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Advancements in ACL Surgery
If you've ever had a knee injury, you know how much it affects your every mood and how disruptive and painful it can be. Dr. Wasik Ashraf discusses the progress in knee injury treatments such as advancements in ACL surgery.
Featured Speaker:
Wasik Ashraf, DO
After graduating summa cum laude with a degree in biology from the New York Institute of Technology in Old Westbury, New York, Dr. Ashraf went on to receive his medical degree from the New York College of Osteopathic Medicine, also in Old Westbury. He then trained in Orthopaedic Surgery at North Shore University Hospital in Plainview, New York, and recently completed a sports medicine fellowship at the Hughston Foundation in Columbus, Georgia. Before becoming a surgeon, Dr. Ashraf was a licensed emergency medical technician who worked as a volunteer and participated in community education programs. Dr. Ashraf has a passion for sports medicine and research. He has provided team coverage for the Roslyn, Manhasset, and Hewlett, New York high school football teams, and during his Hughston Sports Medicine Fellowship at the Hughston Foundation took care of team coverage for the Columbus Cottonmouth professional hockey team. Dr. Ashraf is currently board eligible in orthopaedic surgery and is a member of the American Orthopaedic Society of Sports Medicine (AOSSM) and the American Osteopathic Academy of Orthopaedics (AOAO) as well as Arthroscopy Association of North America (AANA). Transcription:
Advancements in ACL Surgery
Maggie McKay (Host): If you've ever had a knee injury, you know how much it affects your every move and how disruptive it can be, not to mention painful. But there has been progress in treating knee injuries. To find out about advancements in ACL surgery is Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm your host, Maggie McKay. Thank you so much for being here, Dr. Ashraf, and for your time today.
Dr Wasik Ashraf: Thank you for having me.
Maggie McKay (Host): Absolutely. Let's get right to it. What does ACL stand for? Where is it located and what is its function?
Dr Wasik Ashraf: ACL stands for anterior cruciate ligament. And if you watch sports, TV, ESPN and any type of sporting event or even non-sporting events, we unfortunately see knee injuries and it's a very common injury and the ACL, the best way to think about it, is the primary stabilizer. It gives you the stability we look for when we run, we pivot and we do cutting activities and it's located inside your knee.
Maggie McKay (Host): So, what are the symptoms and causes if you need surgery?
Dr Wasik Ashraf: Right. You know, the injury pattern for an ACL tends to be from a pivoting injury and one that we see happens in football, basketball and soccer, where your feet or foot is planted onto the turf or grass and you have a twisting on the knee while your foot's planted. And you usually can hear a pop and immediate pain and swelling that occurs afterwards. The first step is really looking at the mechanism of injury and where it happens. And again, usually, it happens while playing sports. The requirement for surgery is strictly based on age, how active the patient is, and if they have instability of the knee after the injury has healed.
Maggie McKay (Host): And speaking of age, is It more common in younger people or older people?
Dr Wasik Ashraf: It really happens throughout the age from young to older. I have done ACL reconstructions on very active 80-year-olds, they're skiers, and they want to remain active and want stability in their knee. But unfortunately, the trend that we're seeing now is younger and younger patients are sustaining anterior cruciate ligament, ACL injuries. And the difficulty is they're young, their growth plates are open, which can sometimes be a little tricky when we talk about surgery.
Maggie McKay (Host): And do genetics play a part at all?
Dr Wasik Ashraf: Yes. That's something there's a lot of research going into now. What we know is the female athlete have a higher chance of having an anterior cruciate ligament rupture than the male athlete. And that has to do with some genetics and also how the body structure is with the knee angles. But there is a combination of genetic and environmental factors.
Maggie McKay (Host): Doctor, how important is prevention and what does that entail? How can you prevent it?
Dr Wasik Ashraf: Unfortunately, a lot of injuries that happen so fast, it's very hard to prevent an ACL injury, but there is a huge part of prevention. Soccer, for example, for female soccer players, there's a whole rehab program that includes warmups to decrease the incidence of ACL injuries during sports. Some people recommend using bracing as to prevent ACL injuries, but that has not kind of worked out in our scientific literature. But a proper warm-up, cool-down, proper footwear is what's important in preventing an anterior cruciate ligament rupture.
Maggie McKay (Host): What about they're kind of like ACE bandages for the knee. Someone gave me those for Christmas for pickleball, and I thought those must be preventive measures. Is that right?
Dr Wasik Ashraf: Yes and no. So pickleball, by the way, great sport. I'm planning on getting down to Naples, which is the pickleball tournament in the US that happens every year. But, as far as the knee sleeves, the sleeves are really compression. And what we know from compression is-- days of rest, ice compression, elevation. Compression helps things feel good. So using compressive devices during sport has been shown to make it feel more comfortable, but it does not prevent an injury. An injury that can happen will happen with or without a knee sleeve on.
