sports-

Sports Medicine

As the trend to participate in sports activities and exercise continues to grow, so do the injuries that result from these activities. OICJ offers a comprehensive sports medicine program to accommodate just about anyone's injuries. Whether it is a torn ACL in a high school football game or a shoulder injury by a "weekend warrior", OICJ will provide the proper treatment with highly skilled physicians using the latest, state-of-the-art equipment.

OICJ continues to increase their involvement in Central New Jersey's athletic community by providing medical coverage for area high schools, club sports and any athlete in need of orthopaedic care. The physicians at OICJ serve as the area's most highly regarded Sports Medicine specialists.

Your anterior cruciate ligament (ACL) stabilizes your knee to prevent unwanted movement of the bones that meet to form the knee. When the ACL is injured, it can be surgically repaired to restore the knee's stability and normal function.

The Knee Joint
The knee, which is the largest joint in the body, is considered a "hinged" joint since it is designed to allow the knee to flex (bend) and extend (straighten). The knee is formed by the femur (thigh bone), tibia (shin bone) and patella (kneecap). Each bone is covered with a layer of smooth cartilage, called articular cartilage.

The knee maintains its stability through a series of ligaments that act like rubber bands to allow motion while maintaining proper orientation of the bones.

Both the anterior cruciate ligament, or ACL, and the posterior cruciate ligament (PCL) stabilize the knee. The ACL and PCL cross each other in the center of the knee. The ACL is tightest when the leg is straight, and the PCL is tightest when the leg is flexed. The ACL, which runs from the front of the tibia to the back of the femur, prevents the tibia from gliding forward. The PCL prevents the tibia from gliding backward.

If these ligaments are stretched too far, they can tear or separate. This injury can require replacement of the torn ligament with tissue from other locations to make a supporting structure similar to the original ligament.

Anterior Cruciate Ligament Tears

The demands placed on the knee sometimes exceed its limits.
In fact, the knee is the most commonly injured area for athletes.

Explaining to your doctor what movement caused your injury helps your doctor determine which part of your knee was damaged.

One common cause of ACL tears is rotating the leg inward while the rest of the body is turning outward. ACL injuries also may occur when the knee is turned outward while the upper leg is turning inward. This is most commonly seen in athletes as they change direction.

Determining the Need for Surgical Reconstruction
Whether your injury is treated with surgery depends on many factors, including your lifestyle. An active person may require surgical treatment to obtain the knee stability needed to continue their activities. Your surgeon will also consider whether there are additional knee injuries which make surgery necessary, such as a meniscal tear. Your expectations for knee function or performance may also play a role in determining whether reconstruction is needed. With an ACL tear, your knee will be unstable. This instability will cause your knee to " give out," which will significantly influence knee function.

Before Surgery
The amount of time between your injury and when the reconstructive surgery is performed will be decided by your surgeon. Many surgeons will operate within in two weeks of the injury, while some recommend a slower approach to surgery.

In preparation for surgery, several guidelines must be followed to ensure complete recovery and restore normal function after surgery. Physical therapy will be started before your surgery. This will help you learn the exercises you will need to perform during the initial phases of recovery after surgery. Physical therapy will focus on the following goals:

Establish a full range of motion (bending and straightening).
Reduce swelling in your knee.
Strengthen the musculature surrounding your knee.

Your Surgery
Ask your surgeon whether your surgery will be done on an outpatient basis, or if a short hospital stay is necessary.

Upon arrival at the surgery center, you will be assessed by a surgical nurse and prepared for surgery. Approximately 30 minutes before your surgery, you will be transferred to the operating room where an anesthesiologist will probably give you a choice between general anesthetic and epidural (local) anesthetic. The anesthesiologist will explain these options.

Your surgeon will then examine your knee to compare the stability of your injured knee to your other knee. After this examination, your knee will be evaluated with the help of an arthroscope. The arthroscope is a tiny illuminated fiberoptic camera that is inserted into your knee through very small incisions, allowing the surgeon to see the interior of your knee on a video monitor. With the help of the arthroscope, the surgeon can often repair ACL tears and treat meniscal or cartilage damage.

ACL reconstruction is indicated, the surgeon will use the arthroscope to perform this procedure through very small incisions. The ACL reconstruction usually involves replacing the damaged ligament with a tendon graft. The graft is most often obtained from the central third of your patellar tendon, or from a portion of your hamstring tendons. The graft will be placed in your knee in the exact location of your natural ACL.

After the arthroscopic evaluation, two small tunnels will be made. The first tunnel is placed through the tibia, and the second will be in your femur. This prepares your knee for graft placement. The graft is pulled into place through the tunnels in the exact position of your ACL. After the graft has been inserted into the new tunnels, it is fixed in place.
This will secure the graft until complete healing can take place.

After Your Surgery: The Recovery Room
After your surgery, you will awaken in the Post-Anesthesia Recovery Room where you will stay until you recover from the anesthesia; are breathing well; and your blood pressure and pulse are stable. If you experience pain or discomfort, medication will be available. In the recovery room, your knee will be in a postoperative leg brace or knee immobilizer to limit motion.

A cold pack, fluid-filled wrap or a continuous circulating cold therapy device will be placed around your knee to provide compression and cooling and control your inflammation, pain and swelling.

Special hose or stockings will cover your injured leg to prevent clots. Your surgeon will tell you how long the hose should remain on your leg; however, the time period is usually 10 to 14 days.

Your surgeon may use a Continuous Passive Motion (CPM) machine. The CPM machine will establish your knee motion in the days following surgery. If the CPM machine is recommended by your surgeon, you will be told how to use it. You will probably be directed to use a cooling system on your knee for approximately 30 minutes each hour. You should keep your knee elevated above your heart as much as possible.

It is normal to feel pain and discomfort after surgery. Pain medication and anti-inflammatory medication will be given to you after your surgery to ease the pain and swelling.

A brace and crutches will be provided. You will need to wear the brace at all times for six weeks after your surgery. Crutches will also be needed for the first 10 to 14 days. You may put weight on your knee when it is comfortable for you. Expect to feel weak for a few days after surgery.

On the day after surgery, you may change all of your surgical dressings except for the steri-strips. The steri-strips are tape strips that are placed directly on the incision. Do not remove the steri-strips. You can expect some bleeding from your incision, which should stop in 24 to 48 hours. Make sure to keep your wounds clean and dry for 10 to 14 days. You should also expect to feel weak for a few days after surgery. A follow-up appointment with your doctor will be made after surgery.

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Resuming Activity
After your ACL reconstruction and rehabilitation program, you can expect to return to an active lifestyle. Some surgeons may recommend a functional knee brace for a period of time after surgery and possibly for extended use during sports-related activities.

ACL reconstruction has become a safe and common knee procedure. Today, ACL injuries are no longer devastating to knee function. New technologies and surgical techniques combined with aggressive postoperative care and therapy allow a full return to normal activity.
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*The Healthy Knee*	*The Ligaments*