Tag Archives: ACL Tear

Lacrosse Injuries: Women Younger Than 20 Face “82 Percent” Risk Of Additional Surgeries After ACL Tear


ACLWomenKnee

Women and patients under 20 years of age are more likely to need additional surgery for one of the most common knee injuries, a new study says.

Researchers analyzed reconstructive surgery outcomes from the largest number of patients included in a study of anterior cruciate ligament (ACL) injuries and found:

• An 82 percent increased risk for additional ACL surgery for those younger than 20.

• A 43 percent increased risk for more ACL surgery in patients aged 20 to 29.

• Females require subsequent knee surgery about 18 percent more often than males.

• Patients whose surgeons performed fewer than six ACL operations a year or who had operations in hospitals that handled fewer than 24 ACL cases a year are at higher risk for repeat surgeries.

The study’s author, Dr. Stephen Lyman, director of epidemiology and biostatics at the Hospital for Special Surgery in New York, says younger patients are likely to be at higher risk because they are more active and less likely to follow rehabilitation restrictions.

Results were published this month in The Journal of Bone and Joint Surgery.

LEARN MORE: Go to http://www.mayoclinic.com and search “ACL injuries;” to read the report, http://www.ejbjs.org and click on “current issue.”

SOURCES: American Academy of Orthopaedic Surgeons; The Journal of Bone and Joint Surgery

http://www.dallasnews.com/sharedcontent/dws/fea/healthyliving/health/stories/DN-nh_healthalerts_1027gd.ART.State.Edition1.4bc206d.html

Lacrosse Injuries: Girls Lacrosse Knee Injuries, Including ACL Tears, Can Be Prevented By Intensive Conditioning And Strength Training From SportsMetrics (Video)


The Sportsmetrics program focuses on developing overall leg strength and improving the balance of strength between the quadriceps and the hamstrings. Through proper jumping techniques, strengthening, speed and agility, an athlete will refine their neuromuscular control of the lower limbs, thereby reducing the amount of serious knee injuries. As a result, one will be able to utilize proper muscle recruitment, land with less valgus (knock-kneed) stresses and decelerate properly.

 

(From AuburnPub.com Article) As an orthopedic surgeon, I take care of/repair many injuries caused by playing sports. Many of these injuries are actually preventable! Believe it or not, even though I am a surgeon, I do have a very keen interest in prevention. I believe that the only true way to cut the high cost of health care in the long run is to emphasize prevention in all aspects of medicine. In sports medicine, there are many injuries/ailments that are preventable. I am going to spend the next three columns on talking about one of the many injuries that are preventable – or at least we know scientifically that we can lessen the number of these injuries. I want to give credit to Erin Johnson, ATC, the director of the Sportsmetrics training program at Victory Sports Medicine & Orthopedics for providing much of the specific details of the content of the next few columns I am going to write.
An alarming number of young athletes are experiencing serious knee injuries. The question arises: What is the reasoning behind this? There are many possibilities: Is it due to an increase of athletes focusing on just one sport? Are the technologies in field surfaces and/or equipment a contributing factor? Or is just that more females are participating in sport and raising the injury rate? If that is the case, are females more prone to injury and if so, why?

There has been a large increase in female athletic programs, beginning at an early age, that encompass a broad range of activities, from individual to team sports and contact versus non-contact activities. Research has shown that females are 10 times more prone to knee ligament injuries than males, particularly the anterior cruciate ligament (ACL). These injuries, from non-contact sports that involve pivoting, cutting and jumping, could sideline an athlete for an entire year. One may ask, “Why is the ACL important and what function does it play with knee movements and sports?”

