Study: Autograft ACL repair better in young athletes

Written by admin on February 25, 2013 – 3:45 pm -

(FoxNews: May 3, 2012)

A new study suggests young athletes who need knee ligament surgery do better over the long run when their own tissue is used for the reconstruction procedure, rather than tissue from a donor.

The anterior cruciate ligament (ACL) connects the upper and lower leg bones and helps stabilize the knee. It gets the most use in athletes who play a sport such as basketball that involves quick cuts and changes in direction.

Those athletes are also the most likely to suffer a torn ACL — the same injury that took down Chicago Bulls player Derrick Rose in the first round of the National Basketball Association playoffs last weekend.

The new findings support past research suggesting that when those injuries occur, it’s better to use a person’s own tissue to repair their ACL — also known as an autograft, said Dr. Cassandra Lee, a sports medicine doctor at the University of California, Davis, who wasn’t involved in the new study.

Typically, the tissue for an autograft is taken from a person’s hamstring or patellar tendon. The alternative — an allograft — is donated tissue from a cadaver.

For the new study, researchers at the United States Military Academy in West Point, New York tracked members of their 2007 through 2013 classes who had ACL reconstruction before entering the Academy. The students ranged from 18 to 23 years old.

Dr. Brett Owens, the study’s senior investigator and chief of orthopedic surgery service at Keller Army Hospital in West Point, told Reuters Health the researchers started their study after noticing an increase in the number of reconstructions using donated tissue that had failed.

They identified 120 cadets who’d had a total of 122 ACL reconstructions. Of those, 106 had their ACLs reconstructed with autografts; the rest had donor tissue.

Since all cadets receive medical care at the Academy, the researchers knew 20 of the ACL reconstructions failed — meaning cadets had to have the surgery re-done. Those failures happened an average of a year and a half after students started at the Academy.

Of the reconstructions that failed, 13 were from surgeries using the cadets’ own tissue — about 12 percent of all autografts — and seven were from cadavers, accounting for 44 percent of reconstructions that used donated tissue.

The researchers reported that cadets who had ACL allograft reconstruction were almost seven times as likely to need a second surgery compared to when cadets’ own tissue had been used.

Owens and his colleagues also reported that ACL allograft reconstructions failed much earlier, on average, than autografts.

They wrote in the American Journal of Sports Medicine that they recommend the use of autografts in young athletes.

There are about 150,000 ACL injuries every year in the U.S., according to the American Orthopaedic Society for Sports Medicine. The cost of reconstruction surgery varies, but typically runs between $5,000 and $7,000.

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Soccer players often recover fully from ACL surgery

Written by admin on February 24, 2013 – 7:48 pm -

(FoxNews: September 28, 2012)

Most soccer players are able to return to the field after surgery to repair torn knee ligaments, a new study suggests.

But out of 100 athletes who had reconstructive surgery on their anterior cruciate ligament, or ACL, researchers found female and older players were less likely than younger men and boys to get back in the game.

And by seven years out, 12 of the athletes had undergone a second ACL surgery on the same or opposite knee.

“The good news is, you can get back to a sport like soccer after an ACL reconstruction,” said Dr. Robert Brophy, an orthopedic surgeon from the Washington University School of Medicine in St. Louis, who led the study.

But athletes who’ve had an ACL tear, he added, “need to have a sense of the fact that they’re going to be at risk for future injury.”

The ACL, located in the middle of the knee joint, is most commonly injured during sports that require jumping or quick changes in direction, or when the knee gets overextended.

Female athletes are known to be at higher risk of ACL tears. Regardless of gender, those are typically thought of as season-ending injuries because rehab takes months of working to regain strength and range of motion.

For the new study, Brophy and his colleagues interviewed 100 soccer players who’d undergone surgery to repair a torn ACL in 2002 or 2003.

At the time of surgery, those athletes ranged in age from 11 to 53 years and included high school and college players as well as recreational athletes. Forty-five of them were female.

