Jan 29, 2015
Bulletin Board

What Causes Failed ACL Repairs?

It is estimated that 400,000 people have ACL reconstruction surgery each year. Of those, 18,000 to 35,000 repairs will eventually fail and require surgical revision–a procedure that tends to be more complicated, less successful, and more challenging to rehab than the initial surgery.

While the reasons behind failed repairs vary, Jon Sekiya, MD, Associate Professor of Orthopaedics at the University of Michigan, says improper surgical techniques are usually to blame. “The most common reason for an ACL [repair] to fail is technical error, where the actual graft is placed in a non-anatomic position and the most common wrong position is too vertical–too up and down–which doesn’t allow the graft to restore rotation,” Sekiya told MedicalNewsToday.com.

Backing Sekiya’s claim is an American Board of Orthopedic Surgery survey that found 85 percent of surgeons who perform ACL reconstruction surgeries do 10 or fewer per year. “I definitely don’t think that the exact number of surgeries you do is indicative of necessarily the skill level,” Sekiya said. “However, I do think there are subtleties to this surgery that if encountered during an operation, may not be recognized in a less experienced ACL surgeon and can lead to failure.”

Because experience is typically the best teacher, Sekiya advises those with torn ACLs to seek out surgeons with a strong body of work. “When trying to choose a place to take care of their ACL and their injury, [patients] should make sure the surgical staff and therapists are well versed to take care of all the problems they may encounter,” he said. “Patients can simply ask their surgeon if they are comfortable doing the procedure–they will likely get an honest answer.”

Ed Wojtys, MD, Director of the MedSport sports medicine clinic at Michigan, agrees with Sekiya’s assessment and advice. He also believes history is a fair indicator of risk for a second ACL tear. “Why those ligaments fail is subject to a lot of debate,” Wojtys told MedicalNewsToday.com. “But [it] probably has something to do with the techniques used the first time, and then the fact that so many [patients] go back to the sports that originally caused the problem.”

Strengthening Hips May Alleviate Knee Pain

Research out of Indiana University-Purdue University Indianapolis (IUPUI) has shown that a twice-weekly hip-strengthening regimen performed for six weeks can reduce and even eliminate patellofemoral pain (PFP) in female runners. Lead investigator Tracy Dierks, PhD, Assistant Professor in the Department of Physical Therapy at IUPUI, hypothesized that strengthening a runner’s hips would remedy the mechanical flaws that lead to PFP and says his six-week pilot study is the first of its kind to test a possible treatment for PFP in female runners.

PFP results when a runner’s thigh bone rubs against the back of their kneecap. The pain typically begins with activity, grows worse over the course of a run, and then subsides when the activity is completed.

The study examined five runners performing a hip strengthening routine and a four-person control group that did not. Twice a week for 30 to 45 minutes, the five runners performing exercises did single-leg squats and other work using a resistance band. Hip strength measurements were taken before and after a six-week period.

Running on a treadmill, the subjects performing the exercises began the six-week trial reporting an average pain level of seven on a scale of zero to 10. After the six-week strengthening program, all the runners reported pain levels of two or lower on the same scale.

“I wasn’t expecting such huge reductions,” Dierks said in a statement. The findings were presented at the American College of Sports Medicine Annual Meeting in June. Dierks said he plans to seek funding to test the effect of the same exercises on a larger group of runners.

Milking It For Muscles

Women looking to tone up and shed a few pounds may find a helping hand in their refrigerator. A new study from researchers at McMaster University, which appeared in the June issue of Medicine & Science in Sport & Exercise, found that women who consumed two glasses of milk within two hours after weight-training lost fat and improved muscle tone.

The results caught the researchers a little off guard. “We expected the gains in muscle mass to be greater, but the size of the fat loss surprised us,” Stu Phillips, a professor in the Department of Kinesiology at McMaster, wrote in the study. “We’re still not sure what causes this but we’re investigating that now… The combination of calcium, high-quality protein, and vitamin D may be the key, and, conveniently, all of these nutrients are in milk.”

Conducted over a 12-week period, the study monitored young women who had not previously participated in a resistance training program. Their routine–which consisted of bench presses, chest flys, seated lateral pull-down abdominal exercises without weights, leg presses, and seated two-leg hamstring curls–was overseen by personal trainers who provided technique instruction.

Two hours before each session, the women were prohibited from eating or drinking anything except water. Then immediately after exercising, one group consumed 500 milliliters of non-fat milk while another consumed the same amount of a similar-looking energy drink that was sugar-based. An hour later, the participants consumed another 500 milliliters of what they drank earlier.

“The women who drank milk gained barely any weight because what they gained in lean muscle they balanced out with a loss in fat,” wrote Phillips, whose lab is conducting a large clinical trial studying weight loss in women. “Our data show that simple things like regular weightlifting exercise and milk consumption work to substantially improve women’s body composition and health.” The study also reported that the milk drinkers displayed better muscle tone than those who consumed the sugar-based energy drink.

To view the abstract of the study, “Body Composition and Strength Changes in Women with Milk and Resistance Exercise,” go to: bit.ly/MilkStudy.

Study Says Body Mass Index is Misleading

Though convenient and easy to calculate, Body Mass Index (BMI) is not an accurate indicator of obesity in high school football players, because it doesn’t differentiate between muscular bodies and fatter ones. So says a study presented at the 2010 American College of Sports Medicine Annual Meeting.

Following an overnight fast, 71 males from seven different high schools were examined by researchers who evaluated each subject’s body weight, height, body fat percentage, fat mass, and lean mass. According to the results, 45 of the players had a weight in the “normal” range, 18 were considered overweight, and six were obese. However, based on BMI, only 26 players would be classified as being a normal weight, 21 would be overweight, and 24 would be obese. In other words, around 40 athletes were misclassified as overweight or obese according to BMI.

“The use of age-adjusted BMI percentile rank in high school football players is not effective for determining overweight/obesity levels as it can lead to misclassification of overweight and obese status,” said study presenter Gary D. Steffes, who completed his research as an exercise science major at Miami University. “This is especially true for bigger athletes such as linemen.

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