The ACL, along with the hamstring muscles, help to control twisting and anterior movement/translation of the knee. If the knee experiences excessive shear forces, it can tear an ACL. Weak musculature and jumping/twisting motions incurred in sport can lead to these excessive shear forces. The hamstrings flex the knee, which in turn protects the ACL from injury when landing. When jumping, females tend to depend on ligaments to protect their knee joints rather than controlling the slack with their muscles, and are more prone to landing from a jump in a “knock-kneed” position that will increase the pressure on the knee/ACL. Females also tend to have greater power and strength in the quadriceps (front thigh muscles) versus the hamstrings (back thigh muscles) with activity, therefore increasing the chance for injury compared to males that have a more balanced musculature of the leg. This is not something that affects only “professional” athletes. Research has shown that injuries generally start to manifest themselves starting during middle school. It has been proven that each year in the United States, one in 100 high school female athletes and one out of 10 female college athletes will suffer a serious knee injury.

With ACL injuries on the rise, there has been much scientific energy focused on creating and finding a prevention program for females to help diminish such injuries in sports such as volleyball, soccer, basketball, lacrosse and hockey. The physicians and researchers at Cincinnati Sports Medicine Research and Education Foundation, under the direction of Dr. Frank Noyes, spent more than 10 years to scientifically develop an injury prevention/performance enhancement program named Sportsmetrics, and have continued to be leaders in developing programs to ensure that athletes play well and stay well. Many trained professionals, including orthopedic surgeons, athletic trainers, personal trainers and physical therapists, collaborated together to produce a well-rounded injury prevention program. This is the first scientifically proven program that utilizes proper training and techniques for jumping, landing from a jump and decelerating to decrease serious ACL injuries in middle school and high school athletes. Since 1992, when it was conceptualized, Sportsmetrics has become a world-wide program with certified Sportsmetrics trainers across the United States, Europe and Australia.

The Sportsmetrics program focuses on developing overall leg strength and improving the balance of strength between the quadriceps and the hamstrings. Through proper jumping techniques, strengthening, speed and agility, an athlete will refine their neuromuscular control of the lower limbs, thereby reducing the amount of serious knee injuries. As a result, one will be able to utilize proper muscle recruitment, land with less valgus (knock-kneed) stresses and decelerate properly. Sportsmetrics is progressive in nature, building on previous exercises and drills. It includes five aspects: a dynamic warm-up, jump training, speed and agility, strength training and flexibility. Each of the certified Sportsmetrics trainers emphasizes technique and proper training throughout each section of the program to help cue the athlete where their body should be when in motion or preparing for motion.

Members of the Cincinnati Sportsmedicine Research and Education Foundation team came to Skaneateles in January 2009 to train 15 members of the staff at Victory Sports Medicine & Orthopedics in Sportsmetrics, making Victory Sports Medicine and Orthopedics the largest certified site in New York state. Having a large number of certified Sportsmetrics trainers allows Victory Sports Medicine & Orthopedics the opportunity to work with local high schools and community programs to help instill proper training techniques and hopefully decrease the incidence of knee injuries. For more information on the Sportsmetrics injury prevention/performance enhancement program, feel free to contact Erin Johnson, ATC, at 658-7544. She is a certified Sportsmetrics trainer and also spent a six-week internship at Cincinnati Sports Medicine working with Dr. Noyes and his certified Sportsmetrics staff during the spring of 2009.

Dr. Marc P. Pietropaoli is a board certified/fellowship trained orthopedic surgeon/sports medicine specialist and is president of Victory Sports Medicine & Orthopedics in Skaneateles

 

ACL Injuries In Girls Lacrosse: High School Girls Lacrosse Players At Risk For ACL Tears As They Enter Puberty And Add Weight And Height But Not Strength To “Control Deceleration”


“Orthopedic surgeons insist that the problem is the ‘Q’ angle at women’s knees,” says Timothy Hewett, PhD, a professor of pediatrics and orthopedic surgery at the University of Cincinnati and the Cincinnati Children’s Hospital and the lead investigator of the girl’s case study. “They think the problem begins because women’s hips are wider” than men’s. Other researchers have looked at the role of female hormones on tendon looseness in the knee. Peter Dazeley/Getty Images

