hello and welcome to HealthLine.

Thanks so much for joining us tonight.

I'm Jennifer Bloomquist.

I have the privilege of hosting the program this evening.

If you're one of our regulars you kind of know the routine but if you're new to our show I just want to guarantee you that you will learn something tonight.

>> It's a great way to get some free medical advice.

Maybe you have a question about yourself that you want to ask our guests tonight or maybe it's a loved one or friend or somebody we're doing an orthopedic program tonight in particular we're focusing on issues of the knee.

We're going to be talking about ACL tears and all kinds of options and treatment and so forth.

So that's why we keep that phone number up at the bottom of the screen throughout the show it's (969) 27 to zero.

It is a toll free call if you're outside of Fort Wayne just put an 866- in front of there.

You have two options when you call in you can ask a question if they don't just throw you on the air, you will talk to a very nice call screener first and then we will take your calls live during the show.

I like that option because the doctor might need to ask you some more questions to be able to give you a better answer.

But I understand if you'd rather just give the call screener the question and then I'll ask for you.

That's another way to get your information.

So I just want to make you aware of your options and in the meantime we're going to introduce you to our guest, a new guest just brand new to four weight actually.

>> So we appreciate him joining us.

This is Dr.

Daniel Anderson and he is a sports surgeon and next to him is an anatomical me.

>> So we're going to be using that during the show to show you exactly what he's talking about.

So thank you so much.

>> Thanks for having me.

I'm excited.

Well, I you know, I was glad you picked out the topic of ACCL tears because I imagine pretty much everyone out there watching says Oh yeah I know you know so and so my family had Nicotera my childhood but I bet no but I mean I know I couldn't go to the knee and show you I know kind of what it is but I don't know where or what exactly happened.

So can we start there and just explain them.

>> Yeah kind of brief over the ACL tears like kind of a buzzword you if you watch the NFL on Sunday.

>> Oh sure you'll hear oh he talks ACL.

Yeah what does that mean.

So you know the ACL is a really important ligament in the knee.

>> It's a really important stabilizer for the knee.

>> So here's our knee here.

The front of it has your patella in the patella tendon.

So what kind of move that out of the way here?

>> OK, and that's you look in the front of the knee there's this main ligament going right up into the middle of it and that is your ACL or the anterior cruciate ligament.

>> OK, there's a pickle.

There's also we love using letters NORTHMEAD to name things just shortens it.

>> But you know the main role of ACL is to keep the stability of your knee specifically keeping the tibia or the shinbone from shifting forward .

OK, and that plays a pivotal role when we are talking about athletics sporting any sort of high level activity.

>> OK, you know the ACL can turn a number of different ways .

>> There's noncontact injuries.

So anything where you land awkwardly and you feel pop in your knee feel that shift, you feel it move you know that could be a sign that this whole tour there's also contact injuries if you have your foot planted in you know, somebody runs into your knee all of a sudden your knee tries to shift on it.

>> The last thing holding on might be that ACL and so unfortunately that's one that can sometimes go out.

I mean do you normally hear a pop?

I have one in my families, yes.

But I mean I imagine it would hurt I have I have not torn ACL heels.

>> Luckily it typically the patients say that they feel a pop.

>> Oh, I think I've heard someone say they heard it but it's usually this I stepped wrong.

My knee shifted, I felt a pop and I went down and then they're just like I don't know what happened.

>> It's weird and other times they can get up and walk on it.

I was going to ask if you if you could put weight on.

Yeah.

So that's the that's the weird thing.

It's you know it feels weird you injured it and there's a lot of other injuries that can go along with the ACL but a lot of times you can get up and walk on it and then yeah but you just kind of know something's wrong.

>> That's usually what a lot of my athletes and patients will tell me.

It's just like something happened.

>> This is not quite right.

So what do you do if this happens?

I mean can you do you have to do an MRI or some type of an x ray won't show it because it's soft tissue.

>> Yeah.

So the typical progression is you know, you go and get it checked out.

You always start with an x ray because there's a lot of different things that can go wrong when you tear your ACL you can injure other ligaments, you can even injure the bones with more severe injuries.

>> So x rays are always the start.

Sure, but you're dead on an MRI really shows all the soft tissues of the knee in a really important point to that MRI is that it can show us if there's any tearing in the meniscus as well.

>> Yeah, that's another one we've done so far.

