ACL Reconstruction and Meniscal Transplants Aid Athletes
When athletes suffer season-ending injuries to the anterior cruciate ligament (ACL) or meniscus, choosing the best treatment helps prevent reinjury and future arthritis.
To evaluate the extent of injury and required treatment, PCPs often refer patients to orthopedic surgeons. In the Northland, many of these cases are referred to James Reardon, MD, with Northland Bone and Joint, or Matthew Thompson, MD, with Drisko, Fee & Parkins. Both practices are on the North Kansas City Hospital campus.
"Evaluation of patients includes not only a history of the injury but a physical exam," says Dr. Reardon. "Two tests we use are the Lachman and pivot shift tests. Many times the patient heard or felt a pop in the knee and had immediate swelling. About 75% of the time this is an ACL tear. Finally, we order an MRI to define this and any other knee injuries."
"After diagnosis and to determine the best course of treatment, we have a discussion with the patient," says Dr. Thompson. "Generally, the younger the patient and the higher his activity level, the more likely he will choose surgery to prevent further damage. In teens who are younger than 14 or 15, we have to use specific techniques to protect the growth plates that are still open."
"Recent evidence over the last few years shows us that in younger patients, we should use their own patellar tendon or hamstring tendon versus donor tissue for reconstruction because there is a higher success rate," he continues.
"The patient needs to go into surgery well prepared," explains Dr. Thompson. "We may wait a few weeks for swelling to go down and for the patient to regain some range of motion. Sometimes I send patients to what I call ‘prehab’ where the patient meets several times with their physical therapists prior to surgery. By starting that relationship early, they also get a better understanding of what they will experience."
According to Dr. Thompson, ACL surgery has a 95% success rate. "Usually the younger the person is when she tears her ACL, the higher the risk of tearing the ACL in the future," he says. "It’s not uncommon to see a college athlete who has already had two ACL tears, with the first one as a young teen."
"Through transplantation, we have the ability to restore the actual joint surface and build a biologic total knee."
James Reardon, MD
"A warm-up program called the PEP Program has shown to reduce the incidence of ACL tears in athletes," Dr. Thompson notes. "When tested on female soccer players, it was found that when they did specific warm-ups early in the season and before their practices and games, they had a lower rate of ACL tears throughout the season. More teams are starting to utilize a warm-up program designed to reduce the rate of ACL injuries as well as other knee and ankle injuries."
Unfortunately, patients with ACL injuries often damage their meniscus at the same time.
Meniscal Repairs and Transplants
The meniscus responds well to repair and with suturing, the damaged tissue heals 80-90% of the time, Dr. Reardon reports. Left untreated, a torn meniscus will continue to break down.
If the meniscus breaks down to the point it can’t be saved, transplant surgery may be necessary. "Meniscal transplants have become more common in the past 10 years," notes Dr. Reardon. He has performed more than 50 Genzyme cartilage and meniscus transplants at NKCH over the last 15 years, with excellent results. "We prefer our patients to be younger, very active and with very little or no arthritis in the knee," he says, "but active people in their 50s and 60s, such as skiers with minimal or no arthritis, can also be good candidates."
"Once a patient is approved for meniscal transplant surgery, we contact one of the many tissue banks in the country," Dr. Reardon explains. "They have very elaborate templating techniques to match patients, and when a match is found, they send a fresh-frozen meniscus. It has to fit within just a few millimeters."
"I do believe there are far more candidates out there who could benefit from meniscus transplants," Dr. Reardon says. "Patients who have lost their entire meniscus from repeat injury are candidates."
Physical therapy for rehabilitation is just as important as the surgery. Dr. Reardon recommends water therapy in the pool at North Kansas City Hospital. To help ensure the best outcomes, he performs all of his joint restoration surgery at NKCH, which provides patients all the resources they need, including highly skilled nursing staff, physical therapy and the rehab pool.
Rehabilitation requires four to six weeks on crutches and two months of rehab. Athletes at a highly competitive level normally return to their sport in 9-12 months. The treatment of sports injuries to knees has evolved greatly over the last decade to not only return athletes to the playing field, but to rebuild their knees to the pre-injury state.
To learn more, call:
816.214.9300 - Northland Bone and Joint
816.561.3003 - Drisko, Fee & Parkins
James Reardon, MD
Dr. Reardon completed his medical training at the University of Missouri – Kansas City and his orthopedic surgery residency at Baylor College of Medicine in Houston. He also had training in reconstructive joint surgery through a traveling fellowship in Australia and Switzerland, and joined Northland Bone and Joint in 1994.
Matthew Thompson, MD
Dr. Thompson completed his medical training at the University of Pennsylvania School of Medicine, and his orthopedic surgery residency at George Washington University in Washington, D.C. He completed a fellowship in sports medicine and shoulder surgery at the Hospital for Special Surgery in New York City, and joined Drisko, Fee & Parkins in 2011.