Typically, he says, the problem blossoms in puberty. “Prepubescent athletes move alike, boys and girls,” Hewett says. But then, although maturing girls sprout in height, they add comparatively little strength, unlike boys. “Their center of mass moves higher and they add weight, but not the power to control it,” he says. They’ve primed themselves for knee damage. Peter Dazeley/Getty Images

(From the “New York Times) Earlier this year, researchers at Cincinnati Children’s Hospital published the most detailed and revealing case study to date of an anterior cruciate ligament rupture waiting to happen in a young girl. The study grew out of the researchers’ ongoing, large-scale examination of ACL-tear risk factors, which had enrolled hundreds of young, female athletes, measured and monitored them, and assigned some to prevention training programs. The girl in the case report hadn’t received training. She was 11 when she joined the study, a small, skinny, prepubescent basketball player. Each year, the researchers noted her height, weight, joint looseness, muscle strength, and biomechanics, using sophisticated motion-capture technology to study how she leaped and landed. At each session, as might have been expected, she’d lengthened, developing coltish legs and a slight but noticeable tendency to wobble and land knock-kneed when she hopped off of a box.

At age 14, charging down the line during a game, she felt her knee pop and collapse. Her ACL had ripped.

ACL tears, especially in young female athletes, have hardly lacked for notice in recent years, including in this newspaper.

Scientists have argued about the injury’s causes and best treatments. Different exercise programs have aimed at prevention. But despite the attention and training, “the incidence of ACL tears hasn’t been
declining,” says Scott McLean, PhD, assistant professor in the School of Kinesiology at the University of Michigan and a member of Michigan’s Bone and Joint Injury Prevention and Rehabilitation Center.

In part, he and many other researchers agree, this is because no scientist yet has pinned down just what causes most ACL injuries. There are theories, including the possibility that women’s knee anatomy is to blame. “Orthopedic surgeons insist that the problem is the ‘Q’ angle at women’s knees,” says Timothy Hewett, PhD, a professor of pediatrics and orthopedic surgery at the University of Cincinnati and the Cincinnati Children’s Hospital and the lead investigator of the girl’s case study. “They think the problem begins because women’s hips are wider” than men’s. Other researchers have looked at the role of female hormones on tendon looseness in the knee.

But in the past few months, and just in time for the start of fall sports seasons, several new studies have been published that look at ACL tears in novel and provocative ways, focusing not just on the structure of the knee but on the role of the rest of the body. Perhaps the most ambitious was led, like the case report, by Hewett and colleagues at Cincinnati Children’s Hospital. They solicited videos from surgeons and coaches showing the exact moment when athletes, male and female, suffered an ACL tear. They also gathered videos of female basketball players performing similar movements — foot plants, pivots, and so on — without tearing their ACLs. Using computer software, they marked and triangulated exactly how the athletes were positioned. What they found, according to the results made available online in April in the British Journal of Sports Medicine, was that young women whose ACLs had popped exhibited more trunk sway than the men or the uninjured women; when they landed, or planted a knee to switch directions, their upper bodies wobbled to one side. This placed great pressure on their planted knee, collapsing it inward and overloading the ACL. “Our research suggests that the issue in injured female athletes,” Hewett says, “is a lack of high-level ability to control deceleration and acceleration at the center of their mass in three-dimensional space.”

In other words, they don’t adequately steady their upper bodies as they move. Typically, he says, the problem blossoms in puberty. “Prepubescent athletes move alike, boys and girls,” Hewett says. But then, although maturing girls sprout in height, they add comparatively little strength, unlike boys. “Their center of mass moves higher and they add weight, but not the power to control it,” he says. They’ve primed themselves for knee damage.

