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Does an ACL Injury Mean Surgery is in My Near Future?

Ah, the dreaded ACL injury … a nightmare scenario for active people – from the professional athlete to the high school soccer star to the weekend warrior. Consider this: Approximately 200,000 ACL-related injuries occur each year in the U.S. and about 100,000 ACL reconstructions are performed on an annual basis.

The anterior cruciate ligament (ACL) – whose primary job is to stabilize the knee – is a complicated ligament and prone to injury, especially in those who participate in high-impact sports such as soccer, football, basketball and skiing. What causes an actual ACL tear? Well, it’s usually due to an abrupt twisting motion when a person suddenly stops to change direction, twisting the wrong way upon landing from a jump or traumatic impact to the knee. The injury itself comes with a popping sound shortly followed by swelling and instability in the knee.

When the ACL is torn, it’s unable to fix itself on its own, especially if other parts of the knee are also damaged. A common question I am asked by patients, friends and family alike is, “do I have to undergo surgery to fix the problem or can I live with it?” My answer is that it all depends on the individual. In short, yes, you can live with a torn ACL, but will it negatively impact your everyday life? The level of activity you like to engage in usually helps in determining if ACL surgery is right for you.

My general rule of thumb is as follows:

• If the knee injury includes more than just a torn ACL, surgery is likely your best option. About half of ACL injuries occur in conjunction with damage to other parts of the knee, specifically the meniscus, articular cartilage, and/or multiple ligaments. In these types of combined injuries, surgical treatment yields better outcomes.
• If you are an athlete or a highly active person that wants to continue to perform your sport or activity to its fullest, ACL reconstruction surgery is for you. While the average healing time following ACL surgery is 6-9 months, it is the quickest option for full recovery.
• If you have a job that requires heavy manual work, you may want to consider surgery – particularly if the job requires use of ladders or moving on uneven ground.
• Certain isolated ACL tears can be managed with physical therapy and bracing alone. The best candidates for non-surgical ACL treatment includes those with:
  • Partial ACL tears
  • No signs or symptoms of knee instability when engaging in low-demand activity (i.e., biking, jogging or swimming) and who are willing to give up high-demand sports and intense activity (i.e., basketball, skiing, high-intensity exercise)
  • Those who lead a fairly sedentary lifestyle
  • Children whose growth plates are still open (if surgery is needed in these cases it is often delayed until the bones are fully formed)

However, it is important to know that people who decide against surgery are more susceptible to recurring instability episodes that can cause secondary knee injuries. These injuries usually involve damage to the joint cartilage or meniscus and can lead to early arthritis down the road.

Bottom-line? It’s not a one-size-fits-all approach. You’ll want to sit down with your orthopaedic surgeon and weigh your options to determine what’s best for you.

Good news, though! Research shows that the risk of ACL injuries can be limited by doing regular exercises that strengthen the muscles that stabilize the knee. For more information and exercises to help prevent ACL injuries, check out the below video

And if you’ve recently undergone ACL surgery, check out the below video to supplement your physical therapy.

Dr. Matthew Boes is a fellowship trained orthopaedic surgeon specializing in sports medicine. He serves as team physician for the NC State University football team. His areas of expertise include sports medicine, shoulder arthroscopy, knee arthroscopy and reconstructive surgery of the shoulder, elbow and knee. For more information on Dr. Boes click here

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Can Rotator Cuff Injuries Heal on their Own?

A common question I hear from patients at least a few times a week is, “Can my rotator cuff tear be treated without surgery?” It’s a simple question with a not-so-simple answer…

Symptoms of a rotator cuff tear can be managed non-surgically with an ongoing course of anti-inflammatories (i.e., ibuprofen, naproxen, aspirin), cortisone injections and a good dose of physical therapy; however, this approach will not totally fix the problem. If you are suffering from tendonitis or have a partial rotator cuff tear and your goal is pain relief, a non-surgical approach may work for you, as good function can sometimes be achieved without surgery.