>> We can go I'm sure we have but we can go back to the model.

Yeah the the meniscus are these little pieces of cartilage in between the two bones and they kind of act like a shock absorber knee.

>> That's the way I like to describe them.

>> They help disperse the forces out when we're walking when your ACL tears there's only a few other structures trying to keep your knees together from really having something bad happen and sometimes the meniscus gets in the way and can tear as well.

>> You can have both you can tell because I've heard of people though just having a meniscus tear.

Sure.

And not end up not the ACL.

Yeah but so if that's the issue if you've got the ACL tear let's just start with that.

>> What are your options at that point and does it depend on your age even.

>> Yeah great question and the short answer is I never like to use an age to tell someone they can or cannot have surgery.

I think age is just a no.

>> Sure.

I really like to look at the patient overall and see how active are you.

>> Are you out there running five KS?

Are you hiking mountains?

Are you staying fit?

Is that important to your life because that'll help us determine what to do with this ECL in general though the major overall consensus is surgery for this and that's usually in the form of an ACL reconstruction which we can get into in a minute.

But I would say the main reason that we talk about surgery is not just so you can walk again or play sports but it's what can happen without an ACL.

>> Yeah, so like I didn't know can you are there cases where you leave it alone?

>> Yeah there are.

What would be the so the bacteria for that the the big risk of not doing it ACL surgery is basically further damage and deterioration to your knee as you go about your normal life and as you start to walk and live your life without the ACL you really develop a high risk of developing arthritis and that's the big scary word that we like to not talk about at my joint replacement colleagues would love to hear more about that but my job is to help prevent that.

So yeah, what we know in our studies is that probably up to half of people develop significant moderate to severe arthritis just 15 years of without having an ACL.

>> Wow.

So if you're twenty five years old and deterioration and you're like well I'm done with high school sports, I'm done with college sports, I don't need surgery.

>> I mean our studies will say by the time you're 40 you might be developing some arthritis and that's hard to come back from because we can't really reverse that right now and then can you prolong this?

>> I didn't mean to interrupt but if you maybe that was somebody's mindset.

You know there are twenty five maybe a couple of years down the road they rethink it.

Is it is there a window of opportunity where you have to say it's too late?

>> Yes and no because the arthritis can sit in but I don't like to think of it as like it's too late and until the to the point where it's like very obviously that even if we gave him a stable knee there's so much arthritis that there's not many great options.

>> But if we get to it before their arthritis and I would say it's not too late OK, we are going back to half of patients if you can go out to twenty five years out from the injury, 90 to 95 percent of patients have arthritis at that point .

So it's it's just something that I would be I mean percentage wise would you say definitely more than half probably get get the surgery I would say right after more than 90 percent of people end up getting stronger.

>> Yes.

OK, well the most common time I see somebody come in who has an ACL injury but it's like chronic or not had just occurred it's when they didn't really know.

>> Oh well they never got it checked out.

So I think that's an important thing if you're playing a sport, playing basketball, doing anything active and you feel a pop in your knee and swells up on you go get it checked out because I was going to say it's never wrong to get it checked out.

>> Yeah.

And it's funny I know your children are much younger than mine but with my own children and even when I was a kid I was always like I will just put some ice on it, OK?

Because it used to be such a big deal to go to the emergency room.

But now we have all these walk in clinics that are specifically for orthopedics.

Are there I that's just commonplace I think everywhere and it's I can tell you it's a totally different experience and waiting three and four hours in an emergency room.

So if that gives you an it because I know a lot of people are you know, even for themselves they'll say well I'll just wait it out and it's so much easier now than it used to four years ago to get just to get it quickly for sure.

>> I have patients getting into my office three days after an injury bill they'll feel pop they go to the urgent care, they get an x ray, they get him to my office so it can happen pretty seamlessly right now, right?

>> Yeah.

Well and with you know, sometimes with kids they don't tell you either right away because I know that it will take them out of their sport.

>> So yeah that's that's a big concern is missing time.

>> Right?

Right.

I think they call that phone call fear of missing out so I feel kind of cool.

That's like young kids are doing so well.

I just want to touch briefly I know we're focusing on the ACL but the meniscus yeah.

If that tears as well, is that something that you pretty much just need to get fixed right away?

>> Yeah.

So if you have a meniscus here with your ACL tear that's definitely something that we would just take care of at the same time of surgery.

