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Treatment Methods for ACL Injuries
Dr. Loveland explains innovative ACL treatment methods being used at Children's Health Andrews Institute for Orthopedics and Sports Medicine.
Featured Speaker:
Dr. Loveland earned his medical degree from the University of Texas Medical Branch. He completed his orthopedic surgical residency at the University of Miami, where he served as chief resident. He was then selected by world renowned surgeon Dr. James Andrews to train as a sports medicine fellow. Dr. Loveland has served as an associate team physician for the University of Miami and Auburn University football teams.
Over 45 million children and adolescents are involved in organized athletics in the United States. Almost 3.5 million under the age of fourteen are treated for sports-related injuries each year, making athletics one of the leading health risks for children.
Dr. Dustin Loveland is combatting that problem by applying his expertise in pediatric and adolescent sports medicine to community outreach. He not only treats sports-injured youth but works with coaches, trainers and parents to help prevent those injuries.
Dustin Loveland, MD
Dr. Dustin Loveland is a board-certified orthopaedic surgeon, fellowship-trained in sports medicine. He specializes in the treatment of fractures and sports injuries among children and young adults.Dr. Loveland earned his medical degree from the University of Texas Medical Branch. He completed his orthopedic surgical residency at the University of Miami, where he served as chief resident. He was then selected by world renowned surgeon Dr. James Andrews to train as a sports medicine fellow. Dr. Loveland has served as an associate team physician for the University of Miami and Auburn University football teams.
Over 45 million children and adolescents are involved in organized athletics in the United States. Almost 3.5 million under the age of fourteen are treated for sports-related injuries each year, making athletics one of the leading health risks for children.
Dr. Dustin Loveland is combatting that problem by applying his expertise in pediatric and adolescent sports medicine to community outreach. He not only treats sports-injured youth but works with coaches, trainers and parents to help prevent those injuries.
Transcription:
Bill Klaproth: ACL tears are one of the most common knee injuries together. The team of surgeons, nurses, and in-house physical therapists at Children's Health offer different methods of treatment for ACL injuries. So let's learn more about these treatment methods that set Children's Health Andrews Institute for Orthopedics and Sports Medicine apart. This is Pediatric Insights, Advances and Innovations with Children's Health where we explore the latest in pediatric care and research. I'm Bill Klaproth. With us to discuss a diagnosis and treatment methods for ACL injuries is Dr. Dustin Loveland, a Board Certified Orthopedic Surgeon at the Children's Health Andrews Institute for Orthopedics and Sports Medicine. Dr. Loveland, thank you so much for your time. First off, could you walk us through the process of diagnosing patients with ACL injuries and how does this process at Children's Health Andrews Institute for Orthopedics and Sports Medicine work?
Dr. Loveland: So it really starts at the time of injury. A lot of times initially it'll be diagnosed by an athletic trainer who we employ plenty of those as well, or a physician at a varsity football games say. There's a lot of times where we personally are on the field and may diagnose it within a minute or two of it happening more commonly though it's at an outside sporting event and we'll see the patient in clinic. So oftentimes we'll be able to see the patient and see that they have some knee swelling, discomfort, pain with walking on it or inability to put weight on it through the discomfort, but the exam is key and so soft and difficult after an injury. But if we can get the patient to relax, we can get a really good knee exam on them and get a pretty good preliminary diagnosis at that time, which gives the patient good expectations. Because a lot of times for confirmation purposes and further planning, we're actually getting an MRI scan of it that will confirm the diagnosis of an ACL injury. And here at Andrews Institute, what I think a little bit different with us is we're kind of all encompassing in the sense a common scenario would be a hurt my knee on Saturday.
I went to Andrews Institute, the doctor told me my knee felt unstable, so they wheeled me over or walked me over to the MRI scanner and we went back after it was done and looked at the results with the doctor and confirmed my diagnosis. So long gone are the days of here's a prescription, go get an MRI, and you know you can come back when you bring a disc and a radiology report. That's not how it works anymore. We bring you in, we get you diagnosed, and a lot of times it's a big undertaking for the family and it's a lot, but to come in and get your diagnosis so we can go over the MRI results. And oftentimes the next step after we talk about treatment options and surgery if needed, is I get them over to the physical therapist and they're working on getting the swelling down and getting the knee back to normal. And clinically they walk out of here better than they came in. Just having some knowledge about what happened to their knee and already being essentially treated for it from a physical therapy standpoint. All that happened in one morning.