However, if you are active – meaning you play sports, regularly exercise or use your shoulder regularly in your work and/or hobbies, then surgery is recommended. There is NO empirical data showing that rotator cuff tears completely heal on their own.

The bottom line is that your rotator cuff is critical to your overall shoulder function and you should talk to your orthopedic surgeon about the best option for you. However, it’s important to note that research continues to demonstrate negative long-term effects associated with rotator cuff injuries, including muscle scaring, muscle shrinkage/atrophy and increased tendon stiffness. Unfortunately, these negative effects are irreversible and can lead to permanent loss of shoulder function. So, the goals of rotator cuff treatment are simple:

• Alleviate pain
• Maximize function
• Intervene before irreversible changes occur

Early surgical intervention is key, especially if you have a full rotator cuff tear, as the smaller the tear, the easier to repair, which will lead to better outcomes.

Whether you undergo rotator cuff surgery or opt for non-surgical treatment, physical therapy plays a key role in ensuring successful recovery. Rotator cuff strengthening exercises found here can help you regain strength and improve overall function in the shoulder. While you can do these at home, it is important to note that these exercises should not be used as a substitute for regular physical therapy visits and guidance from your physician.

Dr. Matthew Boes is a fellowship trained orthopaedic surgeon specializing in sports medicine. He serves as team physician for the NC State University football team. His areas of expertise include sports medicine, shoulder arthroscopy, knee arthroscopy and reconstructive surgery of the shoulder, elbow and knee. For more information on Dr. Boes click here.

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Knee Pain… The Most Common Culprits and When to Consult a Doctor?

Whether you are 18 or 88, knee pain does not discriminate when it comes to age. In fact, about 1 in 17 people visit their doctor every year due to some form of knee pain. It makes sense considering your knees are the largest joints in your body, they support the majority of your weight, and thereby bear some pretty serious abuse on a daily basis.

Popping, buckling, swelling – knee pain is associated with a variety of symptoms. However, you should contact your doctor if you experience the following, as it may be a sign of a serious issue that requires medical attention:

• Your knee looks unusual or deformed (usually due to a fall)
• Sudden swelling and/or a warm sensation around the knee following an injury
• Your knee feels like it is locked, and you are unable to straighten it
• You heard a popping noise accompanied by sudden pain
• You struggle to walk due to severe knee pain

Bottom line – if your quality of life is being negatively impacted due to your knee pain and you cannot engage in everyday activities, consult your doctor.

While there are many causes of knee pain, following are the most common:

PATELLOFEMORAL PAIN SYNDROME (RUNNER’S KNEE) results from muscle tightness or imbalance around the knee. The quadriceps muscles in the front of the thigh and hamstring muscles in the back of the thigh exert considerable pressure on the knee joint. It does not take much over-stress or imbalance from the muscles around the knee to start causing pain in this area. Pain is typically felt around and below the knee cap and usually worsens after prolonged sitting, stair-climbing, or activities such as running. Fortunately, this common condition can be completely relieved by doing simple exercises. For more information and exercises to help relieve runner’s knee, click here.

ACL TEAR: The ACL is one of the main ligaments that stabilize the knee. ACL injuries are common in sports and work activities. Patients usually experience a “popping” sensation and feeling of buckling or giving way in the knee as the injury occurs. Typically, there is immediate swelling and patients are unable to continue activity. ACL injuries can be debilitating and lead to recurrent instability of the knee, which prevents normal function. In active patients, most of these injuries require ACL reconstruction to repair the damaged ligament and stabilize the knee. The goal of surgery is to allow return of normal sports and high-stress recreational activity. Research shows that the risk of ACL injuries can be limited by doing regular exercises that strengthen the muscles that stabilize the knee. For more information and exercises to help prevent ACL injuries, click here.

MENISCUS TEAR: There are two meniscus cartilages in the knee and they are some of the most commonly injured structures in the body. Meniscus cartilages act like shock absorbers between the thigh bone and shin bone. Meniscus tears often cause painful catching or locking in the knee. Pain is usually sharp and felt on one side of the knee in a specific location. Unfortunately, meniscus cartilage naturally has a poor blood supply, and as such most meniscus tears will not heal on their own. The good news is that knee arthroscopy, a minimally invasive surgery, is very effective at treating and alleviating pain from meniscus injuries. Patients generally return to normal function without pain just a few weeks after surgery.