>> OK, you know kind of tilt it see does tend to tear like down the front or like a cross.

You know it kind of depends a lot of times it's in the back always OK.

>> And you know the goal with the meniscus tear especially in younger athletes is to repair it.

So we want to keep your normal meniscus as normal as possible, put it back to where it belongs.

>> You know, there are certain tiers where repairing is not really possible.

>> Those are the ones where we might have to trim away part of the tear.

>> But you know, if we're going to do surgery on the ACL, we kind of just take care of everything all once right there.

>> OK, and we were going to keep talking about this but I don't want to forget to remind you to call in because we only have Dr.

Anderson with us until a little before eight o'clock.

And what tends to happen is people wait toward the end of the show and sometimes we get backed up with the call so we don't have anyone waiting right now.

So feel free to give us a call.

It's (969) 27 two zero.

It's right at the bottom of the screen.

And again, if you're outside Fort Wayne it still is a free call as long as you put an 866- in front of there and you know, maybe you have a concern about an old injury or about something, you know, regarding your kids, your grandkids.

So please give us a call.

>> So what exactly does the surgery entail?

Is it kind of an outpatient you for the most part, yeah.

>> It's an outpatient surgery.

You come and go home the same day.

How long it takes obviously varies depending on how much work there is to do.

There are other injuries but anywhere from an hour to two hours somewhere in that they current yeah.

>> Just just numb it locally is that sometimes some anesthesiologists will do a blocking the leg which basically the whole thing go now I'm sure some facilities may do like spinal cord to help kind of really control the pain.

Yeah but yeah all right so when you're and when you're in there then are you putting any type of replacement material or are you just working with what's there and repairing it.

>> Great question.

So ACL surgery the vast majority of them are called ACL reconstruction and what that means is we actually give you a new ligament.

>> Oh right.

ACL repairs which would be taking your ligament and trying to have it healed back to itself.

>> Yeah, it's becoming a little bit more of a hot topic I think there's some role for it.

>> But overall I would say the gold standard for this is to reconstruct the ligament.

OK, And the way we do that there's a whole lot of different options.

>> We call them graft options.

Yeah.

And just looking at it from a overtop view you can either get the graft from yourself which we call autographed so that's taking your own tissue from somewhere else and reconstructing the ACL with it or taking donated tissue which we call allograft.

>> I would say in my younger athletes more active people using your own tissue is a lot better.

>> It incorporates quicker and incorporates stronger and it's definitely the preferred method for a lot of ACL reconstructions.

>> Can I ask where you would get the tissue?

>> Yeah.

Do you have options?

We do and we actually have some of them here ironically right on the knee.

One great option is what's called the bone tendon bone graft.

OK, so that's kind of an interesting one because it takes a piece of bone from the patella the center portion of your patella and then a piece of bone from down here on your tibia.

>> OK, and we like we take that we harvest it and then we basically recreate your ACL by creating sockets in the bone and filling that in.

>> So then the central portion of your protactinium becomes the new ACL and the two bone plugs go into the sockets to get good bone.

>> The bone healing and you do that all at once.

>> OK, all part of the same surgery.

I didn't know if it was more pain but when you say I was surprised when you say kids because you know we would be good candidates for that because it's a little more and it sounds like it's a little more invasive and if you were to use you know I don't know for sure.

>> Yeah, that's a good consideration is the pain from getting the graft?

Yeah, but there's other options some surgeons like to take the portion of the quadriceps tendons that's like an all soft tissue graft.

I didn't have any bone on.

>> OK, you can also take the hamstring tendons and other soft tissue so we have lots of options for any sort of different reasons why you would pick it, OK?

>> All right.

Well, I want to remind everybody I think we had a couple of people calling somebody I'm going to ask her a question but just remind her go ahead.

Give us a call any time.

Please feel free.

We love you to interrupt us.

>> As interesting as it is, we want to take your calls.

So Dr.

Anderson, somebody named Jenny called she wanted to know how to how our ACL and MCL surgery how far have they come in the last twenty years and what about recovery times?

Sure.

>> Has that has that changed because we've used to have an orthopedic surgery years ago you were in the hospital.

Yeah, I mean overnight you used to stay overnight all the time even for ACL surgeries.

So that part of the process has become way better and that's that's a team effort.

That's not just the surgeon that's the anesthesiologist, the preop nurses, the PACU nurses, everyone basically making it where it's a safe time to get in get out and recover at home because we know that people recover better in their own home.

