Although they rank among the most common sports-related injuries, anterior cruciate ligament (ACL), medial collateral ligament (MCL), and meniscus injuries are often misdiagnosed and/or perpetuated.
To understand the issues around diagnosis, we sat down with Victor Khabie, M.D. , FAAOS, FACS, Chief of the Department of Surgery, Co-Director of the Orthopedic and Spine Institute and Chief of Sports Medicine at Northern Westchester Hospital…
To achieve timely diagnosis and treatment, Dr. Khabie stresses the importance of physicians and athletic coaches recognizing the signs of each injury and knowing when it is appropriate to refer to a specialist.
According to Dr. Khabie, the signature characteristic of an ACL injury is an audible pop in the knee accompanied by swelling, difficulty walking and an inability to continue certain activities. While MCL and meniscus injuries also result in swelling and pain, athletes may still be able to move and participate, albeit in a diminished capacity. Patients may attempt to treat these injuries at home with propping and icing; however, many find their injuries do not improve.
The team of board-certified sports medicine specialists at Northern Westchester Hospital utilizes state-of-the- art, minimally invasive surgical approaches to reconstruct patients’ knees. An alliance with Burke Rehabilitation provides patients easy access to a premier physical therapy facility and the benefits of a team approach that yields a high standard of care.
‘Prehab’ and Rehab
Although hard to endure for athletes accustomed to overcoming obstacles rapidly, surgical treatment for an ACL injury should not be performed immediately after the injury, according to Dr. Khabie. Instead, he says, surgery should be put off for at least three weeks while the patient undergoes pre-rehabilitation to restore the knee to as close to pre-injury status as possible. However, he adds, those three weeks can be made up during post-surgical rehabilitation when necessary. When done before surgery, rehabilitation reduces swelling and the chances of scar tissue and muscle atrophy developing after surgery.
“If you take a knee that is swollen, stiff and atrophied and subject it to an operation, the knee reacts as though it’s another injury,” Dr. Khabie says. “It’s like a one-two punch in a boxing match, and the knee tends not to rebound as quickly. If you give it more time to heal from the first injury and then subject it to surgery, it has a much better capacity to rebound from the second ‘injury.’”
Dr. Khabie notes postsurgical rehabilitation for ACL reconstruction typically lasts between six months and one year and focuses on regaining strength, reflexes and other protective mechanisms such as proprioception — the feedback from nerve endings that gives the patient a sense of where the knee is in relation to the rest of the body. It is during this six- to 12-month period that the athlete and physician must take their time and allow the injury to heal.
Although some athletes have ideas regarding the nature of their injuries before consulting a physician, Dr. Khabie emphasizes the importance of thorough evaluation before beginning treatment.
“Every injury is unique,” he says. “Treatments are very specific and tailormade to the injury and to the athlete.”
For more information about New York Sports Medicine, visit the Orthopedic and Spine Institute at Northern Westchester Hospital.