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Knee and ACL Injuries: Treatment and Recovery

October 9, 2013 11:59 AM with Dr. Mark Bowen

Knee and ACL (anterior cruciate ligament) injuries are common in our very active population. Athletes, young and old, are increasingly susceptible to ACL tears from both contact and non-contact mechanisms. Surgical treatments have advanced significantly over the last decade, allowing successful return to activities at all levels of competition. Mark Bowen, MD, Orthopedic Surgeon in Sports Medicine at NorthShore and team physician for the Chicago Bears, will answer your questions on knee and ACL injuries: how they occur, typical symptoms, options of treatment, surgical techniques and rehabilitation. Submit your questions early.

Angela (Moderator) - 11:44 AM:
Welcome! Today’s chat: Knee and ACL Injuries: Treatment and Recovery will begin shortly. Please start submitting your questions and Mark Bowen, MD will begin answering them as soon as we get started. While you are waiting for the chat to begin, feel free to visit the, Sports Medicine page on our website. We will do our best to answer all of your questions, but because this is such a popular chat, the physician may not be able to answer all of your questions in the time allowed. Your understanding is greatly appreciated.

  john (skokie) - 11:57 AM:
I had an ACL injury 3 yrs ago while playing basketball which was confirm by an MRI 1 year ago. I have been holding off treatment since I dont have any pain or discomfort. I tried playing ball several times and I know it's no longer stable because my knee gave out on multiple occassions. Im already 30 yrs old and wont be playing as hard as I used to, so do you still advise to have this repaired regardless? And what's the prognosis with surgery considering that it's been that long?
Dr. Mark Bowen (NorthShore)
At this point the primary indication for you to have an ACL reconstruction is instability and the risk for further damage if you continue to play pivoting sports with an unstable knee. If you want to remain active and decide to have your knee reconstructed the prognosis for a stable knee that you can play sports with is very good and not affected by the 3 years you have waited. Good luck!

  Sue (Decatur Illinois) - 12:01 PM:
I had my R knee scoped in July. Surgeon removed 90% of ACL and quite a bit of both meniscus...stability is a problem...what is my option now?
Dr. Mark Bowen (NorthShore)
Likely whatever ACL is left is not functional and not keeping your knee stable. ACL reconstruction should reliably restore your knee's stability, and would be indicated.

  Jen M (Galena, IL) - 12:05 PM:
I have torn the same ACL three times. For my most recent tear, I have to have two surgeries. I don't have the time or the money for these. I've been fully functional in playing competitive sports. Is there another treatment option besides surgery?
Clearly a very unfortunate and difficult situation to get you to a stable condition. While surgery may still be successful, I understand your hesitation. ACL functional bracing and rehabilitation/strengthening may allow you to participate in some activities but I would caution you to avoid aggressive cutting and twisting sports due to the risk of further damage to your cartilage.

  David (Barrington, Il) - 12:13 PM:
Hey I'm 19 years old and I am having my ACL reconstruction and latertal meniscus tear surgery in a week, I was just wondering about the severity of my trauma and advice u could give me for post surgery? I also received this injury a year ago and wondering if it would have any affect on the surgery?
Dr. Mark Bowen (NorthShore)
Good luck! I don't think the year time frame will likely matter in the outcome unless there in cartilage or meniscus damage that has occurred since your initial injury. Post surgery I would suggest you follow your surgeons instructions carefully, ice regularly, try to contract your thigh muscles frequently and let your body tell you the pace you can proceed at. You will receive good coaching from your therapist as well.

  Eric (Wauconda, il) - 12:19 PM:
What are other alternatives to surgery? I have no pain running forward and backward, only when cutting, is there a brace that's able to support these types of movements?
Dr. Mark Bowen (NorthShore)
Primarily stenghtening the entire core and lower extremities, as well as activity modification to avoid cutting, twisting, pivoting activities and use of a Functional ACL brace. These braces can help but can not be perfect in preventing giving way episodes, depending on the motions and loads applied to the knee. For people who restrict their activites to straight ahead like swimming, biking or even jogging a brace might not even be necessary.

  Donna (Gurnee, Il) - 12:24 PM:
My 17 year old son suffered a left knee injury during a lacrosse game.He dislocated the knee and had an ACL tear.Do all tears require surgery.? He had several weeks of physical therapy and was sidelined for the entire season.
Dr. Mark Bowen (NorthShore)
If he had a complete or functionally complete ACL tear and desires to continue to play cutting sports like lacrosse it would be recommended that he have an ACL reconstruction surgery. If he attempts to participate in such activities with an unstable knee he runs the risk of having instability episodes that can cause further damage to the knee cartilage and meniscus. In addition, if he actually dislocated his knee it is likely that he injured other ligaments in his knee other than just his ACL.

  Sam (Chicago, IL) - 12:30 PM:
What are options for someone who has had an unsuccessful knee replacement surgery?
Dr. Mark Bowen (NorthShore)
This depends on the underlying reason for the replacement not being successful. The answer might be different if it stiff, unstable, painful, loose among other reasons. Typically, this requires a careful analysis of the cause so that further treatment, even possible further surgery can address this and hopefully correct the issue.