>> Yeah, okay.

ACL surgeries overall in the last twenty years I think I've been getting a lot better.

>> Our techniques have gotten better.

The graft options that we have are becoming more streamlined and slick and we're learning a lot more about the recovery process in general to make it better because we're getting more data the more that people are taking their ACLS, the more data we have, the better decisions we can make as surgeons.

>> Yeah, like how soon after the surgery do most or most people able to put weight on it?

Yeah.

And what do you do?

You put I mean I don't even know do you bandages are they on crutches or what do you normally do so for the vast majority of mine from experience is I have you weight bearing is tolerated right away so you can put weight on that doesn't mean you go and play soccer the next day but you're up with crutches and you're walking with it and I have people in a brace for a few weeks.

>> The brace at first is kind of locked an extension just to protect everything but you get started in therapy that week I was just a physical I would imagine physical therapy physical therapy is more important than the surgery in my opinion.

>> OK, that is the key to recovery is doing good therapy, having a good therapist which luckily we have a lot of great therapy locations around the city.

I was going to say that's another thing that's changed dramatically.

I was in the last twenty years is it used to be hard to find a physical therapist now one in every corner I know and honestly, you know, we've had we've needed it in our family and and it actually can be kind of fun.

>> I know that doesn't sound but they do a lot to try and make it fun.

You know, a little different music.

>> Yeah, they have jokes and actually physical therapists maybe they make a lot of money.

I don't but they're very happy people.

>> I've never met anybody at the physical therapy office who's not really an outgoing happy person.

>> Yeah, but I guess getting back into the recovery timeline and everything.

Yeah.

You know the big question everyone asks is I tore my ACL when can I play?

>> Yeah.

When do I get back to the people want that.

>> It's a hard question to answer with one.

No the range is anywhere from seven to nine months is it.

>> That wasn't a long time and that doesn't matter.

Does it matter whether you have the reconstructive or not really it's kind of the same the repair.

>> The reconstruction yeah.

In general you're looking seven to nine months.

>> Wow.

I didn't realize it was that long which is why classically we say well your season's over and you know it's a hard thing to tell a sixteen year old whose life is football or volleyball or soccer and you're like I'm sorry but you that yeah.

>> It's not a phone conversation but sometimes it's an incentive I think that isn't it like hashtag come back stronger you know.

>> Yeah.

I mean incentive recovery yeah it's all good the the whole process takes that long but that doesn't mean you're not doing things and getting ready to return OK you know you're in a brace for a little bit you're working on just your motion.

That's the first thing we need to get back after the surgery and then you start to strengthen your leg.

Yeah.

And about four months you're already in therapy working on like plyometric work jogging and things like that.

>> So you're getting ready.

You're not just sitting know seven months you're not allowed to just sit around.

>> No, no.

And then really the last thing to come back is the connection between your mind and your knee.

>> Oh, really the psychological component I think is really undervalued.

Okay.

And that but usually most people are I mean is it does it require follow up after that or you pretty much done after so if you get like cleared yeah yeah.

I mean as long as everything is good you're good to go all right but it's that final step where if the patient or the athlete you know they're like they know their knees ready they know they pass on tests but they're like afraid to step on the floor.

>> Yeah.

So there's like sports psychology.

There's this whole great movement and I think that's another big progression that has been made lately in the last 20 years.

Going back to that question where we have a lot of resources to help help athletes say I'm ready to get back your knees ready to go back, let's do it.

>> Yeah, yeah.

It's interesting you brought up the psychology because I have heard of that and I've met a lot of kids in high school and college that have needed that.

So yeah, Doctor, I understand we did have somebody else call in.

I wanted to ask you a question.

Larry said that he had knee replacements surgery years ago but says it popped a week after and it still hurts and he's wondering would that be is ACL or probably not.

>> And the reason for that is because of knee replacements.

>> Yeah.

Take out the ACL.

Oh, they do.

That's part of that.

You replace your knee, your ACL gets taken out with Yeah.

>> With the surgery to get ready for the implants with the metal and plastic OK so a pop after a knee replacement could be a lot of different things.

>> Sure your PC sometimes is spared which is the ligament right behind the ACL which is another important stabilizer.

OK so it could have been that it could have been your MCL which is on the inside part of your knee so it could have been a lot of different things but I don't think it was ACL.

