy the repair. This new repair has been shown to have higher satisfaction rates with how the knee feels after surgery and after rehabilitation has been complete with similar retear rates.
Amanda Wilde (Host): So this surgery for repair is really regenerating tissue?
Dr. Peter Howard: Correct. The new collagen implant that has been invented allows for the ACL to grow inside it and reorganize the collagen, which makes up the ACL to repair itself without taking a piece of healthy tissue from elsewhere in the body.
Amanda Wilde (Host): Now who is a candidate for this kind of surgery?
Dr. Peter Howard: Currently, the candidate for this ACL repair would be someone who is active and is willing to undergo the rehabilitation for ACL surgery. From the early teenage years up to about age 50, and the patient has to present within 50 days of the tear to the surgeon. Otherwise, the repair likely will not work. So if the patient is interested in this sort of surgery, they have to get their MRI and get into the surgeon quite quickly.
Amanda Wilde (Host): Why the 50-day limit?
Dr. Peter Howard: The 50-day limit is imposed by the Food and Drug Administration for approval of the new implant. The idea is in the studies that develop this new implant, that only fresh tears still had biologic ability to repair themselves with the assistance of the new implant. Other studies are ongoing, trying to see if that 50-day window can be pushed further. But currently, those are the indications that the FDA has allowed for this new technology.
Amanda Wilde (Host): Now you mentioned rehabilitation. It sounds like it might be a bit intense. What is the recovery time after this procedure?
Dr. Peter Howard: Well, Amanda, an ACL tear is a big injury for any patient. There is lots of rehabilitation that needs to take place after any surgery on the knee. Unfortunately, with any ACL surgery, the quadricep muscle becomes very weak and takes many months to get back to its original strength. Hamstring tendons take a long time to come back to the original strength as well. This new technology has been shown to restore hamstring strength at a greater amount during that rehabilitation phase because the hamstring, which is a very common source for a new ACL, isn't touched or sacrificed or used as a new ACL.
Rehabilitation for an ACL tear can take six months minimum before the patient is allowed to play sports again, and some patients may take up to a year. It is a long recovery to recover from an ACL surgery.
Amanda Wilde (Host): So like any rehabilitation really, you have to be in it for the long term.
Dr. Peter Howard: Correct. The first few months are always the toughest to recover, but then as time goes on, it’s like driving down the highway. It’s very boring and you’re not doing much of anything new, but you’re making a lot of progress. So it’s a lot of exercises that the patient performs every day, and usually as the patient approaches the six-month mark, the physical therapist will start to test the patient’s strength to make sure that they fully recovered and are able to go back to sport with low risk of retear.
Interestingly, the new repair technique with the new implant suggests a much lower retear rate of that ACL on the opposite knee. Currently, when you tear your ACL on your other knee, you have a seven to 10% chance of tearing that ACL. We’re not exactly sure why. With the new implant, some of the early studies have shown that there’s a 50% or so reduction in other side ACL tears.
Amanda Wilde (Host): So there are some huge benefits to doing the implant or regeneration process for ACL. I’m wondering what other benefits you’ve seen compared to other options for treating ACL?
Dr. Peter Howard: Part of the benefit of this newer technique is that since we're not taking pieces of the body that are healthy to use them as the ACL, there can be less pain during the recovery process and there's less incisions, to heal, less chance of infection or other complications. The benefit also being that the patients report in a lot of the studies, that their knee feels more normal than with some of the other techniques.
So this is really what we've been looking for over the past few decades. When patients say, won't it just heal itself? And we're really getting to the point where potentially, yes, it can heal itself. It does need some assistance from a surgeon. But yes, we can heal that ACL tear.
Amanda Wilde (Host): Whereas it used to be, it doesn't heal itself.
Dr. Peter Howard: No, unfortunately, the joint fluid, which normally is providing the nutrition for the cartilage, it works against healing of the ACL and actually prevents healing an ACL once it's torn. This new implant technique avoids the Synovial fluid, which is what the joint fluid is called from getting into that ACL repair.
Amanda Wilde (Host): So very high success rate.