KNEE ARTHRITIS is caused by wearing down of the normal cartilage cushion in the knee joint, similar to wearing of treads on a tire. Cartilage wear leads to swelling, stiffness and pain in the knee that usually gets worse with activity such as walking all day. Pain can also be felt at night when trying to sleep. Treatment includes ice, anti-inflammatiories, activity modification and cortisone injections to limit inflammation in the knee. Knee exercises are important to relieve stress on the knee and strengthen the muscles around the joint to help prevent recurrence of symptoms. Click here for easy knee arthritis exercises that can be performed at home.

Dr. Matthew Boes is a fellowship trained orthopaedic surgeon specializing in sports medicine. He serves as team physician for the NC State University football team. His areas of expertise include sports medicine, shoulder arthroscopy, knee arthroscopy and reconstructive surgery of the shoulder, elbow and knee. For more information on Dr. Boes click here.

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Add a Secret Weapon to your Home Sports Medicine Arsenal

If sports, work and activity related aches and pains have got you down, try foam rolling. It’s a cheap, convenient tool to help relieve sore, achy body parts, such as the shoulders, hamstrings, knees, calves and back. And if done correctly, it really helps!

Most overuse pain is due to muscle irritation and spasm, which results in painful muscles that can easily be re-aggravated with basic day-to-day activity. For instance, weakened stability in the hip joint can cause your IT band to overcompensate during exercise, leading to fairly significant knee pain that won’t go away. Another common issue is shoulder pain due to exercise or poor posture from sitting at a desk all day.

These types of pain can be alleviated – and even prevented – with foam rolling. The secret behind the effectiveness of foam rolling in alleviating pain lies in the benefits of manual muscle release or deep tissue massage. When pressure is applied directly to the painful area it causes the muscle to relax, which results in pain relief.

It can cost more than $100 an hour for a deep tissue massage from an experienced and licensed massage therapist. Foam rolling allows you to get similar results just by doing simple exercises at home. Additionally, it will only cost you an initial $20-30 for the foam roller device itself. What’s more, the results can be remarkable and offer significant pain relief. If you’ve not tried foam rolling, I’d highly recommend you invest the time in learning more about it. Foam rollers [as pictured above] come in in many shapes and sizes can be readily purchased online or at sporting goods stores. A simple Google or YouTube search should give you an idea of the types of exercises and positions to work on at home. As always, consult your physician or a sports medicine doctor if you have any questions or concerns in starting this type of home therapy regimen. My bet is that this becomes your “go to” for alleviating sore muscles.

Best of luck!

Dr. Matthew Boes is a fellowship trained orthopaedic surgeon specializing in sports medicine. He serves as team physician for the NC State University football team. His areas of expertise include sports medicine, shoulder arthroscopy, knee arthroscopy and reconstructive surgery of the shoulder, elbow and knee. For more information on Dr. Boes click here.

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Importance of ACL Prevention Training

Proper muscle control is essential to minimize risk of knee injury from jumping, cutting, and twisting motions in sports. Research shows this is particularly true for female athletes.

A recent study of elite female soccer players in Sweden and published this year highlighted the value of ACL prevention training and the role poor body mechanics can play in predisposing athletes to ACL injuries that can lead to ACL surgery. Players who had ACL reconstruction surgery were compared to healthy athletes in 5 common agility tests. Both groups differed only minimally in ability to perform functional tests – demonstrating the high success rate of ACL surgery in returning athletes to high level activity.