Happily, if Hewett’s theory holds, they can train away some of that risk. Specific exercise programs that target strength and balance or proprioceptive deficiencies could “reduce female athletes’ risks until they’re almost comparable” to the risks for male athletes, Hewett says. Parents and coaches can begin with a few, simple, at-home diagnostics to find girls who are most at risk, he says. Set up a foot-high box. Have the athlete stand on it and hop down lightly, then immediately leap straight up as high as she can and land back on the ground. Watch closely or videotape her. Did her knees move toward each
other as she landed the first time? Did they seem to collapse inward as she exploded back up? Did she lean forward or to the side as she landed back on the ground? Those are each probable hallmarks of high
risk, Hewett says.

Hewett hopes to have more support for his theory after he tabulates the results of an ongoing intervention he’s begun among schoolchildren in Kentucky. Some of the participants are being taught how to balance and control their midsections with exercises that concentrate on core muscle stability, one-leg balance training, and so on. Others are participating in a more-standard, ACL-injury-prevention program of strength and speed training. “We think that the group” receiving trunk management
instruction “will have fewer ACL injuries,” he says. The final tallies won’t be available for several years, however.

In the meantime, McLean, at the University of Michigan wonders whether all of the current theories about ACL injuries in girls are reductionist. For a study made available online in May in the journal The Knee, he attached ACL-damaged knees from male and female cadavers to a machine that applied loads similar to those experienced during various athletic movements and found that, “really, no two knees respond alike,” he says. Some ACLs from male cadavers readily tore; some from women held fast under every tension. “I think we need to move away from this tight focus on gender-based and rather generic risk factors,” he says, “and start finding ways to make our recommendations specific to each person.” At his lab, he tests boys and girls, beginning at age ten, on measures of strength, balance, bodily proprioception, and so on. “The ideal situation,” he says, “is for parents to bring young athletes to a lab, run them through the tests, and send them home with a personalized prescription for how to reduce their individual risk.”

Since that’s not practical for most young athletes outside of university towns, he agrees that some basic principles make sense, and are in line with Hewett’s prescriptions. “Teach kids, boys and girls, to land softly,” McLean says. “Teach them to control their trunks and work on body alignment.” And start early. “Don’t wait until high school,” Hewett says. “Begin when kids are 11 or 12.”

http://well.blogs.nytimes.com/2009/09/09/phys-ed-preventing-acl-injuries-in-girls/

Lacrosse Injuries: New Research Shows That “Mental Fatigue” Increases Risk Of ACL Tears And Suggests That “Virtual Reality Technology” That Immerses Athletes In “Complex Athletic Scenarios” May Help With Prevention


"These findings suggest that training the central control process—the brain and reflexive responses—may be necessary to counter the fatigue induced ACL injury risk," said McLean, who also has an appointment with the U-M Bone & Joint Injury Prevention Center.

"These findings suggest that training the central control process—the brain and reflexive responses—may be necessary to counter the fatigue induced ACL injury risk," said McLean, who also has an appointment with the U-M Bone & Joint Injury Prevention Center.

New research shows that training your brain may be just as effective as training your muscles in preventing ACL knee injuries, and suggests a shift from performance-based to prevention-based athletic training programs.

The ACL, or anterior cruciate ligament, is one of the four major ligaments of the knee, and ACL injuries pose a rising public health problem as well as an economic strain on the medical system.

University of Michigan researchers studying ACL injuries had subjects perform one-legged squats to fatigue, then tested the reactions to various jumping and movement commands. Researchers found that both legs—not just the fatigued leg—showed equally dangerous and potentially injurious responses, said Scott McLean, assistant professor with the U-M School of Kinesiology. The fatigued subjects showed significant potentially harmful changes in lower body movements that, when preformed improperly, can cause ACL tears.

“These findings suggest that training the central control process—the brain and reflexive responses—may be necessary to counter the fatigue induced ACL injury risk,” said McLean, who also has an appointment with the U-M Bone & Joint Injury Prevention Center.

McLean says that most research and prevention of ACL injuries focuses below the waist in a controlled lab setting, but the U-M approach looks a bit north and attempts to untangle the brain’s role in movements in a random, realistic and complex sports environments.