Dr. Peter Howard: Yes. It has a very high success rate. It has a very new promising technique and technology that may lead us to, the future of not even sacrificing other parts of the body for new ACL. Now, not everyone will qualify for this particular technique, and it's up to the surgeon and the patient to figure out if it's best for them, but it's something that you should ask your surgeon about if you qualify for.
Amanda Wilde (Host): Yeah, it's really a significant advance. Thank you so much for this really crucial information on ACL repair.
Dr. Peter Howard: Amanda, thanks so much for having me on today, and I hope that I was able to really educate your listeners on some of the new technologies we have for the knee.
Amanda Wilde (Host): That is Dr. Peter J. Howard, fellowship-trained orthopedic sports medicine surgeon at BayCare. and that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcast. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Amanda Wilde. We'll talk again next time.
ACL Surgery
Amanda Wilde (Host): This is BayCare HealthChat. I'm Amanda Wilde. The ACL is a ligament in the knee that helps stabilize the joint. Unfortunately, ACL tears are common and painful and they affect your stability and mobility. We'll talk about recent innovations and techniques for treating ACL tears with fellowship-trained orthopedic sports medicine surgeon Dr. Peter J. Howard. Thanks for being here today, Dr. Howard.
Dr. Peter Howard: Thanks, Amanda. It's a great opportunity.
Amanda Wilde (Host): Let's start with what the ACL is and where is it?
Dr. Peter Howard: The ACL is a ligament inside the knee. It stands for the anterior cruciate ligament. The ACL stabilizes front to back motion of the knee and twisting motions of the knee. The ACL is present in all knees and is commonly injured in sports injuries that are experienced by people of all ages.
Amanda Wilde (Host): And what happens when your ACL tears?
Dr. Peter Howard: When an unfortunate circumstance of an ACL tear happens, oftentimes it's not a direct blow to the knee that tears the ACL. But a sudden shifting or pivoting from side to side. ACL tears are very common in soccer, volleyball, basketball, or football. When the ACL tears, there's a lot of bleeding that happens inside the joint from the torn ligament. The knee fills up with blood and becomes very painful and hard to walk on. It can take several weeks to come back to normal. Often a patient will say that their knee feels like it's going to give way anytime they turn a corner or try to squat or move in a way that isn't walking in just a straight line. Unfortunately, ACL tears tend to affect younger populations, even children. And without an ACL, the knee can remain very unstable.
Amanda Wilde (Host): So what are the different types of ACL repairs?
Dr. Peter Howard: There are many different types of ways to restore stability to the knee. An ACL repair, which was done 20 or 30 years ago differs very, very much from the ACL repair we perform today. The ACL repair is simply stitching the ACL either back together or back to the bone. And this had high failure rates with high retear rates. This was unacceptable to the surgeon community. So we came up with a reconstruction. Which is taking another ligament or tendon from elsewhere in the knee, either the patella tendon, quadricep tendon, or hamstring tendon, and replacing the ACL with that tendon.
That has proven to be an excellent surgery but comes at the cost of removing a healthy piece of tissue and replacing it into where the ACL used to be. The new ACL repair regenerates the ACL within the knee. A special new implant is installed in the knee, which provides a cocoon for the ACL ligament to regrow and not be exposed to joint fluid, which normally would destroy the repair. This new repair has been shown to have higher satisfaction rates with how the knee feels after surgery and after rehabilitation has been complete with similar retear rates.
Amanda Wilde (Host): So this surgery for repair is really regenerating tissue?
Dr. Peter Howard: Correct. The new collagen implant that has been invented allows for the ACL to grow inside it and reorganize the collagen, which makes up the ACL to repair itself without taking a piece of healthy tissue from elsewhere in the body.
Amanda Wilde (Host): Now who is a candidate for this kind of surgery?
Dr. Peter Howard: Currently, the candidate for this ACL repair would be someone who is active and is willing to undergo the rehabilitation for ACL surgery. From the early teenage years up to about age 50, and the patient has to present within 50 days of the tear to the surgeon. Otherwise, the repair likely will not work. So if the patient is interested in this sort of surgery, they have to get their MRI and get into the surgeon quite quickly.