However, the data also showed only 1 out of 5 athletes in BOTH groups performed the functional tests in a manner considered “protective” against future ACL injury. The data revealed deficiencies in performance for both healthy and recovering athletes despite ability to return to high level sports. The study revealed that many athletes have some degree of improper body mechanics leading to an increase risk of knee injury. All athletes participating in sports with cutting, pivoting, and jumping motions can benefit greatly from training programs to develop protective muscle control patterns to help prevent future ACL injury. To learn more, click link below

ACL Prevention Rehabilitation

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“Heads Up” Program Lowers Rate of Concussion in High School Football

With football season right around the corner, thoughts are returning to the ever-present challenge of player safety. A study presented at this year’s Annual Meeting of the American Academy of Orthopaedic Surgeons in San Diego gave encouraging results for limiting concussion risk in high school football. A new curriculum from USA Football known as “Heads Up” sets guidelines and a framework for high school athletic programs to improve football safety. The program includes certification of coaches, instruction in safer blocking and tackling techniques, as well as training on concussion recognition and response protocols.

Last season, 2500 high school players in South Carolina were studied for the effects of the program. The players were divided into two groups: one group were from schools that had instituted the “Heads Up” program, and the other group of players came from schools that did not. The study authors found an astonishing 33% reduction in the number of concussions over the course of the season for teams involved in the Heads Up program. What’s more, Heads Up players who did sustain a concussion were safely returned to play 27 percent faster than non-Heads Up players – likely due to earlier recognition and implementation of appropriate treatment.

This study was one of the first of its kind to demonstrate how a program to teach better and safer technique can successfully limit the number of concussions in high school football. Organizers plan wider implementation and a larger study that will no doubt continue to improve the effectiveness of the program. Click here for more information.

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ACL Tears Growing in Teen Girls; Preventive Exercises Are Key

A new study reports that ACL injury rates are raising exponentially in teen girls who play sports. Specifically, the study analyzed 148 million people in the United States, and found that the average annual ACL surgery rate climbed 22 percent from 2002 to 2014. However, for teen girls, the average annual knee surgery rate escalated by 59 percent. While the study didn’t point to specific factors that contributed to this increase, common trends such as year-round sports participation as well as the specialization in a singular sport likely play a contributing role.

ACL prevention programs have been shown to reduce ACL injury rates by 75-80 percent. Check out these ACL Prevention Exercises, which are designed and proven to reduce the rate of ACL tears in young – as well as older – athletes. Conduct the exercises 3-4 times per week prior to practice or other workout activities. And don’t worry – it’s quick, typically taking 15 minutes to complete.

Also, remember these tips as you engage in exercise or athletic activity:

• Always, always, always warm up.
• Stretch… flexibility can help you maintain proper form throughout your exercise session or game.
• Strength train. It’s important to have good strength in your thighs and hips, as these body parts help support and stabilize the knee. Think squats and lunges. But remember proper form is key.

Dr. Matthew Boes and his team are committed to providing patients with unparalleled, first-rate care when it comes to the diagnosis treatment of knee injuries and conditions. Whether you are an athlete who requires reconstructive knee surgery due to a sports injury or you are an active adult needing total knee replacement, our team is dedicated to returning you to full, pain-free function.

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Runner’s Knee 101

Yes, it is true… runner’s knee is most often caused from running…and other sports or exercise related activity. Medically referred to as patellofemoral pain syndrome (PFPS), this condition in marked by pain in the front of the knee and/or around the knee cap (patella). The pain can ebb and flow – sometimes sharp, other times dull. It may go away while running or engaging in exercise, only to come back afterward. Most commonly occurring in active females and young adults, the overall pain can make it hard to engage in everyday activities, such as going up and down the stairs and/or bending down. But all is not lost… and the good news is that more often than not you won’t require knee surgery to get better. 

What Causes Runner’s Knee?

Running, right? Most likely, the answer is yes. Runner’s knee is most often caused by overuse… meaning repeated physical activity that puts stress on the knee. Think running, squatting and jumping. A sudden change in your workout routine could also be the culprit. Maybe you started going to your bootcamp class 5 days a week instead of your normal three. Or perhaps you bumped up your long run to prepare for that marathon. We also see runner’s knee occur because of improper training form or technique. And believe it or not, it could even be those new tennis shoes you just bought.