The findings could have big implications for training programs, McLean said. Mental imagery or virtual reality technology can immerse athletes to very complex athletic scenarios, thus teaching rapid decision making. It might also be possible to train “hard wired” spinal control mechanisms to combat fatigue fallout.

In a related paper, McLean’s group again tested the single leg landings of 13 men and 13 women after working the legs to fatigue. While both men and women suffer an epidemic of ACL injuries, women are two to eight times likelier to tear this ligament than men while playing the same sport. However, the study showed that men and women showed significant changes in lower limb mechanics during unanticipated single leg landings. Again, the findings point to the brain, McLean says.

During testing, a flashing light cued the subjects to jump in a certain direction, and the more fatigued the subjects became, the less likely they were able to react quickly and safely to the unexpected command.

The research suggests that training the brain to respond to unexpected stimuli, thus sharpening their anticipatory skills when faced with unexpected scenarios, may be more beneficial than performing rote training exercises in a controlled lab setting, which is much less random than a true competitive scenario. In this case, expanding the anticipated training to include shorter stimulus-response times could improve reaction time in random sports settings.

“If you expose them to more scenarios, and train the brain to respond more rapidly, you can decrease the likelihood of a dangerous response,” he said. It’s analogous to how a seasoned stick shift driver versus a novice learner might both respond to a sudden stall. The inexperienced driver might make a slow or even incorrect decision.

Journal references:

  1. Mclean et al. Fatigue-Induced ACL Injury Risk Stems from a Degradation in Central Control. Medicine & Science in Sports & Exercise, 2009; 41 (8): 1662 DOI: 10.1249/MSS.0b013e31819ca07b
  2. Brown et al. Differences between Sexes and Limbs in Hip and Knee Kinematics and Kinetics during Anticipated and Unanticipated Jump Landings: Implications for ACL injury. British Journal of Sports Medicine, 2009; DOI: 10.1136/bjsm.2008.055954
Adapted from materials provided by University of Michigan.

College Women’s Lacrosse: Northwestern’s Hilary Bowen Will Play In NCAA Semi-Finals After Delaying Season-Ending Surgery For ACL Tear


hilary bowen northwesternHilary Bowen is a cheerful person by nature.

In fact, that’s probably an understatement. It’s rare to see the Wildcats’ star senior attacker without a wide smile stretched across her face.

Less than two minutes into Northwestern’s 21-4 win on April 4 against California, Bowen collapsed in pain after trying to make a sharp cut to the goal. Despite her optimistic outlook, even Bowen said she did not think she would play again this season.

“When I fell, I knew right away that something wasn’t right,” she said. “I was really upset more than anything – that the first thought that goes through your head is, ‘My season’s probably over.'”

Bowen had never been seriously injured before, but she suspected she might have injured her ACL, based on what she had heard and read. On the sidelines, Bowen asked trainer Lisa Palazzo to be up front with her about what it looked like when she went down. Palazzo said it looked like she damaged her ACL, confirming Bowen’s fears.

Generally speaking, knee injuries like that take months to come back from – especially for a high-speed sport like lacrosse that requires constant change of direction. The likelihood of being able to play again before the end of the year was somewhere between slim and none.

“I knew there was a very small chance that I’d be able to make it back,” Bowen said.

Bowen took her recovery one day at a time, so she wouldn’t be disappointed if she couldn’t return to the field. But the early signs after her injury were encouraging, and she decided to postpone season-ending surgery.

It was a difficult decision, because there was a chance of permanent damage to her knee if she came back too quickly. On the other hand, women’s lacrosse is not a sport that has a professional league for players after they graduate. This year is the end of Bowen’s playing career, and winning her fourth consecutive national title is the ultimate accomplishment.

“It’s easy for everyone on the outside to say, ‘Think about your long-term health,'” Bowen said. “And I do think about that. But I also think about the team and how hard I’ve worked to get to this point this season and just knowing that it’s my last shot at it. This is what you live for in this sport.”

Bowen’s teammates fully supported her decision. They cheered her on the first time she ran and encouraged her, without pushing her to do anything she was not capable of doing.