After surgery, 72 of the athletes returned to playing soccer, usually after a year or so, with most reaching their pre-injury level of play. That included 42 male athletes and 30 female athletes who said they’d gone back to the sport.

People who were younger at the time of injury were more likely to return to the field.

Seven years after surgery, 36 out of the 100 initial athletes were still playing soccer, the researchers reported in The American Journal of Sports Medicine. By then, nine female athletes and three males reported having had another ACL surgery.

The American Orthopaedic Society for Sports Medicine estimates there are about 150,000 ACL injuries in the U.S. every year.

Brophy said there are many reasons why athletes may never return to their sport of choice after an ACL tear. They may not get their conditioning back to where it once was, or they may feel okay running but have trouble with the type of knee function required for soccer or football.

In addition, “they may be afraid of re-injury or feel like it’s not worth the risk,” he told Reuters Health.

That may be especially true for older athletes, he said.

“Life demands may make the rehabilitation more challenging and more difficult to get through, as well as make it more difficult to say, ”(It’s) worth it to go back and play.’”


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New thoughts on the origins of IT Band Syndrome

Written by admin on January 11, 2013 – 2:06 pm -

“Iliotibial band syndrome is a common injury, occurring in up to 12 percent of all runners.1 The pain associated with this syndrome is often described as “burning” and is reproduced clinically with Noble’s test, in which the examiner compresses the distal band against the lateral femoral condyle while the knee is flexed 30 degrees. Although early research suggested the iliotibial band produced injury by snapping back and forth over the lateral femoral condyle (traumatizing the bursa trapped beneath), more recent research confirms that this theory is invalid”. (Dr. Thomas Michaud)

For more information and images click the attachment below.

Iliotibial Band Syndrome article


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“The Right Shoes Can Ease Knee Pain”

Written by admin on January 3, 2013 – 8:45 am -

“Boots, sandals, pumps, sneakers, loafers … When it comes to shoes, the options are dizzying. What you wear on your feet can affect your knees, so it pays to know which footwear may lessen pain and protect your knee joints. These tips can help you choose the right shoes.”

To read the entire article, please click here.

Medical Reviewer: Williams, Robert, MD
Copyright: © Copyright 2011 Health Grades, Inc


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The Relationship Between ACL Injuries and Physical Fitness…

Written by admin on December 31, 2012 – 8:15 am -

While “several physiological and physical variables, such as muscle strength, aerobic and anaerobic power, coordination, flexibility and the ability to sustain stress, are required (for physical activities/ exercise). Carter and Micheli stated in their review that poor physical fitness in youth athletes is a risk factor for sports-related injuries”

“This study contributes to the current knowledge of physical fitness as a modifiable ACL injury risk factor by identifying one main risk factor in young ski racers: core strength deficit. Coaches must understand the importance of core training and the strength and neuromuscular aspects of core training. The current findings provide evidence that the ACL injury risk was greater in female…”

For more information or to read the entire British Journal of Sports Medicine article by Christian Raschner, Hans-Peter Platzer, Carson Patterson, Inge Werner, Reinhard Huber, and Carolin Hildebrandt please click below.

skiier article


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…”effect of repeat injections of hyaluronic acid unclear. May not halt progression of OA nor delay knee replacement”…

Written by admin on December 29, 2012 – 11:02 am -

“Osteoarthritis (OA) is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth, which ultimately lead to pain and joint stiffness. Most commonly affected joints are the knees, hips, and joints in the hands and spine. OA of the weight bearing joints (e.g. knee and hip) typically have the most clinical significance. The causes of OA are presumed to be related to mechanical and molecular events in the joint (http://www.cdc.gov/arthritis/basics/osteoarthritis.htm).

OA usually begins after the age of 40. OA affects 13.9% of adults aged 25 and older and 33.6% of those aged 65 and over (http://www.cdc.gov/arthritis/basics/osteoarthritis.htm). Among those affected, approximately one quarter of them are severely disabled. [3] Osteoarthritis is the leading cause of mobility disabilities such as difficulty walking or climbing up stairs. OA of the knee is one of five leading causes of disability among non-institutionalized adults. [4]

Knee OA is the most prevalent, followed by hip OA. Both knee and hip OA result in joint pain and stiffness which can ultimately interfere with function and restrict activities of daily living [5].

