BYOL: Bring your own ligaments

t’s funny how things change as you age. For instance, we all reach a point where we don’t have to have the newest or best of everything – we just need something that works. You might feel that way about your car or your phone, but what about your ACL and PCL?

A new total knee replacement features a shape that protects that island of bone & saves the ligaments Click To Tweet

The ACL, or anterior cruciate ligament, and PCL, or posterior cruciate ligament, are located in your knee and are essential to natural knee movement and function. That’s why you hear about so many athletes getting a torn ACL repaired – you need those ligaments to function properly.

“These ligaments provide stability for the joint and increase the patient’s ability to perform complex movements, such as dancing, gardening or golfing,” explained Dr. Bill Bryan, a Houston Methodist orthopedic surgeon.

When you are old enough for a knee replacement, your ACL and PCL are certainly a bit worn out, but they still work, which is good enough for you. So why do surgeons remove the ACL and PCL when you have a knee replacement? Until now, they’ve not had an option.

A traditional total knee replacement requires removing the “island” of bone to which the ACL and PCL are attached. A new total knee replacement implant features a shape that protects that island of bone and saves the ligaments.

Dr. Bryan was one of 10 surgeons from across the country and the only surgeon in Houston to be selected as an early evaluator of the XP knee, made by Biomet, which features the new ligament-saving design.

“Most of my knee replacements patients are completely happy with their new knee, but some complain that they are not able to physically do everything they previously could,” Dr. Bryan said. “By saving the ligaments, this knee implant provides an improved range of motion and increases joint stability and natural movement for knee replacement patients,” Dr. Bryan said.

Dr. Bryan believes that another benefit of saving the ACL and PCL for knee replacement patients is that the ligaments will take some of the strain off the metal and plastic components of the knee replacement and help it to last longer. Most artificial knees last approximately 10 years before needing to be replaced.

“For many years, orthopedic surgeons have recognized the need for total knee replacements that save the ligaments,” Dr. Bryan said. “Now that technology and design have caught up with us, patients can now get a total knee replacement that works and feels a lot like a normal knee.”

How often do ACL tears happen to athletes?

How’s your fantasy football team doing? Lost any star players to an anterior cruciate ligament or ACL tear? St. Louis Rams quarterback Sam Bradford is out for a tear in his left knee for the second season in a row. Stephen Tulloch, a linebacker for the Detroit Lions, went down in week three with an ACL tear in his left knee.

ACL tears are common in football players and in professional, amateur and youth athletes in other contact sports with more than 250,000 occurring each year. An ACL tear is a season-ending injury, but does it signal the end of an athlete’s career? Not necessarily.

ACL tears affect 250,000 athletes each year Click To Tweet

So how often do athletes with ACL tears return to the sport they love? Dr. Joshua Harris, a Houston Methodist orthopedic surgeon, sought out to find just that. He matched athletes with ACL tears in the National Football League, National Basketball Association, National Hockey League, Major League Soccer and the X Games to athletes without tears based on age, experience and pre-tear performance.

“In addition to determining how often these athletes are able to return to sport after an ACL tear, our studies also revealed interesting patterns in ACL tears,” Dr. Harris said. “For example, we were able to determine which NBA playing positions had a harder time recovering and which knee was more susceptible to ACL tears in MLS players.”

National Hockey League

Athletes in the NHL had a return to sport rate of 97 percent – the highest rate of all major sports leagues. Left-handed shooters are more likely to tear their ACL, but all performed better after returning to the ice.

National Football League

Because the rates of ACL tears in the NFL are so high and specific offensive and defensive positions are unique in their cutting and pivoting demands on the knee, Dr. Harris and his team decided to narrow their research for this study to quarterbacks. The researchers found quarterbacks have a return to sport rate of 92 percent and, on average, played for five years after returning from an ACL tear, which proved ACL tears are not career-ending injuries for quarterbacks.

 

National Basketball Association

Dr. Harris found that 62 percent of ACL tears in the NBA occur in the second half, mostly in the fourth quarter of the game, possibly due to fatigue. Overall, NBA athletes have a high return to sport rate of 86 percent. Guards have the most difficult time returning to sport, while centers have the most predictable outcomes.

Major League Soccer

While most injuries in Major League Soccer athletes are non-contact injuries, these players tend to have more ACL tears in their left knee and have a 77 percent chance of returning to the field after an ACL tear.

“Because of the cutting and pivoting nature of soccer, MLS players may have more ACL tears in the leg they plant with,” Dr. Harris said. “The majority of soccer players kick with their right and plant with their left, which may explain why they tend to have more ACL tears in their left knee.”

X Games

Dr. Harris and his team looked specifically at skiers and snowboarders. Skiers tend to have more tears in their left knee and had an 87 percent chance of returning to their sport. Snowboarders had a 70 percent return to sport rate and won more medals after recovering from an ACL tear.

“This injury can happen to anyone,” Dr. Harris explained. “Researching ACL tears in athletes helps all of our patients because we are able to evaluate treatments and bring the best solutions back to our practice.”