It all paid off last Saturday. Just 41 days after tearing the ACL in her left knee, she had recovered well enough to start in the NCAA quarterfinals against Princeton. Not only did Bowen start – she scored on a free-position shot from eight meters out in the first half.

Bowen played the majority of the first half. She did not start the second half, but was on the field for a few minutes until the Cats had put the game away.

The performance suggested that the winner of the last two NCAA tournament MVP awards could be a valuable weapon down the stretch.

“Hilary is definitely mobile,” coach Kelly Amonte Hiller said. “I don’t think anyone expected her to be as strong as she is. Just being out there gives our offense a boost.”

Bowen gives Amonte Hiller’s squad strategic advantages by being a lefty and forcing teams to worry about where she is. More importantly her presence was comforting.

“It felt nice just to look over to my left and to see her there and to see her score in her first game back,” senior attacker Hannah Nielsen said. “She took a few one-on-ones, split a couple of double teams and looked like the Hil-Bo of old.”

Bowen might make it look easy, but she is still trying to get back into the flow of the game. Even though she can make cuts and shots, building back the confidence that she can play without hurting herself again takes time.

The Princeton game was important because she proved that she was still capable of being a factor. Now, she gets to finish her career the right way: competing in the NCAA semifinals against Penn, her close-knit classmates.

“We’ve been through so much as a senior class, and there’s no way I’d rather end it than out on the field with them,” Bowen said.

http://media.www.dailynorthwestern.com/media/storage/paper853/news/2009/05/22/Sports/Lacrosse.Bowen.Beats.Odds.Beating.Injury-3743577.shtml

Lacrosse Injury Prevention (Video): ACL Tear Prevention Programs Stress Conditioning And Strengthening


ONS Foundation for Clinical Research and Education, Inc. An injury prevention program of conditioning and strengthening exercises to help prevent ACL injuries in youth athletes. Part 1 of 2 parts.

Lacrosse Injuries: Partial ACL Tears Could Be Repaired Using Athlete’s Hamstring Or Patellar Tendon To Reconstruct Native ACL


A novel approach to repairing partially torn anterior cruciate ligaments in young athletes has shown promise, according to a group of orthopedic surgeons in Italy.

The anterior cruciate ligament, or ACL, is the key ligament stabilizing the knee, and is especially important for holding the joint steady during jumping, pivoting and twisting.

 Dr. Alberto Gobbi and colleagues at Orthopedic Arthroscopic Surgery International in Milan found that combining standard ACL repair techniques with bone marrow stimulation helps restore stability and function in youthful athletes with acute partial ACL tears.

 “Our technique,” Gobbi told Reuters Health, “avoids the use of the patient’s own hamstring or patellar tendon (in the kneecap) to reconstruct the native ACL,” eliminating the problems associated with tendon “harvesting.”

 “Our goal is to enhance natural healing processes to regenerate the partially torn ACL,” Gobbi added.

 In The American Journal of Sports Medicine, Gobbi and colleagues note that standard ACL reconstruction is the conventional method and has about an 80 percent success rate.

 To determine whether ACL repair combined with bone marrow stimulation of the ACL might also be of value, the researchers employed the approach in 26 athletes, ranging in age from 17 to 37 years. All of them had arthroscopically confirmed partial ACL tears.

The repair procedure involves suturing of the tear and creating small holes around the remaining healthy part of the ACL — the idea being to facilitate release of mesenchymal stem cells from the bone marrow in order to promote healing. Mesenchymal stem cells are immature cells than can give rise to bone.

 All the patients then participated in a rehabilitation program and, over time, the majority saw marked improvement in ACL functioning and improved knee stability.

 Only five patients (19 percent) did not return to the same level of sports activity. This was by choice in three patients.

 SOURCE: American Journal of Sports Medicine, March 2009.

http://uk.reuters.com/article/healthNewsMolt/idUKTRE53N41120090424?sp=true