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Prakash Chandran (Host): Whether you’re a profession athlete, weekend warrior, or someone who just likes to keep active, you don’t want pain from an ACL or a meniscus tear to keep you out of the game. Let’s talk to Dr. Hans Bengtson, an orthopedic surgeon at Northfield Hospital. This is Northfield Hospital and Clinics podcast series. I’m Prakash Chandran. Dr. Bengtson, what’s the ACL and what happens when it’s injured?

Dr. Hans Bengtson (Guest): The ACL is one of the main ligaments in the knee that does help with stability, that’s its main role. It helps with front to back stability, but also some rotation stability between our femur or thigh bone and the tibia or shin bone. Obviously a very, very critical ligament that you’ve probably heard about in stories of athletes who have had injuries, the ACL is just critical for that knee stability that we need to perform certain cutting, pivoting, even landing from a jump type of activities.

Host: Yeah, it’s an injury that I’ve actually had myself. I play a lot of pickup basketball, and one time there was a – I fell on it wrong, or I had a sharp pain in my knee, and then it just started to get worse and worse over time, so is that what you see the most ACL tears from, from basketball?

Dr. Bengtson: Such a great question. ACL tears are common with those cutting or pivoting type sports, and so basketball is one of those sports. Other sports that are involved include soccer, field hockey for girls can be a high risk sport, downhill skiing. All these things are ones that cause us to have to change directions suddenly, or stop suddenly. This is when people are at a high risk. Football, that’s another one of those sports where people are cutting or trying to shift off one leg to another and that can put people at a high risk for it. You know when people have an ACL tear, some of the things they might experience is severe pain, obviously. They tend to fall to the ground because their knee has buckled. Their knee has shifted in a way that does not provide support, so they get severe pain, probably inability to continue the activity, and maybe even inability to bear weight. They might even feel or hear a pop or popping sensation in the knee and often times they have a significant swelling that accompanies this event soon thereafter.

Host: No one likes to stay out of the game, and when you have an injury like an ACL tear, it really can put you out for a while. So we always like to talk about prevention. What can people do that are playing these sports to help prevent them from getting an ACL tear?

Dr. Bengtson: So prevention’s key right? So I think some of the things that are valuable to know are risk factors that put you at a high risk for an ACL injury, and one of those is simply being a female. We don’t always know exactly why, but there’s perhaps some differences in the anatomy, maybe in the muscle strength or ratio of strength between say the quadriceps muscle and the hamstring. Maybe there’s some hormonal influences that put females at a higher risk for ACL injuries, doing the same sport as a male. So that in itself can make it challenging for preventative action. Certain sports, as we’ve already mentioned like soccer, football, basketball, gymnastics, these put people at a high risk, and so if one chooses to play those sports, that can be a challenging thing to modify. Poor conditioning though is another factor that puts people at a higher risk for it or playing on particular poor surfaces maybe, and some of these things are definitely modifiable risk factors. When it comes to prevention, one of the best things that people can do is maintain a strong core. When we talk about core, it’s really from the armpit area, down to the mid thigh, keeping this part of our trunk strong allows us to improve our balance, especially when there’s an opponent who’s making us adjust mid game. Core strength is huge and that’s something we can all be part of. Other things that we can do to try to minimize or prevent these ACL injuries, there are some specific programs, jump training, or more specifically landing from a jump. If we’re able to train our bodies and our knees specifically to land straight ahead, that can decrease the risk of ACL injuries. Definitely has been shown to be effective for female athletes such as soccer players or basketball players.

Host: Yeah, I had no idea that females were at such a disadvantage, and with the amount of men I see this happening to, it’s just crazy how pervasive this type of injury is, so it’s good to know some of those preventative measures as you’re talking about. The whole body is a support system, so keeping that core strong and flexible so you’re ready to pivot at a moment’s notice is very important. I’d like to shift over to the meniscus. I’d like to learn a little bit about how that injury to that cartilage or area is similar to or different than the ACL.

Dr. Bengtson: You know, meniscus is another structure that’s inside the knee. It is a little cartilage cushion. It’s C-shaped. There’s one on the inside and outside of our knees, so in a way we each have two menisci in each knee. It does act like a shock absorber or cushion between the bones, and so it’s an important structure to help in those factors. When it comes to injuries, it definitely can happen in the same setting as an ACL tear. In fact, that’s a very, very common event to happen, where when the ACL gives way, the knee shifts even more, and that can put increased stress on the meniscus, which is not able to bear that load, resulting in a meniscus tear, but just having that is not the only way meniscus tears occur, they can happen independently as well. It often is some sort of aggressive twisting or pivoting type of knee action. Sometimes it can even be from deep squatting or heavy twisting and squatting at the same time. These are ways that the meniscus can tear. When it comes to what people feel, it’s often a similar thing, in that they feel a pain, maybe a pop in their knee. They often get swelling because when the tissue tears, it does cause some bleeding in the knee. What’s unique about a meniscus tear, is sometimes people might feel that their knee is actually locked where it actually is stuck. They don’t move it, they can’t move it. Sometimes they just have to jostle their leg a little bit to try to almost separate it, and then it will free up that locked feeling.