Your runner’s knee could also be a case of biomechanics. Your patella may be larger on the outside than the inside or it may sit differently in the femoral groove. Weak quadriceps can also cause problems with the kneecap tracking within the femoral groove.

How do You Treat Runner’s Knee?

• Change up your activity. Engage in low-impact activities until your pain subsides. Biking and swimming are great low-impact options.
• Engage in physical therapy exercises to help maximize your recovery. Check out my short video that provides simple exercises you can do at home.
• Ice your knee several times a day to help alleviate pain.
• Elevate your knee as often as possible. Be sure to raise it higher than your heart.
• NSAIDS, such as Aleve, Advil and Motrin can help reduce swelling and alleviate pain. Click here to see my guide to NSAID management.

Knee surgery for patellofemoral pain or runner’s knee is very rare and only done in severe cases. If you do require surgical treatment, your surgeon will likely perform knee arthroscopy, where a small camera is inserted into the knee joint to guide mini surgical instruments that can removed damaged cartilage from the patella or to correct a patellar malaligament.

How do you prevent runner’s knee?

• Build and maintain the muscles around the knee, including the quadriceps and hamstrings. Leg extension exercises can significantly help strengthen these important areas.
• Warm up before engaging in strenuous physical activity. Don’t go all out the moment you start.
• Flexibility is key. Be sure to stretch before and after exercise. Also, consider incorporating yoga into your exercise regimen.
• Wear appropriate shoes for the specific activity.
• Maintain a healthy body weight.

For more information on runner’s knee, click here. And for exercises to help treat the condition, click here.

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The Dreaded ACL Tear… A Sports-Ending Injury or Minor Set-Back?

An ACL injury can be a devastating blow to an athlete or active person. While this type of injury used to end sports careers, thanks to advancements in arthroscopic ACL surgery and patients’ willingness to conduct proper rehabilitation and physical therapy, it’s not all doom and gloom. In fact, studies show that most athletes return to their sport following surgery and thorough rehabilitation. Following is a short Q&A, which explains how the ACL works, what happens when it is injured, how it’s treated and the fastest – and best – way to get back to normal following surgery.

What is the ACL?

The anterior cruciate ligament (ACL) is one of the four major ligaments in the knee that connect the femur to the tibia. It is responsible for front-to-back and rotational stability. Given the important role it plays in the overall function of the knee, it is one of the most commonly injured ligaments.

Each year, approximately 400,000 people tear their ACLs in the United States. And women have a higher risk of suffering an ACL injury than men.

How does the ACL tear?

ACL tears generally occur with a sudden hyper-extension – bending or twisting of the knee. This can occur in sports or activity that involves quick changes in direction, sudden stops or a lot of jumping. A hit to the knee in contact sports can also cause an ACL tear. ACL injuries can happen to anyone – high-level soccer and football players; recreational hikers, skiers and workout enthusiasts; or even someone who is simply coming down their stairs and misses a step.

When an ACL injury occurs, your knee may buckle and you may feel a popping sensation. Swelling, instability, limited movement and pain are key indicators that something is not right. The injury can be mild to severe, depending on the type of tear.

How do you treat a torn ACL?

Depending on the extent of your injury, there are two approaches to treatment:

• Non-surgical treatment, including significant physical therapy / rehab
• ACL surgery to reconstruct the ACL

People who are not very active may decide to take the non-surgical approach to treatment. This involves a detailed physical therapy program to try and prevent further instability symptoms in their knee, such as buckling or giving-way. For patients who engage in only low-demand activities, this may yield acceptable results.

However, most active people opt for ACL surgery to repair the knee and return to their daily activity in a safe and fairly quick manner. During ACL surgery (also known as an ACL repair), the surgeon removes the damaged ligament and replaces it with a segment of a tendon (from another part of the knee or from a donor) known as a graft.

Following surgery, the patient will undergo a rehabilitation/physical therapy program. Click here to check out my comprehensive ACL Rehab Video Series. Successful ACL reconstruction paired with a solid rehab program can usually restore stability and full function to the knee.

How long is the recovery process?

