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Eric Peterson and Jeff Kolpack, Published August 18 2012

ACL injury surgery, recovery have come a long ways

Fargo

Carolyn DeHoff was a women’s basketball player at Arizona State University in the late 1980s. She’s also a witness to the medical progress of anterior cruciate ligament reconstruction.

It’s a knee injury, unfortunately, that has become so common in athletics it’s often acknowledged simply by the initials on first reference – ACL.

DeHoff saw two of her roommates undergo the surgery more than two decades ago. They both wore a hip-to-ankle cast in the weeks following the procedure.

“Imagine trying to haul that around campus,” said DeHoff, the head women’s basketball coach at North Dakota State.

ACL reconstructive surgery and the recovery have changed greatly since DeHoff’s college days. Over the past few months, The Forum tracked five area athletes who suffered ACL injuries – Katie Birkel and Jamie Van Kirk, who both play basketball at NDSU; Katelyn Holland, who plays basketball at Concordia; Brady Syverson, who played basketball at Fargo North; and Spencer Flaten, who plays baseball at Jamestown College.

The goal was to see how each dealt with the injury, the surgery and the recovery for what is one of the most commonly injured ligaments in the knee.

Approximately 150,000 ACL injuries happen each year in the United States, according to the American Orthopedic Society for Sports Medicine. ACL injuries account for an estimated half-billion dollars each year in health care costs.

Due to the frequency of ACL injuries, Dr. Howard Berglund – an orthopedic surgeon at Fargo’s Sanford Orthopedic and Sports Medicine – said many athletes have a general idea of what an ACL tear means.

“Most athletes know that it’s a season-ending injury,” said Berglund, who has performed numerous ACL surgeries in his nearly 20 years of practice. “Years ago, prior to good surgery and good rehab, it used to be a career-ending injury.”

Athletes in the 1980s and prior could only imagine the progress that has been made in ACL repair since their heyday.

Former Chicago Bears running back Gale Sayers is an example of an elite athlete who had his career cut short by knee injuries. Sayers injured both of his knees, one during the 1968 season and one in the 1970 season. Sayers retired prior to the 1972 season after playing in a combined four games in 1970 and 1971.

Today’s technology likely would have allowed Sayers to play longer and at a higher level.

“He probably would have returned to his previous state,” said Bruce Piatt, the NDSU team doctor from Sanford Orthopedics and Sports Medicine. “That was the unfortunate thing for a lot of those guys.”

DeHoff’s ASU teammates were hospitalized, and each wore a cast after their late 1980s surgeries. Today, that same procedure now is like a trip to the dentist.

That same injury that formerly ended athletic careers now carries a 95 percent success rate, Piatt said. He added athletes in that group have a greater chance of injuring the ACL in their other knee than the one that was repaired.

“It’s a predictable operation,” he said. “We expect patients to return to their previous level.”

Piatt said there have been different ACL repair techniques dating back to the early 1900s. However, it’s been in more recent decades the surgery has become widely accepted and fine-tuned.

Piatt started his training in 1989 and said by that time it was becoming pretty acceptable to reconstruct the ACL.

Dr. Jack C. Hughston (1917-2004) once did a presentation that Piatt attended before ACL repair became widely accepted. Hughston is considered by many one of the pioneers of sports medicine. Piatt remembers Hughston saying that the ACL wasn’t important and necessary for the knee, downplaying the injury.

“So it was shortly after that that it really got into favor,” Piatt said. “It was early to mid-80s that it really started to become acceptable.”

The surgery is becoming less invasive all the time.

Piatt said when he first started doing ACL reconstruction, it was a big open operation – the kind that DeHoff’s teammates underwent. Then it became more arthroscopic. Now it’s more endoscopic, Piatt said. That means all the repair is done inside the joint with a scope.

“The only thing done outside is we harvest tissue from the patient,” Piatt said.

Specifically, that tissue usually comes from either the hamstring or patellar tendon in the knee to make a new ligament. That is then grafted to the bone in the knee by some sort of combination of screws or pins.

On the interior of the knee, it’s complicated. On the exterior, it’s hardly noticeable.

“That’s what I can’t get over. It’s amazing,” said Van Kirk, who had her ACL repaired shortly after last season ended.

A surgeon in Lincoln, Neb., near Van Kirk’s hometown of Sutton, Neb., used a hamstring to reconstruct Van Kirk’s ligament. A different surgeon in Lincoln used the patellar tendon to repair the ACL of Birkel.

“It used to be you would be in a cast,” Birkel said. “Now you start moving it right away.”

Berglund said improved recovery techniques have played a critical part in helping today’s athlete return to full strength after ACL repair.

“We have learned so much more about the therapy after,” Berglund said. “I think that is where the biggest improvement has been.”

Readers can reach Forum reporter

Eric Peterson at (701) 241-5513 or at epeterson@forumcomm.com

Readers can reach Forum reporter Jeff Kolpack at (701) 241-5546 or at jkolpack@forumcomm.com