ACL Injury and Prevention

ACL injuries are common and on the rise. These injuries can cause young athletes to sit on the sidelines for months, lose out on valuable scholarship money and lead to long term osteoarthritis. It is estimated that over 50,000 high school and college age female athletes suffer from ACL injuries each year.[1] While some of these incidents cannot be prevented, there are steps that can be taken to reduce the number of injuries. 

One common misconception about ACL tears is that they are a result of player-to-player contact and little can be done to prevent occurrence. While ACLs are injured/torn in this manner, most occur as a result of the following: 

• Sudden change in direction
• Cutting maneuvers coupled with a sudden stop
• Awkward landing following a jump
• Pivoting with knee fully extended while foot is planted on the ground

Unfortunately, female athletes are more susceptible to ACL injury. Anatomical differences, such as a greater Q-angle, are primarily to blame. Other factors include weak muscle groups, bad habits, improper form and decreased range of motion. The good news is that while we cannot change the anatomy, we can identify risk factors and help reduce the chance of injury. 

A few suggestions for prevention would include: 

• Strength training – especially the smaller muscles around the knee and the hamstring 
•  Jump routine exercises emphasizing proper form and landing
• Pivoting exercises – also focusing on proper form

These tools are most successful when implemented in early adolescence. By utilizing prevention tools early in life, we can ensure that kids are learning proper form and technique from the beginning. This alleviates the need to undo risky habits in the future. 

Many organizations are implementing pre-season screening programs where professionals can assess athletes and determine if they are high risk for ACL injury. If you have access to one of these programs, take advantage of it and use the prevention tools provided. In future posts, we will also highlight exercises and routines that could be helpful.

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[1] Stopsportsinjuriesnow.org

Ultrasound Guided Injections in Orthopedic Practice

Recently, my office has begun utilizing ultrasound for the diagnosis and treatment of various musculoskeletal disorders. There are numerous benefits for the use of ultrasound in orthopedics. For one, ultrasound is a non-invasive exam that allows for a high resolution evaluation in real time. This is a wonderful tool for diagnosis. A second use of ultrasound is for performing guided needle procedures. By using ultrasound for guided injections, we can ensure the exact path of the injection.

What can be diagnosed using ultrasound?

Musculoskeletal ultrasound can be used to evaluate the following:

• Tendons
• Partial and full thickness tears
• Degeneration
• Scar tissue formation
• Ligaments
• Muscles
• Tears
• Soft-tissues
• Masses
• Cysts
• Calcification
• Joints
•  Effusions
• Loose bodies
• Hematomas

What procedures are performed?

• Aspiration and/or injection of joints
• Tendon origin injections (i.e. tennis elbow)                           
• Bursa injections and aspirations
• Aspiration of cysts, fluid collections and abscesses
• Lavage and aspiration of tendon calcifications
• Injection of platelet-rich plasma (PRP)

Ultrasound is allowing procedures to be safely performed in the office that historically could not have been treated. For example, we had a patient recently with a painful cyst behind her leg. In the past, we would have had leave the cyst alone because blindly aspirating could increase the risk of damaging surrounding tissues, blood vessels and nerves. With ultrasound, we were able to locate and aspirate the cyst right in the office. Ultrasound allowed us to find the cyst, correctly position the needle and watch the cyst disappear. Musculoskeletal Ultrasound provides physicians with the ability to differentiate between cystic and solid and vascular from non-vascular lesions adding a greater benefit for patient safety.

If you would like to learn more about Musculoskeletal Ultrasound or to make an appointment, please contact the office at 973-300-1553.

Ask the Orthopedic Surgeon: What is the meniscus?

Question:
I keep hearing of athletes tearing their meniscus.  What exactly is the meniscus and what does it do and what happens if it is torn?

Answer: 

What is the meniscus?
The meniscus is a c-shaped piece of cartilage in the knee that acts as a cushion between thigh bone and shin bone.  The meniscus acts as a shock absorber and keeps the knee stable.  The meniscus also distributes our weight evenly over the knee. The most common causes of a meniscal tear are a sudden twist of the knee or overuse.

What are the symptoms of a torn meniscus?

