Monday Medical: Know your knees
December 1, 2013
Steamboat Springs — Skier Grant Juschka was enjoying a classic powder day last February when he stopped on a steep pitch to wait for skiers ahead to find a lost ski. When the line was clear, he pushed off a cornice, eager to meet his buddies at the bottom of the hill.
Chilled and in a poor position, he awkwardly turned and faltered, tearing the anterior cruciate ligament (ACL) in his knee.
"I knew I did something serious," he said about the injury, which landed him in a Steamboat Ski Patrol sled for his descent down the mountain.
The ACL is one of four ligaments that join the femur and tibia bones and provide rotational stability to the knee joint. It can tear during movements that overly twist or bend the knee.
ACL injuries are common in skiing and other sports — including soccer, football, basketball and wrestling — that involve quick stop-go movements, jumping and changing direction, explained Dr. Alex Meininger, an orthopedic sports medicine surgeon specializing in knees at Steamboat Orthopaedic Associates.
Athletes young and old may be at risk for ACL injury. Depending on the activity, women are more likely to tear their ACL due to anatomy, hormones, strength imbalances and other factors, Meininger said. He added that many ACL injuries can be prevented with preseason conditioning and strength training.
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Although we can walk and conduct daily activities without an ACL, treating ACL injuries with surgery or rehabilitation is important to prevent further knee damage. Meininger likened an unrepaired ACL to a car with out-of-balance tires.
"An ACL-deficient knee is more likely to buckle, causing injuries such as meniscus or cartilage tears," he said.
Advancements in ACL reconstruction and rehabilitation are helping many patients return to normal, active lifestyles. Treatment depends on a variety of factors, including a person's activity level, age and extent of damage to the knee joint.
Some people with an ACL tear avoid surgery by quitting skiing and other risky, high-demand sports and committing to a physical therapy routine that strengthens hamstrings, quadriceps and gluteus muscles that reinforce the knee.
That wasn't the best option for Juschka, who tore his ACL and damaged a meniscus, the cartilage cushion separating the upper and lower bones of his knee. At age 40, he also wasn't ready to give up skiing, cycling, hiking and water sports.
"You have to make the best health decisions for yourself," he said. "In my case, it worked out best to do” surgery.
Meininger used an arthroscope, or small fiber-optic camera inserted into the knee joint, to reconstruct the ACL with a tissue graft. ACL surgery patients start physical therapy almost immediately. Complete recovery and a return to sports typically takes three to four months.
"Patience and a commitment to rehab are vital to regaining good ACL function," Meininger said.
Staying put for weeks after surgery was difficult for Juschka. He got through it by reading sports medicine books and educating himself about good nutrition and self-care choices.
"Every day, do something to better yourself in the situation," said Juschka, who estimates he is nearly 100 percent recovered. He is planning his return to the slopes this week.
To prevent ACL injuries, Meininger recommended maintaining good strength and flexibility in your core and legs, focusing equally on strengthening quadriceps and hamstrings to protect your ACL. Balance, agility and power training also help to prevent ski injuries.
For tips on developing a winter exercise routine that will keep you strong and healthy throughout ski season, watch the SportsMed ski fitness video at http://www.yvmc.org/sportsmed.
Tamera Manzanares writes for Yampa Valley Medical Center and can be reached at firstname.lastname@example.org.