ACL News & the 3/31/14 Workout


ACL information & Dr. Howard Luks’s excellent blog:

Got a call from Kaiser and apparently the MRI indicates I don’t have a fully torn ACL. There’s evidence of a big sprain (which is a type of tear) and some damage to the MCL. I don’t know about any damage to the minisci.

On the surface, this sounds good. I’m not certain though that a partial tear is much better than a full tear. Of course I got online and started looking up partial tears and such. I found the site of Dr. Howard J. Luks, MD of New York. His blog is incredibly informative and I got a lot of useful information on all things ACL-related. There’s this post on partial ACL tears which discusses the difference between an ACL reconstruction and an ACL augmentation:

“The difference between an ACL reconstruction and an ACL augmentation is fairly simple. During the process of an ACL reconstruction we will reconstruct or replace the entire ruptured ligament. Anatomically, the ACL is composed of two separate bundles and a complete reconstruction will compensate for both of those bundles. In an ACL augmentation, you have only sustained a partial tear. That means that a portion of your ACL remains intact and might be normal. Many high volume ACL sports medicine orthopedic surgeons are capable of reconstructing only the torn portion of the partial ACL tear. This leaves the normal portion of the ACL alone. There are many advantages to an ACL partial tear augmentation over a full ACL reconstruction. While the discomfort, and the nature of the surgery is virtually identical – – – it is far more likely that someone who undergoes an augmentation will have a much more natural feeling knee when all is said and done. The reason for that is because the normal ACL has certain nerves within it. Those nerves give the brain certain feedback as to the position of the knee joint. It turns out that those nerve fibers are quite important. If we preserve the intact portion of your ACL, then we are preserving those nerve fibers and hopefully preserving the integrity of your knee in the long run.”

Perhaps an augmentation is in my future? I’ll have to ask about that on Thursday when I meet with an orthopedist.

Another post, 4 Tips to Prepare You for ACL Surgery, included (you may have guessed) these four tips:

  1. The technique for performing an ACL reconstruction has evolved significantly.  Over the last few years nearly all high volume ACL surgeons have gone to an “anatomic” approach.  That means that during ACL surgery we put the new ligament in exactly the same position your native ligament was.  Believe it or not, that’s not how we were originally trained how to do it.  The older technique was easier… which is likely the reason why some surgeons still use it.  Take Home Message:   An “anatomic” reconstruction has become the gold standard.  It is a more technically challenging procedure, so be sure to review with your surgeon what technique they plan on using.
  2. Volume matters !  An ACL surgery is a technically challenging procedure. ACL surgery should be performed by those of us who are experienced ACL surgeons.  Take Home Message:  Be sure to find a surgeon that performs a fair number of ACL reconstructions each month… not a few each year. 

    ACL Surgery

    The Dark Side of the Moon?

  3. When we reconstruct the ACL we need to create a new ligament. We can choose to use your hamstring tendons, a piece from your patella, or a donor graft from cadaver tissue. Different grafts are better suited for different situations.  Women tend to be “quadriceps dominant” so a patella graft might better suit their needs.  A patella tendon graft might be better suited for high level contact athletes.  A hamstring graft is a strong graft well suited for most all activities.  The research shows that a cadaver graft in a young active person should probably be avoided due to a high failure rate. Take Home Message:  One graft does not suit all needs for people considering ACL surgery. Be sure to do your research and talk to your surgeon about your goals so the proper graft can be chosen.
  4. If you have suffered an ACL tear, you are at very high risk for re-tearing the ACL in the same knee — or tearing the ACL in the other knee.  Many people have a predisposition due to a “neuromuscular” impairment.  (I hate big words too) That basically means the way you jump, land, pivot, etc needs to be evaluated to correct your biomechanics to diminish your risk of  requiring another ACL surgery.  Take Home Message: Physical therapy is an absolutely critical part of the overall recovery process.  Finishing up with a formal neuromuscular evaluation may play a role in diminishing your risk of a second ACL tear.

The first point about the anatomical graft was news to me. I’ve read a lot on ACL repairs and that bit was new to me. I’ll definitely have to ask about it when I see the doc. On to other things…

3/31/14 Workout:

  • Deadlift:
    • 155 lbs. x 5 – 205 lbs x 5 – 225 lbs. x 5 – 245 lbs. x 5 – 265 lbs. x 5 x 2 sets
    • Used the sumo stance
    • Knee never buckled.
    • Felt good!
  • Super set 1: 4 sets
    • step-up on plyo box: no weight x 10 reps
    • pull-ups: 20 kg kettlebell x 5 reps
  • Super set 2: 4 sets
  • Ab wheel: 5 reps x 3 sets

Everything felt decent. Went up in weight on the deadlift and felt fine. I tried the sumo stance a while back and the knee wanted to cave in. Today it didn’t. Good.