While you will go home the same day as your surgery, the true recovery process from ACL surgery is intense. From surgery through rehabilitation, the recovery process can take six months or more, according to most ACL surgeons. Just remember, if you are serious with your rehab, you will be pleased with the results.

Can you prevent ACL tears?

ACL prevention programs have been shown to reduce ACL injury rates by 75-80 percent. Check out my ACL Injury Prevention Program, which was adapted from “The PEP Program” developed by Bert Mandelbaum, MD (Santa Monica Sports Medicine Research Foundation). This exercise program is designed and proven to reduce the rate of ACL injuries in young athletes. Conduct these exercises 3-4 times per week prior to practice or other workout activities. It typically takes 15 minutes to complete.

Dr. Matthew Boes (knee surgeon) and his team are committed to providing patients with unparalleled, first-rate care when it comes to the diagnosis treatment of knee injuries and conditions. Whether you are an athlete who requires reconstructive knee surgery due to a sports injury or you are an active adult needing total knee replacement, our team is dedicated to returning you to full, pain-free function.

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Protecting Active Shoulders from Rotator Cuff Tears

Do you find yourself plagued with recurrent pain and soreness around the shoulder? The culprit may be your rotator cuff tendons.

Often thought of as an issue that only affects baseball pitchers, rotator cuff problems are actually far more common in active adults. Physical activities can place excessive stress on the rotator cuff tendons. These activities often involve repetitive overhead motions, sudden deceleration of the arm, or loading the shoulder with resistance in extreme positions, such as behind the back. This can lead to tendonitis, or painful inflammation and swelling of the tendons, as well as more serious problems like an actual tendon tear. Understanding what can cause rotator cuff disorders and what can be done to prevent them may help you avoid prolonged periods of discomfort and the need to take a break from your regular activities or exercise routines.

The rotator cuff is a group of four tendons that surround the shoulder joint. It plays a critical role as the main stabilizer of the shoulder. As we age, our tendons can weaken and are more prone to irritation and damage from overuse. Repetitive and forceful shoulder activities can place excessive strain on the tendon fibers and can increase the risk of tendon injury. Fortunately, most rotator cuff injuries are due to tendonitis and can be treated relatively easily with rest, physical therapy and medication. It is important to note, however, that recurrent tendonitis can lead to tearing of the tendon. For a variety of reasons, once a rotator cuff tendon is torn, it will not heal on its own and surgery is often required to restore normal shoulder function. As such, shoulder pain that lasts for weeks or months should not be ignored, as this can lead to a more serious problem in the future. Following are some suggestions to help keep your rotator cuff tendons in check:

• Listen to your body. High-level baseball pitchers are taught to never ignore pain in their shoulders. You should do the same. If you experience pain while engaging in an activity or into the next day, take a break for several days and do something less stressful on the shoulder. This may involve modifying your activities on a long-term basis by avoiding certain weight-training exercises or swimming strokes.
• Avoid activities that force you to place the shoulder in extreme positions, particularly if any weight or resistance is involved. This includes doing things like overhead presses behind the neck, pushups where you touch the floor with your chest, and certain extreme yoga positions. The twisting force on the tendon fibers can cause small tears, which may ultimately progress to larger tears with repetitive activity.
• Incorporate regular low resistance / high repetition rotator cuff exercises into your regular exercise routine. Gentle and focused strengthening of the rotator cuff can go a long way to preventing injury. Check out my Rotator Cuff Strengthening Program for step-by-step video exercises you can do to strengthen the rotator cuff. These exercises can be performed for prevention or following rotator cuff repair surgery.
• Use rest, ice and anti-inflammatories liberally. These simple measures will often completely relieve tendonitis without the need for more involved treatment. Click here for more information on how to appropriately use anti-inflammatories and here on how to distinguish between using ice or heat for an injury.
• Don’t ignore lingering or recurrent pain. See your doctor if pain persists more than a few weeks and is not resolved with the above steps. Early treatment for rotator cuff problems generally leads to better results and will get you back on your feet quicker. Be good to your rotator cuff!

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