The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. Athletes who participate in high demand sports like soccer, football, and basketball can be more likely to injure their anterior cruciate ligaments.
Listen to SMG’s interview with orthopedic expert Dr. David Abrutyn, as he explains the ABC’s of the ACL.
Learn more about Summit Medical's new Orthopedic Location
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ACL Tears: Summit Medical's New Center Can Help
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Learn more about David A. Abrutyn, MD
Learn more about Summit Medical's new Orthopedic Location
David A. Abrutyn, MD
David A. Abrutyn, MD, has expertise in sports medicine, with an emphasis on injuries of the knee and shoulder. Dr. Abrutyn also treats pediatric, adolescent, and adult patients for a wide range of orthopedic problems. His skills include nonsurgical, surgical, arthroscopic, and other minimally invasive orthopedic surgical techniques and reconstructive orthopedic procedures.Learn more about David A. Abrutyn, MD
Learn more about Summit Medical's new Orthopedic Location
Transcription:
ACL Tears: Summit Medical's New Center Can Help
Melanie Cole (Host): The anterior cruciate ligament, or the ACL, is one of the most commonly injured ligaments of the knee. My guest today is Dr. David Abrutyn. He's an orthopedic sports medicine specialist with Summit Medical Group. Welcome to the show, doctor. So, tell us a little bit about the anterior cruciate ligament. People hear “ACL” all the time. They don't even know what this ligament is or what it does.
Dr. David Abrutyn (Guest): Good morning. Thanks for having me. So the ACL, or anterior cruciate ligament, is one of the central ligaments in the center of your knee that prevents the knee from going forward on itself or rotating. It is most commonly injured with non-contact injuries, believe it or not. Even though it seems like a violent injury to the knee, almost 70% of them happen without actually having contact.
Melanie: So what would cause this to be injured?
Dr. Abrutyn: Well, there’s been a lot of research dedicated to why it's so commonly injured. There are several thoughts. Some of it is muscle weakness or the position that the athlete lands with heavy emphasis on their quadriceps or thigh muscle versus more of a natural athletic landing with their hamstrings in a more balanced position. There's been a lot of focus on the female athlete because there's a four to five times higher incidence of ACL tears in the female athlete, and some of these are more biological factors, such as anatomy, hormones, the size of the knee, the bony anatomy of the knee, and just the overall muscle imbalance of different patients. So, some of the stuff that we’ve looked at is things that we could control but a lot of it is things that we can't control. It's just the way we're built.
Melanie: So, women are more at risk. Do they have to be an athlete to be at risk for an ACL injury?
Dr. Abrutyn: You don't have to be an athlete in the true sense of the word, but most commonly these do occur in sport activities. Sometimes, it's the recreational athlete just playing beach volleyball. It could, unfortunately, happen even just falling down your stairs, but, typically, it's with soccer, basketball, football, skiing type of injuries--whether you’re an everyday competitive athlete or just a weekend warrior, recreational athlete.
Melanie: So, doctor, tell us some of the symptoms, because people always say, “Oh, I'm going to hear that pop if it's anything real,” but that's not necessarily the case, is it?
Dr. Abrutyn: No. Most of the time you know something wrong happened in the sense that your knee will buckle on you. A lot of people do describe a pop. About 70% of people with an injury to their knee who have swelling in it and have an ACL tear without even touching them. So, usually there's pain, there's inability to extend their knee, or they have what's called a “quadriceps avoidance gait”. They feel a pop or they have swelling in their knee. But, it's usually confirmed with a physical exam and/or an MRI.
Melanie: If they feel that, do they rush right off to the doctor or can they try some home things like ice or compression?
Dr. Abrutyn: Generally, most people are going to be seen by a doctor. It's not necessarily that you need to go to the emergency room, although most people do because they're not sure what happened and they think they might have broken a bone or what have you. But, generally, it's a pretty painful injury on the front end because there’s typically bone bruising or swelling. You’re unable to straighten your leg. So, it's usually a pretty frightening event for the patient. But, I would recommend ice initially as well.