There is no cure for OA. In addition, there are currently no known therapies that can prevent progression of OA. Treatment of OA typically focuses on minimizing pain and swelling, reducing disability and improving quality of life.
Treatment typically starts with non-pharmacologic therapy approaches including exercise programs, weight loss, patient education and shoe insoles. [6] Non-pharmacologic approaches are typically tried before medications are started.

Pharmacologic treatment is typically the next step and focuses on relief of pain. Pharmacologic therapy typically includes acetominophen, nonsteroidal anti-inflammatory drugs (NSAIDs), cyclooxygenase (COX-2) inhibitors and opiates. Each of these medications can be beneficial in some patients and each is associated with characteristic side effects. Given that the patient population is typically an older one, often with other comorbid conditions, the side effects associated with long term use of some of the OA medications can be particularly problematic.

Intra-articular glucocorticoid injections are another potential component of OA treatment….”

For the entire article please click below.

Hyaluronic Acid for Treatment of Osteoarthritis of the Knee…


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PRP May Be Superior Knee OA Treatment When Compared With Visco Supplementation

Written by admin on December 6, 2012 – 8:18 pm -

Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis.

Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M.


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Marcus Lattimore’s knee dislocation

Written by admin on October 30, 2012 – 8:27 am -

College football fans are all wondering: what happened to that guy’s leg on Saturday? Most fans of college football are aware that University of South Carolina running back, Marcus Lattimore, suffered a severe right knee injury during Saturday’s game versus Tennessee. A statement released by USC indicates that Lattimore suffered injury to several ligaments of the knee with no fractures or additional injuries. Coach, Steve Spurrier, confirmed with reporters that the knee had been dislocated.

A knee dislocation is a serious injury that is not to be confused with a patella dislocation. In a patella dislocation, the “knee cap” is forced out of alignment-painful, yes, but not very severe or career threatening. In contrast, during a knee dislocation, the shin bone (tibia) loses contact with the thigh bone (femur). This requires damage to several ligaments. As is the case with Lattimore, the most common type of knee dislocation occurs with a direct force to the front of the knee results in a high-velocity hyperextension of the knee (forces a knee to straighten beyond its normal limits).

The knee consists of four major ligaments that provide stability to the joint: the anterior and posterior cruciate ligaments (ACL and PCL) and the medial and lateral collateral ligaments (MCL and LCL). When a knee is dislocated through a hyperextension mechanism, the ACL and PCL are most certainly torn. Depending on the extent and direction of the force, the MCL, LCL or both will also be torn. In the case of Lattimore, although it has not been confirmed, it can be reasonable to suspect that both ACL and PCL and at least one of the collateral ligaments are torn.

One may be surprised to learn that the ligament damage is not the initial primary concern when a knee is dislocated. Rather, the evaluation and management of possible vascular or nerve damage is the top priority. Once a dislocated knee has been realigned to its proper position, careful and close monitoring of the patient is required to ensure proper nerve and vascular function are intact.

On replay, the injury leaves many cringing and questioning if Lattimore will ever play football again. While the injury is severe and rehabilitation is extensive, it is possible to return to full participation and compete at a high level. In fact, Lattimore’s injury is not very different from the injury sustained by Willis McGahee during the 2002 Fiesta Bowl. McGahee damaged his ACL, PCL, and MCL in a similar play and resulting from the same type of mechanism. As many know, McGahee is currently in his 9th season in the NFL.

Knee dislocations can be horrifying injuries, for players and fans alike. Fortunately, the injury is manageable and prognosis while guarded can be good.