Maggie McKay (Host): Oh, good to know. So the good part, what are the latest advancements in ACL surgery?
Dr Wasik Ashraf: That's something I'm very excited about that we offer here at St. Luke's Montefiore Hospital in Newburgh. Younger patients that are more active that are playing a single sport all year around is more likely to injure a body parts such as the overhead throwers injure their elbows and they have Tommy John surgeries, an ulnar collateral ligament reconstruction, at a younger age. But when we talk about ACL reconstruction for say a thirteen-year-old where we take a piece of another tendon from their body and remake that ACL, that has its own issues, because we are taking a piece of tissue from some other part of their body. There has been advancements with a bridge enhanced ACL repair, where we actually try to repair what is ripped using technology such as collagen, as well as bone marrow and whole blood to help the tissues heal and tension properly. And this is a newer FDA-approved implant and procedure that we're doing at St. Luke's for our patients that are growth plate open, anterior cruciate ligament rupture, that don't want their ACLs reconstructed with another piece of tissue and wants to try to hold on to their own.
Maggie McKay (Host): That's amazing. That's good news, right?
Dr Wasik Ashraf: Very much so. It really is a great way for us to hold onto what we have. And, you know, ACL reconstruction, unfortunately, a lot of the ways we do it currently are the same way as we did 10 15 years ago with absolute advancements in tunnel positioning and implant positioning. But, this is really a game changer when it comes down to younger patients that need ACL reconstruction. It really is a game changer in that effect.
Maggie McKay (Host): So in a less severe ACL tear, can it heal on its own without surgery?
Dr Wasik Ashraf: Yes. If it's an incomplete ACL, there are some fibers intact, I would absolutely try sessions of physical therapy, home exercises to strengthen the leg as to see if the patient will have instability. We're not just treating MRIs and imaging. We're treating people. And if their knee is stable, even with a partial ACL tear, you don't need surgery. It's that instability that we don't want because what we don't want is if the knee continues to be unstable, it'll rip other important parts of the knee, such as the meniscus and other ligaments, which will face undue tension because the ACL tear is causing instability.
Maggie McKay (Host): Dr. Ashraf, what are the odds of a re-tear?
Dr Wasik Ashraf: Very common question. And actually, they have looked at this, in multiple studies. It really depends on multiple factors. One factor is what is the age of the patient. The younger the patient, more active the patient, higher rate of re-tear. The type of sports they're playing, a player that's playing golf as opposed to someone who's playing pickleball or any type of basketball, cutting activities. And usually, the re-tear rate is highest within the first year after an ACL reconstruction. But interestingly, the rate of tearing the other knee is higher than re-tearing the same knee.
Maggie McKay (Host): Oh, why is that?
Dr Wasik Ashraf: You know, we tend to compensate a little bit. Our way of how we protect the knee that had surgery. It works in such intricate ways. We don't know exactly why that happens, but it's a very common effect, that the other knee ends up getting an injury and not the same knee. But the re-tear is something that happens. And I tell all my patients is if you could tear something that God gave you, your ACL, and we fix it, you can always tear it again. That chance is always there.
Maggie McKay (Host): Is ACL surgery a major surgery. What's the downtime after and how long does it take to walk after surgery?
Dr Wasik Ashraf: With the advancements of how we do the surgery, in the past, you talk about 20, 30 years ago, they're making these big incisions, four-hour procedure, these are now all done arthroscopically through a little camera hole, better visualization, better sutures, better implants to fixate the ACL. So surgery is about 30 minutes to an hour, with increase in rehab protocols, faster recovery. So really it takes a full year to fully recover from an ACL to the point where they can get back to the same level of sporting that they once were. But by about six weeks, they're feeling really, really good. So really, the recovery is much easier and better because of technology and because of surgical technique advancements.
Maggie McKay (Host): And how long are you in the hospital?
Dr Wasik Ashraf: Same day surgery. So you're coming in the morning and you're back home in your pajamas in your couch by that night.
Maggie McKay (Host): You're speaking my language. Dr. Ashraf, is there anything else you'd like to share about ACL surgery and the advancements?
Dr Wasik Ashraf: Well, I will say that here at St. Luke's Hospital, we offer all the technological advancements, as far as from visualization, to the camera we use to do this surgery to pain management, which you think about ACL being very painful, we have really expert anesthesiologists, that really work hard in making sure your pain is under control, so you don't have to have much opioids after surgery. Implant-wise, we have all the things that are necessary to really complete an ACL with top notch implants that are out there, FDA approved. And then, also we talked about the bridge enhanced ACL repair, where now we can repair it instead of getting rid of it and reconstructing it. So, that's something that we have here at St. Luke's, which I'm very excited about.