Melanie: If it is torn, does it heal itself?
Dr. Abrutyn: It does not heal itself. Generally, the only way to fix it is an operation. Not everyone with an ACL tear needs to have their ACL fixed, but typically it's recommended to fix it in the higher demand athlete, even the recreational athlete who wants to continue playing cutting type sports. And even, in patients who say that whatever happened was a fluke, sometimes we attempt to treat them non-operatively but they develop what we call “functional instability”. So, even if they're not playing sports per se, their knees buckling or giving out on them just living their life, stepping off a curb, or walking on uneven surfaces, and then those people we would end up fixing it. So, the majority of people who tear their ACL do end up having it reconstructed surgically but not everyone needs to have it reconstructed.
Melanie: So then, how do you help patients decide whether they need that reconstruction, Dr. Abrutyn?
Dr. Abrutyn: Generally, we treat patients and not the MRI or the actual x-ray. So, we have a conversation with the patient about realistic expectations, what's involved. We try and get a sense of what the patient's expectation, physical demands and activity levels and desires are. And, again, typically, in my practice, the types of patients we’re seeing are motivated people who are playing sports, whether it's a recreational or competitive level, they want to continue doing that, whether they’re 15, 25, or even 60 these days. And if those are their goals, their best chance of getting back to that level would be with surgery. If it's something that was more of just a fluke thing, they were walking their dog and they twisted their knee but they're not playing sports, we would talk maybe about trying to treat them non-operatively and see how they do. The other factor is usually when you tear your ACL, it's not in isolation, so you may have other injuries to your knee such as the meniscus, the other ligaments in your knee or your cartilage. So, we try and factor all that in in terms of making the decision.
Melanie: Then, what is this reconstruction like, and what's the recovery like? How soon can they get back to their activities?
Dr. Abrutyn: It is same-day surgery. Patients go home the same day. They’re using crutches initially. In terms of the surgery, we basically are creating a new ligament and you could do that one of two ways. Either with the patient's own tissue, such as what's called their “patellar tendon bone”, or their hamstrings, or even some people use quadriceps tendon. Or, we could use cadaver or allograft tissue, which again is a conversation that we have to try and make the best choice for the patient. We drill holes in the bone to recreate the tunnel placement. There's been a lot of focus on tunnel position and trying to create an anatomic ACL. The patients usually are independent by 4 to 6 weeks and living their life. They will still know they had a surgery by 4 to 6 weeks, but someone around them wouldn't. We get them moving right away in physical therapy, doing a range of motion, trying to decrease the swelling. And then, usually by three months we let them start running. And, it's usually around 9 to 12 months before patients return to sports.
Melanie: So then, let's talk about prevention. Is there a way to prevent these tears in women or girl soccer players or really anybody who might, as you say, step off a curb? Is there any way to prevent these?
Dr. Abrutyn: Well, there are a lot of studies that have been done to show that there are exercises and neuromuscular programs that may decrease the incidence of ACLs. Unfortunately, there’s no do this and you're guaranteed to avoid an ACL tear, but certainly trying to focus on the things we have control over, which is particularly neuromuscular control, such as balance and strengthening. So, a lot of people have what we call quadriceps dominant gait or landing where their thigh muscle is stronger than their hamstring is, but, actually, for ACL prevention, it's more important that your hamstrings and your gluteal or butt muscles are stronger. So, a lot of emphasis has been on what’s called “plyometric exercises” and there are programs that can easily be introduced into the warm-up routine of soccer players, football, baseball, basketball players. It has sometimes been a challenge to get coaches to buy into this on a large scale, but, certainly, there have been many studies that have shown that they can be effective and/or these days with athletes and patients who are so dedicated to sports, a lot of kids are working out with trainers and with the appropriate trainer or strength conditioning coach, they can do these things as part of their preparation for the season.
Melanie: Wow, great advice. Really great information and so important. Tell us, in the last few minutes about your team at Summit Medical Group.
