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ACL Reconstruction Is Getting Better All The Time

In today’s blog post I’d like to take a look at improved outcomes over the last 25 years from a commonly performed orthopedic sports medicine surgery: ACL reconstruction. We’ve come a long way over this time, with improvements in patient reported outcomes as well as improvements in measured stability of the knee.

Orthopedic surgeons use various objective criteria to assess the stability of the knee. In 1994 when I started my orthopedic practice I typically quoted an 80% success rate in terms of restoring excellent stability to the knee after ACL reconstruction surgery. Today, that number is about 95%.

How the patient who’s had surgery feels about his or her own knee has also improved quite a bit over this time. It’s difficult to find published patient reported outcomes from the early 90s but it’s fair to say that a large percentage of patients weren’t entirely happy with their knees after surgery. Perhaps 40% of people reported difficulties with their knees. Nowadays patient reported outcomes are generally very favorable for about 80% of knees at least two years after surgery.

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Getting Strong Without Getting Hurt

Many injured athletes and other patients I see need to get stronger in order to improve their function or performance. But for many of these folks getting strong through traditional resistance based strength training might lead to pain, or be dangerous after surgery. I wrote a few weeks back about a technique called blood flow restriction training, in which strength gains are made through very low load resistance. I believe there is great benefit for athletes with painful conditions, or rehab after surgery.

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Start ACL Injury Prevention Programs When The Players Are Young

I’ve written and spoken about how much I believe in the value of the FIFA 11 program to reduce ACL and lower extremity injury rates, and make better soccer players. In fact the value of the FIFA 11 has been demonstrated in other sports too. I honestly can’t see why any coach wouldn’t implement this program. It’s part of the regular warmup you’d be doing anyway, and it’s better for your players. Please do it.

ACL tears tend to happen more frequently in teenagers rather than in younger players. Does that mean you should wait until the players are teenagers to start the FIFA 11? This recently published study suggests that the younger players will have greater improvements in body mechanics than the teenagers. The key study result: start the FIFA 11 program in the younger age groups.

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Long Distance Running Won’t Kill Your Knees

I see a lot of folks in my clinical practice with hip and knee arthritis and many of them have extensive running histories. Most of these folks believe that it’s the long term running that eventually led to the arthritis, but the belief that running causes knee arthritis is probably a myth. The idea that running can lead to arthritis makes sense. You run on a hard surface for long distances and over many years the impact leads to wear and tear. Seems pretty logical, right? Well the available evidence points us in a different direction.

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Do I Need To See A Doctor Right Now For My Knee Injury?

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: The SAFE Method is a very handy acronym to assist any coach, athlete, or parent decide whether an injury is serious enough to require urgent evaluation by a trained physician “SAFE” stands for Story, Appearance, Feel,…

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Do You Need An MRI To Diagnose An ACL Tear?

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: A skilled sports knee surgeon or athletic trainer has about a 90% chance of accurately diagnosing an ACL tear on the sidelines immediately after an injury without any imaging From a practical standpoint, most injured athletes…

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Coming Back From: Knee Meniscus Surgery

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Recovery is highly variable, but generally speaking most young athletes can return to sprinting, cutting, and jumping sports at about 6 weeks after partial meniscus removal surgery Generally speaking, most young athletes will return to sprinting,…

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Timing ACL Surgery For High School Athletes
Knee Cap Instability: Surgery Or Rehab?

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Knee cap instability is common in young athletes, especially in girls who participate in jumping, cutting, or pivoting sports Most mild instability issues and first time full dislocations can be treated without surgery Surgery is sometimes…

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Timing ACL Surgery For High School Athletes
Timing ACL Surgery For High School Athletes

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: It’s very important to discuss timing of ACL surgery with your orthopedic surgeon I recommend looking out over your calendar and working backwards one year from when you need to fully compete at your sport. That…

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Can We Predict ACL Injury Risk?

By Dev K. Mishra, M.D. President, Sideline Sports Doc Clinical Assistant Professor of Orthopedic Surgery, Stanford University Key Points: Some abnormal movement patterns, particularly with poor landing mechanics from jumping will lead to an increased risk for an ACL tear Video and forceplate movement analysis systems are available that are very good at screening for…

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