Host: Well that sure is a time saver so you don't have to run around to various appointments. The family can know right away, which is really important. And then as you said, you can often send them right to physical therapy to start rehab, which is really important. So it's kind of a one stop shop, which is really, really convenient for family. So I can see where that really is a special benefit to what you do. I also saw that one of the main goals is to use the most effective and least invasive treatment possible for ACL injuries. What are some of those lesser invasive treatment options you offer to achieve this goal?
Dr. Loveland: So I think it's important if you're having an ACL surgery, it's a big surgery. It sets a surgery that is unfortunately needed quite often, but you only want to have it once and you want to have it done the right way and you want to rehab the right way, and it's not something you want to go through a second time. And that's part of our goal as providers as get it right and not have the patient go back with any more risk of reinjury than they need it. So in terms of minimally invasive, the techniques that surgeons that are board certified in both orthopedics and sports medicine is we're using the most modern techniques, which are generally the procedures done arthroscopically. So yes, it's an escope and really the bigger portion of the surgery or the bigger scar that you'll ever see is really to harvest the tissue. Because in these young patients, we don't use donor ligaments or cadaver ligaments, we're using their own healthy tissue and just in a sense, making a new ACL and putting it where their old one was. And so what we call the all inside ACL simply, it's all done arthroscopically and really maybe one, two centimeter or one centimeter incisions is really the biggest one and everything else is small incisions. And these don't even require stitches outside the skin. We just use dissolvable stitches. So it's pretty slick method that's kind of evolved over the years. But really our current form and preferred way of fixing them.
Host: Well, besides the small incisions, what are some other benefits of these less invasive type treatment options?
Dr. Loveland: So there's two things that I think are really important that we have access now that were not around a decade or two ago and minimally invasive is a good thing to think about just in general from any surgery. Is that a plus trauma? You've already had enough trauma to the knee. That's the whole point. When we discuss getting into physical therapy before surgery, we want to calm that knee down and get it out of this inflammatory phase. And so with the less surgery done to you, we're not bringing on our own new inflammation so it's less to recover from. And then the other thing that's new is our methods, and we don't have to go into detail, but the way we stabilize the ACL, when they're done in the operating room, that thing is solid and long gone to the days where you have to be concerned about them moving it to early, putting pressure on it too early. And so a lot of our patients, pretty much all of mine within three or four days are in physical therapy and learning how to put pressure on it. And so I think the new techniques allow us to be more aggressive post-surgically which minimize the downtime and recovery in the long run.
Host: Which is another benefit and really important point. So what types of patients qualify for these less invasive options?
Dr. Loveland: Really all of them. I mean I can't say without any other major ligament damage. We make the smallest incision necessary to safely obtain our new ACL that we're going to make. And then outside of that, it's everybody's getting it. So I think that's just becoming the standard of care.
Host: So certainly a progression and evolution in ACL surgery. So then how long does treatment for an ACL injury typically last?
Dr. Loveland: So it's a process. This isn't a, you know, some surgeries you, you get it done, you get it over with and then you're good to go. And that's, this is really one where how good you are really depends on how much work you put in it. And so surgery typically takes an hour to two hours, depending on the magnitude of the injury. You go home the same day, you're rehabbing soon after, but it takes, you know, a couple of weeks to get off crutches even longer sometimes. It takes a few weeks to start running and then the strength that we want the patient to have, even in the hardest workers from what we know, in order to return safely, it's really eight to 12 months to be released back to sports without restrictions. And that's in those that are the hardest workers.
Host: So let's talk a little bit more about their return to play. What's your strategy then for monitoring patient progress and whether they can return to playing sports.
