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Alpine Sports Medicine Monthly Topics...

Is there a doctor in the house? The Alpine Advantage means individual care for you. Many times topics of medical interest are recurring. On our Monthly Topics page, Dr. Meyers and other staff answer or address some common topics regarding sports medicine. Find out why you should take advantage of Alpine Sports Medicine...the Alpine Advantage! If you have a basic question for Dr. Meyers that perhaps might pertain to many people, please e-mail him and, whenever possible, he will address a common concern or topic here on Monthly Topics!

Anterior Cruciate Ligament Injuries

Injury to the anterior cruciate ligament (ACL) of the knee is not uncommon. A variety of injury mechanisms may play a role, but classic mechanisms include alpine skiing, and women’s basketball. As our understanding of the role the ACL plays in biomechanics of the knee improves, so has our understanding of the mechanisms of injury. Specifically, in the examples mentioned, alpine skiing equipment directly loads the ACL which in turn renders the ligament more susceptible to injury. While ladies basketball is more complicated, anatomical and athletic biomechanical factors have been demonstrated to be responsible for the almost epidemic level of ACL injury in female basketball.

No mistake, the ACL is vital to a properly functioning knee. As a ligament, the ACL connect two bones, the femur (thigh), and the tibia (shin) bones. The knee has four primary ligaments functionally, and each are important, but the ACL is the one that stabilizes the relationship of the bones under quadriceps muscle (or extension) loading. The quads are the muscles in the front of the thigh that straighten the knee, hold us up when standing or walking, and allow us to jump. When they contract, they place forces across the knee that the resistance of the intact ACL allows to be translated into normal extension of the knee. Without the ACL, the relationship between the femur and tibia is distorted, and abnormal forces are placed through, and into, the knee joint.

These abnormal forces are therefore at work with simple standing, walking, and getting out of a chair, and greatly magnified with running, jumping, and cutting. The distortion of the position of the bones leads to collapse or ‘giving way’ of the knee. Very inconvenient, but worse the constant shifting in the knee causes deterioration of the meniscal cartilages in the knee. These cartilages fit between the bones and are the shock absorbers and load sharers of the joint. When the meniscal cartilages go, the surfaces of the joint accrue damage and the knee becomes arthritic.

It is important to understand this degenerative process can be accelerated if the cartilages, or the joint surfaces, are damaged at the time of the original injury as well. This concomitant damage is actually typical, and represents a serious challenge to the long term health of the joint.

It is generally understood, and agreed that immediate attention in the form of surgery gives the best results to an ACL injured knee. Our understanding of these processes has led to a continual improvement in the surgical techniques used. Constructing the ACL in a more complex, but anatomically correct “double bundle”, leads to improved mechanics in the reconstructed knee (as opposed to the more simple single bundle that has been performed, and still is largely). At Alpine Sports Medicine we have been performing the double bundle technique for over 4 years, which is commensurate with being a leader in the field of Orthopedic Sports Medicine. We not only believe it is a better technique, our clinical results have shown that even though older techniques (greater than five years ago for US) gave excellent reconstruction results (well over 90%), there is a difference in what constitutes excellence. Knees reconstructed with the newer techniques are also stable, but they also have a Normal feel on exam (like the uninjured knee) due to improved rotational control of the graft construct. We are proud to continue to provide Northern Nevada access to techniques and results that are otherwise confined to metropolitan subspecialty centers catering to professional athletes.

This is an incomplete and short discussion of a rich and complicated subject. Other factors, including timing, graft material, rehabilitation, etc, are beyond the scope of this forum, but may be included later if requested.
Please feel free to contact us for an appointment if you have a problem related to this subject or any problem that would benefit from true Sports Medicine. That’s what we are, and what we do.

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