Post by Dr. Mark Galland and Matt Rongstad, ATC/LAT


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Dr. Mark Galland Releases Podcast On Double Bundle ACL Reconstruction Procedure

Written by admin on September 6, 2012 – 11:33 am -

RALEIGH, N.C. – Dr. Mark Galland, a physician at Orthopaedic Specialists of North Carolina (www.orthonc.com/galland.html), has announced the release of a podcast discussing the double bundle, or anatomic, ACL reconstruction procedure. In the podcast, Galland discusses what the procedure entails, what types of injuries require the surgery, candidates for the surgery and the proper patient treatment after the procedure. Galland serves as the team physician and orthopaedic consultant to the Carolina Mudcats, as medical director and orthopaedic consultant to the Louisburg College athletic program and as the team physician and orthopaedic consultant to several local high schools. The podcast can be found at: http://bit.ly/PoN4AM.

QUOTES:

“I am happy to share my knowledge about ACL injuries and the current treatment methods,” said Galland. “ACL injuries are very common for athletes and need to be treated with the best procedure possible.”

ABOUT DR. MARK GALLAND:

Dr. Mark Galland is an orthopaedic surgeon, sports medicine specialist and physician at Orthopaedic Specialists of North Carolina. Galland received his medical degree from Tulane University’s School of Medicine and completed his residency in the university’s Department of Orthopaedic Surgery. He began his career in orthopaedic surgery and sports medicine while serving in the United States Navy at a naval hospital at Camp Lejeune, N.C. There, he served as chief of orthopaedic surgery and was the recipient of numerous awards for both leadership and excellence in treating injuries common to sailors and marines. Since beginning with Orthopaedic Specialists of North Carolina, Galland has continued to treat injured athletes. He currently serves as a team physician and orthopaedic consultant to the Carolina Mudcats, the AA affiliate of the Cincinnati Reds Major League Baseball team, and as medical director and orthopaedic consultant to the Louisburg College athletic program. He also serves as the team physician and orthopaedic consultant to several local high schools.


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Josh Baker’s (NY Jets) ACL Injury

Written by admin on September 2, 2012 – 10:33 am -

Josh Baker

The NFL pre-season has yet to begin. Unfortunately for Josh Baker, a NY Jets tight end, the season has already ended. In only the third preseason game of the year; Baker received a blow to his right knee by an opponent’s helmet when attempting to catch a touchdown pass Sunday night in the Jets 17- 12 loss to the Carolina Panthers. The injury may be seen at http://assets.sbnation.com/assets/1316218/kneeinjury.gif
Baker was assisted off of the field. The results of the diagnostic tests concluded that Baker had torn the anterior cruciate ligament (ACL) in his right knee. The ACL is one of the commonly injured ligaments of the knee. Other ligaments of the knee include the posterior cruciate ligament (PCL), medial collateral ligament (MCL), and the lateral collateral ligament (LCL). Although not all ACL injuries require reconstruction; it is recommended that those who tear their ACL have reconstructive surgery if he/she plans to return to sports/activity in the future. If the individual does not receive surgery he or she may need to wear a brace for support and/or modify their activities to accommodate the instability of the knee, and Osteoarthritis of the knee is certain to follow.
Dr. Galland is Board Certified in Orthopedic Surgery and in Orthopaedic Sports Medicine., Dr. Galland recommends and performs the Anatomic-Double Bundle Technique over the traditional “trans-tibial” Technique. These techniques are very different as the traditional trans-tibial technique only reconstructs the anterior-medial portion of the ACL and ignores the posterior-lateral portion of the ligament. The double-bundle technique reconstructs both the anterior-medial and posterior-lateral portions of the ACL. Dr. Galland prefers this technique as it has been shown to improve stability, range of motion and performance while promising to decrease the risk of degenerative arthritis in the joint, and decreases the chance and severity of post-surgical complications.
Galland, M. (2012). Restoring the knee after anterior cruciate ligament (acl) injury using the anatomic-. Retrieved from http://www.orthonc.com/articles/DB_ACL_final_revision_vype.pdf
Posted by Caitlin Davis, ATC/LAT, resident, GOSM program.

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