Dr. Loveland: So, if you've had an ACL and you're going to return to the sport that you tore it, especially if it's a cutting, pivoting soccer, basketball, football type sport. We know you're at risk to reinjure it or even kind of forbid injured the other side. But all we can do is use everything in our armamentarium to ensure that you are as safe as we can get you to return to play. So what that entails is most of the time an assessment with our physical therapists testing the strength compared to your non-surgical leg. We want that under 15 or ideally under 10% of a deficit in your strength from side to side. We run them through balance tests. We run them through a hop test where they're hopping and stabilizing just on their surgical leg, so we want to make sure that they're comfortable with their new knee before we just send them out there because they feel like they're ready to go back no matter what. We just have to do everything we can to make sure their risk of reinjury is going to be as low as
Host: Right, and that's what everybody wants. Well, Dr. Loveland, this has really been interesting and informative. Thank you so much for your time.
Dr. Loveland: Thank you.
Host: That's Dr. Dustin Loveland thanks for listening to Pediatric Insights. For more information, please visit childrens.com/Andrews. And if you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. This is Pediatric Insights, Advances and Innovations with Children's Health. Thanks for listening.
Bill Klaproth: ACL tears are one of the most common knee injuries together. The team of surgeons, nurses, and in-house physical therapists at Children's Health offer different methods of treatment for ACL injuries. So let's learn more about these treatment methods that set Children's Health Andrews Institute for Orthopedics and Sports Medicine apart. This is Pediatric Insights, Advances and Innovations with Children's Health where we explore the latest in pediatric care and research. I'm Bill Klaproth. With us to discuss a diagnosis and treatment methods for ACL injuries is Dr. Dustin Loveland, a Board Certified Orthopedic Surgeon at the Children's Health Andrews Institute for Orthopedics and Sports Medicine. Dr. Loveland, thank you so much for your time. First off, could you walk us through the process of diagnosing patients with ACL injuries and how does this process at Children's Health Andrews Institute for Orthopedics and Sports Medicine work?
Dr. Loveland: So it really starts at the time of injury. A lot of times initially it'll be diagnosed by an athletic trainer who we employ plenty of those as well, or a physician at a varsity football games say. There's a lot of times where we personally are on the field and may diagnose it within a minute or two of it happening more commonly though it's at an outside sporting event and we'll see the patient in clinic. So oftentimes we'll be able to see the patient and see that they have some knee swelling, discomfort, pain with walking on it or inability to put weight on it through the discomfort, but the exam is key and so soft and difficult after an injury. But if we can get the patient to relax, we can get a really good knee exam on them and get a pretty good preliminary diagnosis at that time, which gives the patient good expectations. Because a lot of times for confirmation purposes and further planning, we're actually getting an MRI scan of it that will confirm the diagnosis of an ACL injury. And here at Andrews Institute, what I think a little bit different with us is we're kind of all encompassing in the sense a common scenario would be a hurt my knee on Saturday.
I went to Andrews Institute, the doctor told me my knee felt unstable, so they wheeled me over or walked me over to the MRI scanner and we went back after it was done and looked at the results with the doctor and confirmed my diagnosis. So long gone are the days of here's a prescription, go get an MRI, and you know you can come back when you bring a disc and a radiology report. That's not how it works anymore. We bring you in, we get you diagnosed, and a lot of times it's a big undertaking for the family and it's a lot, but to come in and get your diagnosis so we can go over the MRI results. And oftentimes the next step after we talk about treatment options and surgery if needed, is I get them over to the physical therapist and they're working on getting the swelling down and getting the knee back to normal. And clinically they walk out of here better than they came in. Just having some knowledge about what happened to their knee and already being essentially treated for it from a physical therapy standpoint. All that happened in one morning.
Host: Well that sure is a time saver so you don't have to run around to various appointments. The family can know right away, which is really important. And then as you said, you can often send them right to physical therapy to start rehab, which is really important. So it's kind of a one stop shop, which is really, really convenient for family. So I can see where that really is a special benefit to what you do. I also saw that one of the main goals is to use the most effective and least invasive treatment possible for ACL injuries. What are some of those lesser invasive treatment options you offer to achieve this goal?