  Diane (Arlington Heights) - 12:34 PM:
I sustained a knee injury that resulted in an inoperable partial meniscus tear that left me walking with a limp and in constant pain and stiffness. I have had cortizone and synvisc shots to my knee. I heard about cartildge transplant surgery. Is this surgery considered a research trial or is it accepted as treatment. Am I a candidate for this surgery? Do you perform this at NorthShore?
Dr. Mark Bowen (NorthShore)
I would first wonder why your meniscus tear would be considered to be "inoperable." If it is because you have significant arthritis then a knee replacement might be appropriate. If you have had your meniscus completely removed, have pain and a limp, and minimal arthritis then you may be a candidate for meniscus transplant surgery. This is a newer, but standardly performed procedure that is done at NorthShore.

  Jackie (IL) - 12:39 PM:
How do ACL injuries occur? In athletes, can they occur because of over training or is this normally a hit or a fall?
Dr. Mark Bowen (NorthShore)
ACL tears occur from an acute trauma not from overuse or overtraining. The most common mechanism is twisting of the body on a planted or highly loaded foot, deceleration or landing. In skiing, its twisting of the knee when the ski gets stuck and often the bindings don't release. Contact injuries to the knee may also tear the ACL, and are frequently seen with other knee ligament injuries such as the MCL

  Nate (Gurnee) - 12:44 PM:
Will an ACL injury heal without surgery?
Dr. Mark Bowen (NorthShore)
A complete ACL tear will not heal without surgery. There are some partial tears that may result in a stable knee, but my experience is that most of them are not stable enough to play cutting sports or go on to a complete tear at a later time.

  Mark (Evanston, IL) - 12:47 PM:
I've had mild left knee pain when running or otherwise exerting energy for the past several years. It's not debilitating by any means, but there's definitely a dull pain that occurs. Could there by a serious problem that I'm overlooking?
Dr. Mark Bowen (NorthShore)
In most cases, pain that only occurs with sports or physical activity, is from a mechanical cause such as limb allignment, muscle imbalance, or inflexibility. Other good signs would be absence of swelling, locking, catching, pain with simple day to day use. As always, a condition that persists for more than a few weeks should probably be evaluated by a physician.

Angela (Moderator) - 12:49 PM:
Thank you everyone for your great participation. The chat will be ending in approximately 10 minutes.

  Asher (Chicago) - 12:51 PM:
I'm very active in high impact sports and certainly feel the soreness afterwards, but when I squat, both my knees crackle with the left being the worst, sort of sound like popcorn popping, not particularly painful but uncomfortable nonetheless. Can this be symptoms of arthritis and can it be corrected arthroscopically?
Dr. Mark Bowen (NorthShore)
The most common cause of what you describe is wear of the smooth cartilage that covers your kneecap of the groove it glides over. Technically, this wear is considered arthritis and is ofter referred to using the term chondromalacia. Typically, first line treatment is physical therapy. There are some situations where surgery might be indicated and helpful.

  Amy (Chicago, IL) - 12:54 PM:
I was diagnosed with runner's knee in May. I love to run and lift weights, but am afraid of injury. How can I still workout without hurting myself?
Dr. Mark Bowen (NorthShore)
Runner's knee is not really a specific diagnosis, and might cover a number of different causes. More needs to be known about the true cause and intensity of your symptoms, but typically I would advise avoiding impact activities and work on strengthening your core and upper leg muscles.

  Peter (Evanston) - 12:56 PM:
I had a knee scoped 4 years ago...stability,pain, stifness has been a problem. OrthoVisc injections help temporarily, I have been told I need a knee replacement since I have no more cartilege to stabalize my knee. Am I a candidate for cartilege transplantation? Do you perform this surgery?
Dr. Mark Bowen (NorthShore)
If by xray you have no articular cartilage and are "bone on bone" you are not a candidate for cartilage transplantation and a total knee replacement would be appropriate and should relieve your symptoms and restore knee function.

  Jessica (Clinton, il) - 12:58 PM:
What would you say are future complications or issues after having multiple ACL surgeries? I am 23 years old and have been told I will have arthritis by the time I'm 40. Is there truth in this or other future problems?
Dr. Mark Bowen (NorthShore)
Unfortunately you are very young to have so many knee surgeries. The future is best predicted by loss of meniscus tissue, knee stability and how you treat your knee going forward in terms of impact activites. If you have had significant meniscus removed I would strongly advise you to exercise on a bike or swim.

  Lynnette (Chicago, il) - 1:01 PM:
I started training for a half marathon in January ran it in July now my right knee randomly hyperextends itself backwards randomly when I stand. It hurts when it happens! What would you suggest I do?
Dr. Mark Bowen (NorthShore)
In the absence of a true injury the cause is likely muscular or neuromuscular and likely can be dealt with through rehabilitation, gait analysis and training. Might be worth it to see a rehab medicine physician or primary care sports medicine doctor to be evaluated.

Angela (Moderator) - 1:03 PM:
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