Host: Yeah I was just going to ask you about the differences in terms of the way that it feels between the two. So it sounds like when there’s a meniscus tear, it’s going to feel like your leg is stiff or your knee is locked and when you have that ACL tear, you’ll be able to move it but there’s going to be some extreme pain, is that right?

Dr. Bengtson: That is absolutely correct. Both of them are going to cause your knee to swell in a short time after the injury often, but you’re absolutely right it’s that catching or getting stuck feeling or stiff sensation that meniscus tears might produce.

Host: Okay, I want to talk a little bit about treatment for the both of these because I’m just remembering when I got my ACL tear. You know, I immediately want to think about, okay I really need to take care of this so I can get back on the courts with my friends. So I’ve heard of that acronym RICE, which is rest, elevation, icing, and compression. Talk to us a little bit right after you sustain that injury, what you should be doing and when it’s appropriate to see a doctor.

Dr. Bengtson: You’re a well informed patient that’s for sure. That RICE treatment is ideal. So the resting is important just to take some of the pressure off the knee. Icing, always valuable when it comes to joints. The purpose is to calm inflammation. We said that the knee tends to swell after these injuries, and so ice tries to combat that and minimize how much swelling. The compression does that same thing and the elevating does a similar thing, trying to minimize how much swelling occurs in that joint. While those are all things that are very valuable in the short term, and probably are valuable for multiple days, just to be clear, it is important to have your knee evaluated to determine what is the main source of this pain, swelling that a person might be experiencing. Because moving forward, the treatment might vary depending on what is injured. ACL injuries might warrant a different type of treatment compared to a meniscus injury in and of itself.

Host: Okay, that makes a lot of sense because not every injury is the same. So let’s say you go to the doctor, talk to us a little bit about how you diagnose the problem and the potential rehabilitation that someone needs to go through afterwards.

Dr. Bengtson: From a diagnosing standpoint, there’s nothing that beats the history and physical exam, opportunity to actually hear the patient’s story and find out how it happened, what you experienced immediately after that is so valuable. And then the physical exam gives us great insight as to what might be causing the problems. That might be some manipulation of the knee and cause a little discomfort at that time, but truly provides great value. MRIs, these are things that people know a lot about. These are very valuable at looking at the soft tissues inside the knee, things like the ACL or the meniscus. Definitely can help us evaluate what other things might be going on in addition to the main focus. X-rays can still be valuable. We want to ensure that there’s no significant fractures or malalignment or the bones are properly positioned. These are still important things to evaluate. Once the diagnosis has been made, the rehabilitation is still very important when it comes to taking care of the patient. In fact, ACL injuries, if a person wants to continue playing a sport, may warrant a surgery, but doing the surgery immediately is not always the right answer. Studies have shown that getting that knee moving again where the motion’s restored, the strength is restored, and the swelling has calmed down, those are very, very important to do before jumping to surgery. We found that if we go to surgery too quick when the knee is stiff, it comes out even stiffer, and that’s not a good situation. From a meniscus standpoint, if someone has a locked knee where they really can’t move it, yes that might require surgery to unlock the knee, but if the knee is not in that state or was and is no longer in that state, then rehabilitation is still valuable for those same reasons, to calm the swelling, the get the motion back, and to make sure that the muscles are firing properly.

Host: It really does seem like you need to work with your doctor who knows better on the rehabilitation plan because like you said, for example, even if the knee needs surgery, there may be a course of rehabilitation that you need to go through to get that knee back to mobility before you take those steps, and I imagine some of the most common things that you see because I am 100% guilty of this is going back too early and trying to play on something that isn’t fully healed, would that be right?

Dr. Bengtson: Oh you said it, you know one of the things we’re learning as time goes on and our research gets better is that we just need time for the body to heal. There’s time for the new ACL or the meniscus repair to heal, to have a chance to get back to its normal state, and then it’s a matter of getting the muscles restored. We know that building strength takes a long time for anybody, and we’re talking strength of the thigh muscles, I mention again like the core. The core is very important to get strong again. If you follow any professional athlete, you’re finding more often than not, they’re having to wait 7, 8, 10 months, maybe even a year before they’re ready to get back, and these athletes have the best physical therapy, the most time to commit to it, right? They don’t have other jobs or other things going on, so we know that it just takes time to get the athletes back to full go.

Host: Yeah, it’s really good that you said that, and for everyone listening, it is so important to strength those supporting muscles and that core, especially if you want to be out there playing all the time. So doc, I so much appreciate your time. That’s Dr. Bengtson, an orthopedic surgeon at Northfield Hospital. Thanks for checking out this episode of Northfield Hospital and Clinics podcast series. Head over to northfieldhospital.org to get connected with Dr. Bengtson or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check the entire podcast library for topics of interest to you. Thank you so much.