Dr. Abrutyn: At Summit Medical Group, we’re a multispecialty physician practice. We have 33 orthopedic surgeons throughout the State of New Jersey. Many of us who specialize in sports medicine injuries but we cover the full range of orthopedic injuries and treatment. And our goal is to do the best for the patients and get them back in the game and back feeling and living well.
Melanie: Thank you so much for being with us today. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. This is Melanie Cole. Thanks for listening.
ACL Tears: Summit Medical's New Center Can Help
Melanie Cole (Host): The anterior cruciate ligament, or the ACL, is one of the most commonly injured ligaments of the knee. My guest today is Dr. David Abrutyn. He's an orthopedic sports medicine specialist with Summit Medical Group. Welcome to the show, doctor. So, tell us a little bit about the anterior cruciate ligament. People hear “ACL” all the time. They don't even know what this ligament is or what it does.
Dr. David Abrutyn (Guest): Good morning. Thanks for having me. So the ACL, or anterior cruciate ligament, is one of the central ligaments in the center of your knee that prevents the knee from going forward on itself or rotating. It is most commonly injured with non-contact injuries, believe it or not. Even though it seems like a violent injury to the knee, almost 70% of them happen without actually having contact.
Melanie: So what would cause this to be injured?
Dr. Abrutyn: Well, there’s been a lot of research dedicated to why it's so commonly injured. There are several thoughts. Some of it is muscle weakness or the position that the athlete lands with heavy emphasis on their quadriceps or thigh muscle versus more of a natural athletic landing with their hamstrings in a more balanced position. There's been a lot of focus on the female athlete because there's a four to five times higher incidence of ACL tears in the female athlete, and some of these are more biological factors, such as anatomy, hormones, the size of the knee, the bony anatomy of the knee, and just the overall muscle imbalance of different patients. So, some of the stuff that we’ve looked at is things that we could control but a lot of it is things that we can't control. It's just the way we're built.
Melanie: So, women are more at risk. Do they have to be an athlete to be at risk for an ACL injury?
Dr. Abrutyn: You don't have to be an athlete in the true sense of the word, but most commonly these do occur in sport activities. Sometimes, it's the recreational athlete just playing beach volleyball. It could, unfortunately, happen even just falling down your stairs, but, typically, it's with soccer, basketball, football, skiing type of injuries--whether you’re an everyday competitive athlete or just a weekend warrior, recreational athlete.
Melanie: So, doctor, tell us some of the symptoms, because people always say, “Oh, I'm going to hear that pop if it's anything real,” but that's not necessarily the case, is it?
Dr. Abrutyn: No. Most of the time you know something wrong happened in the sense that your knee will buckle on you. A lot of people do describe a pop. About 70% of people with an injury to their knee who have swelling in it and have an ACL tear without even touching them. So, usually there's pain, there's inability to extend their knee, or they have what's called a “quadriceps avoidance gait”. They feel a pop or they have swelling in their knee. But, it's usually confirmed with a physical exam and/or an MRI.
Melanie: If they feel that, do they rush right off to the doctor or can they try some home things like ice or compression?
Dr. Abrutyn: Generally, most people are going to be seen by a doctor. It's not necessarily that you need to go to the emergency room, although most people do because they're not sure what happened and they think they might have broken a bone or what have you. But, generally, it's a pretty painful injury on the front end because there’s typically bone bruising or swelling. You’re unable to straighten your leg. So, it's usually a pretty frightening event for the patient. But, I would recommend ice initially as well.
Melanie: If it is torn, does it heal itself?
Dr. Abrutyn: It does not heal itself. Generally, the only way to fix it is an operation. Not everyone with an ACL tear needs to have their ACL fixed, but typically it's recommended to fix it in the higher demand athlete, even the recreational athlete who wants to continue playing cutting type sports. And even, in patients who say that whatever happened was a fluke, sometimes we attempt to treat them non-operatively but they develop what we call “functional instability”. So, even if they're not playing sports per se, their knees buckling or giving out on them just living their life, stepping off a curb, or walking on uneven surfaces, and then those people we would end up fixing it. So, the majority of people who tear their ACL do end up having it reconstructed surgically but not everyone needs to have it reconstructed.