-        A “pop” may be felt at the time of the injury

-        Pain

-        Stiffness & Swelling

-        Limited range of motion

-        “Locking or Catching”

How is a torn meniscus treated?

Treatment of meniscal tears vary depending on the size, severity and location of the tear.  Tears that are small in size and on the outer edge of the meniscus may not require surgery.  In these cases, the protocol is RICE:  Rest, Ice, Compression and Elevation combined with anti-inflammatory medications (aspirin or ibruprofen). The patient may or may not be required to wear a brace.

If the meniscal tear is moderate to severe, a knee arthroscopy is often needed. Knee arthroscopies are performed through a small incision in the knee.  An orthopedic surgeon then inserts a small camera, which provides a clear view of the knee.  From there, the orthopedic surgeon either repairs the tear or removes the torn portion of the menisci.

Depending on the location of the tear, an orthopedic surgeon decides whether to remove or repair a tear.  The outer layer of the meniscus is often referred to as the ‘red zone’ because it has a good blood supply, which is necessary for healing.  The inner layer is sometimes referred to as the ‘white zone’, which lacks a decent blood supply and makes healing difficult.  If the tear is located in the red zone it is normally repaired, but if it is in the white zone, it is normally fully or partially removed.  Full removal is normally avoided, if possible, as it can leave the patient more prone to osteoarthritis in the future.

For a meniscal repair, the recovery time is about 3 months, with 4-6 weeks on crutches and physical therapy.  A partial menisectomy (removal of the meniscus) has a recovery time of about 6 weeks and only 3 days on crutches.  Physical therapy is needed as well.  In both cases, patients are able to return to full activity. 

If you have an orthopedic question for John Vitolo, MD, please email your question to kim_abbasi@skyvieworthopedic.com.  John Vitolo, MD is Board Certified in Orthopedic Surgery and Sports Medicine.  Skyview Orthopedic has offices in Sparta and Randolph.

*Picture Source:  American Academy of Orthopedic Surgeons

Why are women more susceptible to ACL tears?

In recent years, there has been discussion on why women and young girls are more susceptible to ACL tears. There are many theories on the reasons why, but today we will examine a main anatomic difference between men and women that is a contributing factor: the Q-Angle and wider pelvis.

The Q-angle is the angle at which the femur (upper leg bone) meets the tibia (lower leg bone). The Q-angle is determined by three areas of the human anatomy – the Anterior Superior Iliac Spine (ASIS), the center of the kneecap (patella) and the tibia tubercle.  The Q-angle is basically a line drawn from the ASIS down to the center of the kneecap to the tibia tubercle (see picture below).

The Q-angle in women is greater because women are anatomically built with a wider pelvis than men.  A normal Q-angle in men is 14 degrees, while women have a normal angle of 17 degrees. The greater the angle, the more at risk the person is for knee injuries, including ACL tears.

The fact that the q-angle is more pronounced in women than men leads to more stress on the knee joint and makes it less stable when put under stress. For this reason, when a woman participates in sports involving jumping, running or pivoting, she is naturally more likely to suffer an ACL tear. 

What can we do to prevent ACL tears in women?

Recently, emphasis is being placed on neuromuscular training programs.  Neuromuscular training teaches the body better biomechanic movements to improve the control of the dynamic knee stabilizers (the ACL and major ligaments that surround the knee).  Exercises that are included in a neuromuscular training program include stretching, plyometrics and strength training.  The goal of these programs is to teach athletes how to land, pivot and control the knee without placing as much force on the ACL.  One program was developed by the Santa Monica Sports Medicine Research Foundation and is known as the PEP Program: Prevent Injury and Enhance Performance. To learn more about this program, please visit http://smsmf.org/files/PEP_Program_04122011.pdf.  

If you suspect that you have an ACL tear or other orthopedic injury, it is important to see an Orthopedic Surgeon.  Skyview Orthopedic, the office of John Vitolo, MD is available to treat all your orthopedic injuries and concerns.  Our office is focused on treating each patient individually and offering the highest quality orthopedic care.  John Vitolo, MD holds dual board certification in Orthopedic Surgery and Sports Medicine. For more information call the office, 973-300-1553 or visit us online at www.skyvieworthopedic.com.