Maggie McKay (Host): That's all very encouraging and good news. Thank you so much for your time, doctor.
Dr Wasik Ashraf: You have a great day.
Maggie McKay (Host): That's Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall. Visit montefioreslc.org for more information about our orthopedic services. Please remember to subscribe, rate and review this podcast and all the other Doc Talk podcasts. This has been Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Maggie McKay. Be well.
Advancements in ACL Surgery
Maggie McKay (Host): If you've ever had a knee injury, you know how much it affects your every move and how disruptive it can be, not to mention painful. But there has been progress in treating knee injuries. To find out about advancements in ACL surgery is Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall.
Welcome to Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm your host, Maggie McKay. Thank you so much for being here, Dr. Ashraf, and for your time today.
Dr Wasik Ashraf: Thank you for having me.
Maggie McKay (Host): Absolutely. Let's get right to it. What does ACL stand for? Where is it located and what is its function?
Dr Wasik Ashraf: ACL stands for anterior cruciate ligament. And if you watch sports, TV, ESPN and any type of sporting event or even non-sporting events, we unfortunately see knee injuries and it's a very common injury and the ACL, the best way to think about it, is the primary stabilizer. It gives you the stability we look for when we run, we pivot and we do cutting activities and it's located inside your knee.
Maggie McKay (Host): So, what are the symptoms and causes if you need surgery?
Dr Wasik Ashraf: Right. You know, the injury pattern for an ACL tends to be from a pivoting injury and one that we see happens in football, basketball and soccer, where your feet or foot is planted onto the turf or grass and you have a twisting on the knee while your foot's planted. And you usually can hear a pop and immediate pain and swelling that occurs afterwards. The first step is really looking at the mechanism of injury and where it happens. And again, usually, it happens while playing sports. The requirement for surgery is strictly based on age, how active the patient is, and if they have instability of the knee after the injury has healed.
Maggie McKay (Host): And speaking of age, is It more common in younger people or older people?
Dr Wasik Ashraf: It really happens throughout the age from young to older. I have done ACL reconstructions on very active 80-year-olds, they're skiers, and they want to remain active and want stability in their knee. But unfortunately, the trend that we're seeing now is younger and younger patients are sustaining anterior cruciate ligament, ACL injuries. And the difficulty is they're young, their growth plates are open, which can sometimes be a little tricky when we talk about surgery.
Maggie McKay (Host): And do genetics play a part at all?
Dr Wasik Ashraf: Yes. That's something there's a lot of research going into now. What we know is the female athlete have a higher chance of having an anterior cruciate ligament rupture than the male athlete. And that has to do with some genetics and also how the body structure is with the knee angles. But there is a combination of genetic and environmental factors.
Maggie McKay (Host): Doctor, how important is prevention and what does that entail? How can you prevent it?
Dr Wasik Ashraf: Unfortunately, a lot of injuries that happen so fast, it's very hard to prevent an ACL injury, but there is a huge part of prevention. Soccer, for example, for female soccer players, there's a whole rehab program that includes warmups to decrease the incidence of ACL injuries during sports. Some people recommend using bracing as to prevent ACL injuries, but that has not kind of worked out in our scientific literature. But a proper warm-up, cool-down, proper footwear is what's important in preventing an anterior cruciate ligament rupture.
Maggie McKay (Host): What about they're kind of like ACE bandages for the knee. Someone gave me those for Christmas for pickleball, and I thought those must be preventive measures. Is that right?
Dr Wasik Ashraf: Yes and no. So pickleball, by the way, great sport. I'm planning on getting down to Naples, which is the pickleball tournament in the US that happens every year. But, as far as the knee sleeves, the sleeves are really compression. And what we know from compression is-- days of rest, ice compression, elevation. Compression helps things feel good. So using compressive devices during sport has been shown to make it feel more comfortable, but it does not prevent an injury. An injury that can happen will happen with or without a knee sleeve on.
Maggie McKay (Host): Oh, good to know. So the good part, what are the latest advancements in ACL surgery?
Dr Wasik Ashraf: That's something I'm very excited about that we offer here at St. Luke's Montefiore Hospital in Newburgh. Younger patients that are more active that are playing a single sport all year around is more likely to injure a body parts such as the overhead throwers injure their elbows and they have Tommy John surgeries, an ulnar collateral ligament reconstruction, at a younger age. But when we talk about ACL reconstruction for say a thirteen-year-old where we take a piece of another tendon from their body and remake that ACL, that has its own issues, because we are taking a piece of tissue from some other part of their body. There has been advancements with a bridge enhanced ACL repair, where we actually try to repair what is ripped using technology such as collagen, as well as bone marrow and whole blood to help the tissues heal and tension properly. And this is a newer FDA-approved implant and procedure that we're doing at St. Luke's for our patients that are growth plate open, anterior cruciate ligament rupture, that don't want their ACLs reconstructed with another piece of tissue and wants to try to hold on to their own.
