HYANNIS – One sudden move – sometimes that’s all it takes for an ACL to tear.
“The majority of ACL injuries are non-contact, just like Patriots player Julian Edelman,” said orthopedic surgeon Leonard Remia, MD, of Cape Cod Orthopaedics. “He cut and pivoted and that was it. It’s unusual for patients to be subject to the kind of injury Tom Brady suffered in 2008,” when he was hit by an opposing player.
“It’s the same with skiing. The patient is usually not traveling very fast and makes an awkward turn. You catch a tip of the ski and that’s it. The ski gets caught and then you pivot and the ACL tears. It’s typically not when you’re bombing down the hill.”
The anterior cruciate ligament (ACL) connects the femur (thighbone) and tibia (shinbone) and provides stability to the knee. ACL injuries are extremely painful, but a recent study shows great hope for long-term recovery.
Researchers from the Multicenter Orthopaedics Outcome Network (MOON) followed patients with ACL reconstructions for 10 years and found that patients had excellent results.
“An active patient may view an ACL injury as devastating, but our research adds to short- and long-term studies that show a good prognosis for return to pre-injury quality of life,” said study author Kurt P. Spindler, MD, of the Cleveland Clinic Department of Orthopaedic Surgery in a press release. “This can help medical providers continue to make good treatment decisions, and present these injuries as simply a setback.”
The study was presented recently at the American Orthopaedic Society for Sports Medicine’s annual meeting in Toronto.
“We’ve known for the past 15 or 20 years that people do very well with ACL reconstruction, but no one has done as good or as well-controlled a prospective study as this one,” said Dr. Remia after reviewing the MOON study. “This was a true prospective study with 80-percent participation and 10-year follow-up.
“It puts an end to any debate whether or not patients can expect excellent quality of life in terms of getting back to sports and activities after ACL reconstruction.”
Dr. Remia underwent his sports medicine fellowship training at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles, which works with players from the Los Angeles Lakers, Los Angeles Dodgers, Anaheim Angels and Anaheim Ducks, as well as USC.
ACL reconstruction uses tissue – the hamstring tendon, for example – either from the patient (an autograft) or a cadaver (an allograft) to replace the damaged ACL.
“With the newer, less invasive techniques that have been developed over the past 10 years or so, studies show these procedures are very successful in 90-plus percent of patients,” he said. “You do the surgery, the graft takes, it heals, and the patient gets back to a stable knee.
“The take-home message is that it’s a very successful operation. Patients can feel comfortable saying, ‘It’s going to be a long recovery, but I’m going to get back to activity.’ Rather than being a devastating injury, for the great majority of people it’s sort of a blip on the radar screen in terms of your sports activity.”
Patients who are having functional instability, meaning their knee is giving way or buckling with everyday activity or if they’re an athlete and can’t go back to their sport, are good candidates for ACL reconstruction, Dr. Remia said.
“If patients tear the ACL and they’re relatively sedentary or their knee is stable with everyday activity, especially with older patients, you may elect not to reconstruct the ACL,” he said. “It’s a case-by-case basis.”
ACL repair is less successful if the patient is overweight or has had previous knee surgery, according to the MOON study.
If you’re wondering if Edelman will be able to play again, consider this: It’s been nine years since Brady’s knee injury. In 2014, ESPN.com selected an all-star team of NFL players who had played successfully after ACL injuries – and the team was led by Brady.
Patriots player Rob Gronkowski, NBA star Derrick Rose and soccer player Alex Morgan are among other athletes who have successfully recovered from ACL injuries.
“It’s a common injury that we see in orthopedics and we counsel patients that we can help them get back to their sports activities or just daily functioning,” said Dr. Remia. “We’re able to tell them it’s a very successful procedure in the majority of instances.”
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