>> OK well I would say Larry maybe should follow up.

Yeah.

With the surgery that you saw before.

Yeah.

>> If it still hurts if you felt a pop go go get it checked out maybe there there's something we can do for you for sure.

All right.

We just have five minutes left but that is plenty of time to take a question or two so I don't want to dissuade anybody from giving us a holler (969) to seven to zero or keeping those phone lines open as we continue our conversation.

>> Does it ever get like do you think that somebody is at a greater chance I guess after having this surgery of having it injure the injured again or I guess at greater risk of tearing because I could see psychologically where that would kind of freak you out?

>> Yeah, I would say yes.

>> I think overall there's always that chance of retiring which is a really unfortunate situation to be in when you had initial surgery and it appears again like with that could that happen soon after going back into your activity?

It can't be something that usually doesn't happen further down the road.

>> No, it can happen.

I mean unfortunately I've seen it happen.

You know, they did a whole recovery or two months back into the sport and it happens it happens again.

That would just be devastating.

I would think it would be that's not that's not it.

>> No, no good.

So what do you do anything differently if it's a repeat tear.

Yes.

Or ACL revision surgery that's a basically yeah.

You have to do it again and there's a lot of factors that go into that like the graft choice that you chose.

>> You can't choose it again because you already tried it was so you maybe have to go to the other like OK get it from over from the other side or pick a different graft and then you really have to take a good look at how the graft was fixed and the original surgery and kind of determine is everything in a good spot.

>> Was it technically sound the first time?

Is that the reason why it failed or is it just unlucky?

>> Yeah, that would just be so those are those are long conversations in the clinic with a whole group decision on what we can do to help and make it better so somebody in that situation, are they pretty much not clear to do a sport again?

Would it have to be impacted you kind of done at that point?

>> Yeah, well no.

You can get back you could you can do the whole recovery and I've seen it really.

>> Yeah.

People have really incredible drive and yeah I could you want to get back you're going to get back OK.

>> Yeah I didn't know at that point if it was just if it was recommended you discontinue certain sport or something but well that might be the recommendation from the parent but yes as a parent I would say I think we're done but you know we were talking before the show sports is a huge part of our culture.

It really is.

And that's probably why it's so devastating for kids when like we said, you know, we made fun of fear of missing out but it's a real thing it's there I mean even for elementary school kids, you know, I don't know if you have any advice for parents, you know, because you you were just saying how you see so many young kids.

It's a sport is year round now.

>> You know they're doing one sport all year.

Yeah.

I mean talking about that my best advice is play different sports.

>> Yeah.

You know football, soccer, basketball track the different training methods and the different muscles and tendons that you use is is only good for your body.

Yeah.

Doing the same thing all year round puts different like the same repetitive stress on your tendons that can lead to chronic overuse and injuries.

>> All right.

Good advice.

Let's see if we can quickly squeeze in a live question actually I believe Mike, are you still on the line?

>> I I can you hear me?

Yes I can.

Oh hi there.

Go ahead.

>> We got a couple a couple of minutes.

Go ahead quickly with your question.

Yeah.

The doctor made a comment about a knee replaced you lose your ACL.

My question to him would be on a unique compartmental knee replacement a partial on the inside.

>> Is that still true?

So usually with the uni compartment knee replacements or partial needs, the ACL is still there so that is different.

>> Yeah, that's an important distinction for sure I guess.

>> Yeah.

You usually hear people just getting the whole knee replaced you know but as partial kind of common as well or I think it's becoming more common.

>> Yeah OK in in the right patient who has arthritis only one part of the knee it's a great option and it keeps the knee as native as possible keeping your keeping your PC or keeping everything there so OK interesting.

>> Thank you Mike for your question.

Thank Larijani.

I appreciate all the questions tonight.

Thank you so much Doctor Anderson.

Thank you.

The model was a huge help.

I really appreciated you bringing that in so thank you again.

I want to remind you that we have another HealthLine one week from tonight Mark Evans will be hosting and I hope you will join him then he'll have another guest live during the show that you can ask questions.

I'm not sure if they've decided on the topic yet.

That's above my pay grade.

But you'll find out soon they'll be advertising it through the week.

So thanks again to Dr.

Daniel Anderson.

I'm Jennifer Wahlquist for help line.

>> Take care and have a great night.

We'll see you next Tuesday