Maggie McKay (Host): That's amazing. That's good news, right?
Dr Wasik Ashraf: Very much so. It really is a great way for us to hold onto what we have. And, you know, ACL reconstruction, unfortunately, a lot of the ways we do it currently are the same way as we did 10 15 years ago with absolute advancements in tunnel positioning and implant positioning. But, this is really a game changer when it comes down to younger patients that need ACL reconstruction. It really is a game changer in that effect.
Maggie McKay (Host): So in a less severe ACL tear, can it heal on its own without surgery?
Dr Wasik Ashraf: Yes. If it's an incomplete ACL, there are some fibers intact, I would absolutely try sessions of physical therapy, home exercises to strengthen the leg as to see if the patient will have instability. We're not just treating MRIs and imaging. We're treating people. And if their knee is stable, even with a partial ACL tear, you don't need surgery. It's that instability that we don't want because what we don't want is if the knee continues to be unstable, it'll rip other important parts of the knee, such as the meniscus and other ligaments, which will face undue tension because the ACL tear is causing instability.
Maggie McKay (Host): Dr. Ashraf, what are the odds of a re-tear?
Dr Wasik Ashraf: Very common question. And actually, they have looked at this, in multiple studies. It really depends on multiple factors. One factor is what is the age of the patient. The younger the patient, more active the patient, higher rate of re-tear. The type of sports they're playing, a player that's playing golf as opposed to someone who's playing pickleball or any type of basketball, cutting activities. And usually, the re-tear rate is highest within the first year after an ACL reconstruction. But interestingly, the rate of tearing the other knee is higher than re-tearing the same knee.
Maggie McKay (Host): Oh, why is that?
Dr Wasik Ashraf: You know, we tend to compensate a little bit. Our way of how we protect the knee that had surgery. It works in such intricate ways. We don't know exactly why that happens, but it's a very common effect, that the other knee ends up getting an injury and not the same knee. But the re-tear is something that happens. And I tell all my patients is if you could tear something that God gave you, your ACL, and we fix it, you can always tear it again. That chance is always there.
Maggie McKay (Host): Is ACL surgery a major surgery. What's the downtime after and how long does it take to walk after surgery?
Dr Wasik Ashraf: With the advancements of how we do the surgery, in the past, you talk about 20, 30 years ago, they're making these big incisions, four-hour procedure, these are now all done arthroscopically through a little camera hole, better visualization, better sutures, better implants to fixate the ACL. So surgery is about 30 minutes to an hour, with increase in rehab protocols, faster recovery. So really it takes a full year to fully recover from an ACL to the point where they can get back to the same level of sporting that they once were. But by about six weeks, they're feeling really, really good. So really, the recovery is much easier and better because of technology and because of surgical technique advancements.
Maggie McKay (Host): And how long are you in the hospital?
Dr Wasik Ashraf: Same day surgery. So you're coming in the morning and you're back home in your pajamas in your couch by that night.
Maggie McKay (Host): You're speaking my language. Dr. Ashraf, is there anything else you'd like to share about ACL surgery and the advancements?
Dr Wasik Ashraf: Well, I will say that here at St. Luke's Hospital, we offer all the technological advancements, as far as from visualization, to the camera we use to do this surgery to pain management, which you think about ACL being very painful, we have really expert anesthesiologists, that really work hard in making sure your pain is under control, so you don't have to have much opioids after surgery. Implant-wise, we have all the things that are necessary to really complete an ACL with top notch implants that are out there, FDA approved. And then, also we talked about the bridge enhanced ACL repair, where now we can repair it instead of getting rid of it and reconstructing it. So, that's something that we have here at St. Luke's, which I'm very excited about.
Maggie McKay (Host): That's all very encouraging and good news. Thank you so much for your time, doctor.
Dr Wasik Ashraf: You have a great day.
Maggie McKay (Host): That's Dr. Wasik Ashraf, Medical Director of Sports Medicine for Montefiore St. Luke's Cornwall. Visit montefioreslc.org for more information about our orthopedic services. Please remember to subscribe, rate and review this podcast and all the other Doc Talk podcasts. This has been Doc Talk, presented by Montefiore St. Luke's Cornwall. I'm Maggie McKay. Be well.