How to Prevent ACL Injuries
From the Show: Children's Health
Summary:
Air Date: 6/5/20
Duration: 10 Minutes
Dr. Loveland discusses various training tips and exercises to prevent ACL injuries in kids.
Transcription:
Bill Klaproth: You're listening to Children's Health Checkup where we answer parent's most common questions about raising healthy and happy kids. I'm Bill Klaproth, and on this episode we'll talk about ACL injuries, how they're treated, and how they can be prevented with our expert, 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. So first off, what is an ACL injury and what does the acronym ACL stand for?
Dr. Loveland: The ACL stands for anterior cruciate ligament. The ligament inside the knee, it's the main stabilizer of the knee. When we classify injuries, we talk about ACL sprains versus tears, partial tears versus complete. And it can be a life altering injury for a young athlete.
Host: So you just said it potentially could be a life altering injury for a youth athlete. So exactly what happens in an ACL injury?
Dr. Loveland: Sure. So about two thirds or more of the time, it's a non-contact injury. The athlete just steps the wrong way. Knee twists, oftentimes they'll feel a pop. Sometimes it can involve contact, but the knee gets twisted in a manner that the ligament that stabilizes it is actually often torn in two.
Host: Okay, and then how prevalent are ACL injuries in youth sports?
Dr. Loveland: It's pretty common. There's about a hundred to 200,000 ACL ruptures per year, but to put it on a little bit smaller scale, just my practice in the Dallas Fort worth area, I see about a 100 to 150 per year. And really any metric that we're measuring of those tends to be increasing every year.
Host: That's a lot of ACL injuries. Well you said generally this is a non-contact injury, which sports and players are at highest risk then for ACL injuries?
Dr. Loveland: Well, we see it on TV and the media our male Football players get a lot of the press and that seems to be, when we think about ACLs we think about football players. But it's actually females and most commonly females playing basketball and soccer and now those are, especially in our high level soccer and basketball, young athletes, it's really becoming a year round sport. So it's not just sport they play three, four months out of the year.
Host: And then if an ACL injury occurs, how are ACL injuries treated and how long does it take to recover from an ACL injury?
Dr. Loveland: So most ACL injuries are either a sprain, which can be minor, and some that can be rehabilitated in a week to a couple of months or it's a complete tear, which unfortunately becomes a surgical problem. So while it's a very common surgery and the surgery is a quick in and out procedure, the recovery at least to return safely to their sport is often eight to 12 months.
Host: So when I think of ACL, I think of the tear, like you said, we see it on TV usually with male athletes, but it sounds like you can sprain it as well. And then for people that do sprain their ACL, it can heal on their own?
Dr. Loveland: The problem is the location of the ACL inside the knee has a very poor healing capacity. So we don't necessarily think of it as healing as to what the result of the injury was. So if it's a sprain and most of the structures maybe aggravated but intact, those can go on to not have clinical symptoms. If the ACL is torn, there's really little to no healing capacity. So unfortunately if it is a complete tear, its approach is a hundred percent that will need surgery.
Host: So is there any association between ACL injuries and the risk in developing early onset arthritis?
Dr. Loveland: There is, more commonly in those that are not treated surgically. And so that's why we tell our patients, even if their kid is not an athlete or does not plan to return to sports, important for stability of the need to prevent early arthritis. But unfortunately the rates do increase a little bit even with surgery and no further subsequent injuries. It can lead to arthritis early on, but much lower incidence than if it's treated non-surgically.
Host: And let's talk about prevention. How can parents, coaches and athletes work together to reduce the risk of ACL injury?
Dr. Loveland: Well, we can't prevent them all unfortunately, especially those that seem just accidental, athletes steps the wrong way. But we do know there are some things that we can modify. We do have here and throughout the country have ACL prevention programs, usually involved with training facility or physical therapist where we're working on strengthening the muscles that go across the knee, quad muscle strength, hamstring strength, believe it or not. Hip strength actually plays a major factor, especially in the females. So we do have some risk factors that we can modify. But when no matter the preparation, you know, an athlete, especially a female that chooses to play year round soccer, it's just one of those inherent risks that doing the sport you love to play and comes along with some of these risks. And in patients that have torn it previously, not only do we know they're at risk for the sport, they play a cutting, pivoting sport, but we know they're at risk to retear that ACL or even tear the other side, which is a mirror image of the knee that already sustained an injury. So we know to be extra cautious with those and really start to focus on the non-injured leg to hopefully prevent that from happening in the future.
Host: And then last question, Dr. Loveland, what are the metrics you use to judge when an athlete is ready to return to the court or the field or return to normal daily activities?
Dr. Loveland: In general, one of our metrics we use for safe return to play is we test the strength compared to the opposite side. And we'd like to see less than 15 or ideally less than 10% of a deficit, which means when we do deem them safe to play, some players still do have a deficit there, but I preach that the recovery is really a couple years, meaning really two years before your knees strong as it's going to be. And so ideally you'd like to have them stronger than their opposite side. And sometimes we see that. But in general we're just trying to minimize the deficit from one side to the other. And if we were to test those same patients a year after two years after surgery, I think we'd see some of those legs being stronger. Definitely at least the equal strength as the other side.
Host: Well, Dr. Loveland, thank you so much for your time. This has really been informative. Thank you again.
Dr. Loveland: Thanks.
Host: That's Dr. Dustin Loveland. And for more information, please visit childrens.com/Andrews, and if you found this podcast helpful, please rate and review or share this episode, and please follow Children's Health on your social channels. This is Children's Health Checkup, a podcast from Children's Health. Thanks for listening.