Amanda Wilde (Host): Why the 50-day limit?
Dr. Peter Howard: The 50-day limit is imposed by the Food and Drug Administration for approval of the new implant. The idea is in the studies that develop this new implant, that only fresh tears still had biologic ability to repair themselves with the assistance of the new implant. Other studies are ongoing, trying to see if that 50-day window can be pushed further. But currently, those are the indications that the FDA has allowed for this new technology.
Amanda Wilde (Host): Now you mentioned rehabilitation. It sounds like it might be a bit intense. What is the recovery time after this procedure?
Dr. Peter Howard: Well, Amanda, an ACL tear is a big injury for any patient. There is lots of rehabilitation that needs to take place after any surgery on the knee. Unfortunately, with any ACL surgery, the quadricep muscle becomes very weak and takes many months to get back to its original strength. Hamstring tendons take a long time to come back to the original strength as well. This new technology has been shown to restore hamstring strength at a greater amount during that rehabilitation phase because the hamstring, which is a very common source for a new ACL, isn't touched or sacrificed or used as a new ACL.
Rehabilitation for an ACL tear can take six months minimum before the patient is allowed to play sports again, and some patients may take up to a year. It is a long recovery to recover from an ACL surgery.
Amanda Wilde (Host): So like any rehabilitation really, you have to be in it for the long term.
Dr. Peter Howard: Correct. The first few months are always the toughest to recover, but then as time goes on, it’s like driving down the highway. It’s very boring and you’re not doing much of anything new, but you’re making a lot of progress. So it’s a lot of exercises that the patient performs every day, and usually as the patient approaches the six-month mark, the physical therapist will start to test the patient’s strength to make sure that they fully recovered and are able to go back to sport with low risk of retear.
Interestingly, the new repair technique with the new implant suggests a much lower retear rate of that ACL on the opposite knee. Currently, when you tear your ACL on your other knee, you have a seven to 10% chance of tearing that ACL. We’re not exactly sure why. With the new implant, some of the early studies have shown that there’s a 50% or so reduction in other side ACL tears.
Amanda Wilde (Host): So there are some huge benefits to doing the implant or regeneration process for ACL. I’m wondering what other benefits you’ve seen compared to other options for treating ACL?
Dr. Peter Howard: Part of the benefit of this newer technique is that since we're not taking pieces of the body that are healthy to use them as the ACL, there can be less pain during the recovery process and there's less incisions, to heal, less chance of infection or other complications. The benefit also being that the patients report in a lot of the studies, that their knee feels more normal than with some of the other techniques.
So this is really what we've been looking for over the past few decades. When patients say, won't it just heal itself? And we're really getting to the point where potentially, yes, it can heal itself. It does need some assistance from a surgeon. But yes, we can heal that ACL tear.
Amanda Wilde (Host): Whereas it used to be, it doesn't heal itself.
Dr. Peter Howard: No, unfortunately, the joint fluid, which normally is providing the nutrition for the cartilage, it works against healing of the ACL and actually prevents healing an ACL once it's torn. This new implant technique avoids the Synovial fluid, which is what the joint fluid is called from getting into that ACL repair.
Amanda Wilde (Host): So very high success rate.
Dr. Peter Howard: Yes. It has a very high success rate. It has a very new promising technique and technology that may lead us to, the future of not even sacrificing other parts of the body for new ACL. Now, not everyone will qualify for this particular technique, and it's up to the surgeon and the patient to figure out if it's best for them, but it's something that you should ask your surgeon about if you qualify for.
Amanda Wilde (Host): Yeah, it's really a significant advance. Thank you so much for this really crucial information on ACL repair.
Dr. Peter Howard: Amanda, thanks so much for having me on today, and I hope that I was able to really educate your listeners on some of the new technologies we have for the knee.
Amanda Wilde (Host): That is Dr. Peter J. Howard, fellowship-trained orthopedic sports medicine surgeon at BayCare. and that wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcast. For more health tips and updates, follow us on your social channels. If you found this podcast informative, please share on your social media and be sure to check out all the other interesting podcasts in our library. I'm Amanda Wilde. We'll talk again next time.