Dr. Loveland: So I think it's important if you're having an ACL surgery, it's a big surgery. It sets a surgery that is unfortunately needed quite often, but you only want to have it once and you want to have it done the right way and you want to rehab the right way, and it's not something you want to go through a second time. And that's part of our goal as providers as get it right and not have the patient go back with any more risk of reinjury than they need it. So in terms of minimally invasive, the techniques that surgeons that are board certified in both orthopedics and sports medicine is we're using the most modern techniques, which are generally the procedures done arthroscopically. So yes, it's an escope and really the bigger portion of the surgery or the bigger scar that you'll ever see is really to harvest the tissue. Because in these young patients, we don't use donor ligaments or cadaver ligaments, we're using their own healthy tissue and just in a sense, making a new ACL and putting it where their old one was. And so what we call the all inside ACL simply, it's all done arthroscopically and really maybe one, two centimeter or one centimeter incisions is really the biggest one and everything else is small incisions. And these don't even require stitches outside the skin. We just use dissolvable stitches. So it's pretty slick method that's kind of evolved over the years. But really our current form and preferred way of fixing them.
Host: Well, besides the small incisions, what are some other benefits of these less invasive type treatment options?
Dr. Loveland: So there's two things that I think are really important that we have access now that were not around a decade or two ago and minimally invasive is a good thing to think about just in general from any surgery. Is that a plus trauma? You've already had enough trauma to the knee. That's the whole point. When we discuss getting into physical therapy before surgery, we want to calm that knee down and get it out of this inflammatory phase. And so with the less surgery done to you, we're not bringing on our own new inflammation so it's less to recover from. And then the other thing that's new is our methods, and we don't have to go into detail, but the way we stabilize the ACL, when they're done in the operating room, that thing is solid and long gone to the days where you have to be concerned about them moving it to early, putting pressure on it too early. And so a lot of our patients, pretty much all of mine within three or four days are in physical therapy and learning how to put pressure on it. And so I think the new techniques allow us to be more aggressive post-surgically which minimize the downtime and recovery in the long run.
Host: Which is another benefit and really important point. So what types of patients qualify for these less invasive options?
Dr. Loveland: Really all of them. I mean I can't say without any other major ligament damage. We make the smallest incision necessary to safely obtain our new ACL that we're going to make. And then outside of that, it's everybody's getting it. So I think that's just becoming the standard of care.
Host: So certainly a progression and evolution in ACL surgery. So then how long does treatment for an ACL injury typically last?
Dr. Loveland: So it's a process. This isn't a, you know, some surgeries you, you get it done, you get it over with and then you're good to go. And that's, this is really one where how good you are really depends on how much work you put in it. And so surgery typically takes an hour to two hours, depending on the magnitude of the injury. You go home the same day, you're rehabbing soon after, but it takes, you know, a couple of weeks to get off crutches even longer sometimes. It takes a few weeks to start running and then the strength that we want the patient to have, even in the hardest workers from what we know, in order to return safely, it's really eight to 12 months to be released back to sports without restrictions. And that's in those that are the hardest workers.
Host: So let's talk a little bit more about their return to play. What's your strategy then for monitoring patient progress and whether they can return to playing sports.
Dr. Loveland: So, if you've had an ACL and you're going to return to the sport that you tore it, especially if it's a cutting, pivoting soccer, basketball, football type sport. We know you're at risk to reinjure it or even kind of forbid injured the other side. But all we can do is use everything in our armamentarium to ensure that you are as safe as we can get you to return to play. So what that entails is most of the time an assessment with our physical therapists testing the strength compared to your non-surgical leg. We want that under 15 or ideally under 10% of a deficit in your strength from side to side. We run them through balance tests. We run them through a hop test where they're hopping and stabilizing just on their surgical leg, so we want to make sure that they're comfortable with their new knee before we just send them out there because they feel like they're ready to go back no matter what. We just have to do everything we can to make sure their risk of reinjury is going to be as low as
Host: Right, and that's what everybody wants. Well, Dr. Loveland, this has really been interesting and informative. Thank you so much for your time.
Dr. Loveland: Thank you.
Host: That's Dr. Dustin Loveland thanks for listening to Pediatric Insights. For more information, please visit childrens.com/Andrews. And if you found this podcast helpful, please rate and review or share the episode and please follow Children's Health on your social channels. This is Pediatric Insights, Advances and Innovations with Children's Health. Thanks for listening.