Bill Klaproth: You're listening to Children's Health Checkup where we answer parent's most common questions about raising healthy and happy kids. I'm Bill Klaproth, and on this episode we'll talk about ACL injuries, how they're treated, and how they can be prevented with our expert, 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. So first off, what is an ACL injury and what does the acronym ACL stand for?
Dr. Loveland: The ACL stands for anterior cruciate ligament. The ligament inside the knee, it's the main stabilizer of the knee. When we classify injuries, we talk about ACL sprains versus tears, partial tears versus complete. And it can be a life altering injury for a young athlete.
Host: So you just said it potentially could be a life altering injury for a youth athlete. So exactly what happens in an ACL injury?
Dr. Loveland: Sure. So about two thirds or more of the time, it's a non-contact injury. The athlete just steps the wrong way. Knee twists, oftentimes they'll feel a pop. Sometimes it can involve contact, but the knee gets twisted in a manner that the ligament that stabilizes it is actually often torn in two.
Host: Okay, and then how prevalent are ACL injuries in youth sports?
Dr. Loveland: It's pretty common. There's about a hundred to 200,000 ACL ruptures per year, but to put it on a little bit smaller scale, just my practice in the Dallas Fort worth area, I see about a 100 to 150 per year. And really any metric that we're measuring of those tends to be increasing every year.
Host: That's a lot of ACL injuries. Well you said generally this is a non-contact injury, which sports and players are at highest risk then for ACL injuries?
Dr. Loveland: Well, we see it on TV and the media our male Football players get a lot of the press and that seems to be, when we think about ACLs we think about football players. But it's actually females and most commonly females playing basketball and soccer and now those are, especially in our high level soccer and basketball, young athletes, it's really becoming a year round sport. So it's not just sport they play three, four months out of the year.
Host: And then if an ACL injury occurs, how are ACL injuries treated and how long does it take to recover from an ACL injury?
Dr. Loveland: So most ACL injuries are either a sprain, which can be minor, and some that can be rehabilitated in a week to a couple of months or it's a complete tear, which unfortunately becomes a surgical problem. So while it's a very common surgery and the surgery is a quick in and out procedure, the recovery at least to return safely to their sport is often eight to 12 months.
Host: So when I think of ACL, I think of the tear, like you said, we see it on TV usually with male athletes, but it sounds like you can sprain it as well. And then for people that do sprain their ACL, it can heal on their own?
Dr. Loveland: The problem is the location of the ACL inside the knee has a very poor healing capacity. So we don't necessarily think of it as healing as to what the result of the injury was. So if it's a sprain and most of the structures maybe aggravated but intact, those can go on to not have clinical symptoms. If the ACL is torn, there's really little to no healing capacity. So unfortunately if it is a complete tear, its approach is a hundred percent that will need surgery.
Host: So is there any association between ACL injuries and the risk in developing early onset arthritis?
Dr. Loveland: There is, more commonly in those that are not treated surgically. And so that's why we tell our patients, even if their kid is not an athlete or does not plan to return to sports, important for stability of the need to prevent early arthritis. But unfortunately the rates do increase a little bit even with surgery and no further subsequent injuries. It can lead to arthritis early on, but much lower incidence than if it's treated non-surgically.
Host: And let's talk about prevention. How can parents, coaches and athletes work together to reduce the risk of ACL injury?
Dr. Loveland: Well, we can't prevent them all unfortunately, especially those that seem just accidental, athletes steps the wrong way. But we do know there are some things that we can modify. We do have here and throughout the country have ACL prevention programs, usually involved with training facility or physical therapist where we're working on strengthening the muscles that go across the knee, quad muscle strength, hamstring strength, believe it or not. Hip strength actually plays a major factor, especially in the females. So we do have some risk factors that we can modify. But when no matter the preparation, you know, an athlete, especially a female that chooses to play year round soccer, it's just one of those inherent risks that doing the sport you love to play and comes along with some of these risks. And in patients that have torn it previously, not only do we know they're at risk for the sport, they play a cutting, pivoting sport, but we know they're at risk to retear that ACL or even tear the other side, which is a mirror image of the knee that already sustained an injury. So we know to be extra cautious with those and really start to focus on the non-injured leg to hopefully prevent that from happening in the future.
Host: And then last question, Dr. Loveland, what are the metrics you use to judge when an athlete is ready to return to the court or the field or return to normal daily activities?
Dr. Loveland: In general, one of our metrics we use for safe return to play is we test the strength compared to the opposite side. And we'd like to see less than 15 or ideally less than 10% of a deficit, which means when we do deem them safe to play, some players still do have a deficit there, but I preach that the recovery is really a couple years, meaning really two years before your knees strong as it's going to be. And so ideally you'd like to have them stronger than their opposite side. And sometimes we see that. But in general we're just trying to minimize the deficit from one side to the other. And if we were to test those same patients a year after two years after surgery, I think we'd see some of those legs being stronger. Definitely at least the equal strength as the other side.
Host: Well, Dr. Loveland, thank you so much for your time. This has really been informative. Thank you again.
Dr. Loveland: Thanks.
Host: That's Dr. Dustin Loveland. And for more information, please visit childrens.com/Andrews, and if you found this podcast helpful, please rate and review or share this episode, and please follow Children's Health on your social channels. This is Children's Health Checkup, a podcast from Children's Health. Thanks for listening.