Melanie: So then, how do you help patients decide whether they need that reconstruction, Dr. Abrutyn?
Dr. Abrutyn: Generally, we treat patients and not the MRI or the actual x-ray. So, we have a conversation with the patient about realistic expectations, what's involved. We try and get a sense of what the patient's expectation, physical demands and activity levels and desires are. And, again, typically, in my practice, the types of patients we’re seeing are motivated people who are playing sports, whether it's a recreational or competitive level, they want to continue doing that, whether they’re 15, 25, or even 60 these days. And if those are their goals, their best chance of getting back to that level would be with surgery. If it's something that was more of just a fluke thing, they were walking their dog and they twisted their knee but they're not playing sports, we would talk maybe about trying to treat them non-operatively and see how they do. The other factor is usually when you tear your ACL, it's not in isolation, so you may have other injuries to your knee such as the meniscus, the other ligaments in your knee or your cartilage. So, we try and factor all that in in terms of making the decision.
Melanie: Then, what is this reconstruction like, and what's the recovery like? How soon can they get back to their activities?
Dr. Abrutyn: It is same-day surgery. Patients go home the same day. They’re using crutches initially. In terms of the surgery, we basically are creating a new ligament and you could do that one of two ways. Either with the patient's own tissue, such as what's called their “patellar tendon bone”, or their hamstrings, or even some people use quadriceps tendon. Or, we could use cadaver or allograft tissue, which again is a conversation that we have to try and make the best choice for the patient. We drill holes in the bone to recreate the tunnel placement. There's been a lot of focus on tunnel position and trying to create an anatomic ACL. The patients usually are independent by 4 to 6 weeks and living their life. They will still know they had a surgery by 4 to 6 weeks, but someone around them wouldn't. We get them moving right away in physical therapy, doing a range of motion, trying to decrease the swelling. And then, usually by three months we let them start running. And, it's usually around 9 to 12 months before patients return to sports.
Melanie: So then, let's talk about prevention. Is there a way to prevent these tears in women or girl soccer players or really anybody who might, as you say, step off a curb? Is there any way to prevent these?
Dr. Abrutyn: Well, there are a lot of studies that have been done to show that there are exercises and neuromuscular programs that may decrease the incidence of ACLs. Unfortunately, there’s no do this and you're guaranteed to avoid an ACL tear, but certainly trying to focus on the things we have control over, which is particularly neuromuscular control, such as balance and strengthening. So, a lot of people have what we call quadriceps dominant gait or landing where their thigh muscle is stronger than their hamstring is, but, actually, for ACL prevention, it's more important that your hamstrings and your gluteal or butt muscles are stronger. So, a lot of emphasis has been on what’s called “plyometric exercises” and there are programs that can easily be introduced into the warm-up routine of soccer players, football, baseball, basketball players. It has sometimes been a challenge to get coaches to buy into this on a large scale, but, certainly, there have been many studies that have shown that they can be effective and/or these days with athletes and patients who are so dedicated to sports, a lot of kids are working out with trainers and with the appropriate trainer or strength conditioning coach, they can do these things as part of their preparation for the season.
Melanie: Wow, great advice. Really great information and so important. Tell us, in the last few minutes about your team at Summit Medical Group.
Dr. Abrutyn: At Summit Medical Group, we’re a multispecialty physician practice. We have 33 orthopedic surgeons throughout the State of New Jersey. Many of us who specialize in sports medicine injuries but we cover the full range of orthopedic injuries and treatment. And our goal is to do the best for the patients and get them back in the game and back feeling and living well.
Melanie: Thank you so much for being with us today. You’re listening to SMG Radio. For more information, you can go to SummitMedicalGroup.com. This is Melanie Cole. Thanks for listening.