Jeffery Augustin, MD,
Ask a group of orthopedic surgeons what is the most common sports-related injury, and their responses will most likely be – injury to the ACL. Fortunately, for both the professional athlete and the weekend warrior alike, tremendous strides have been made recently in treating such an injury, and Jeffery Augustin, MD, a board-certified and fellow-trained orthopedic surgeon at
According to Dr. Augustin, “ACL or the anterior cruciate ligament connects the upper leg bone or femur with the lower leg bone or tibia. An ACL injury occurs when the knee is straightened beyond its normal limits (hyperextended), twisted, or bent side to side. This may happen when changing direction rapidly, which commonly occurs in sports that require stop-and-go movements. An ACL injury may also occur after contact in a sport or in an accident.”
An ACL injury can be a partial or complete tear of the ligament, a separation of the ligament from the upper or lower leg bone (avulsion), or a separation of the ligament and part of the bone from the rest of the bone (avulsion fracture). Other parts of the knee can be injured at the same time, including the pads that cushion the knee joints (menisci), another knee ligament, or the tissue that covers the ends of bones (cartilage).
“Patients often report hearing or feeling a pop in the knee at the time of injury, pain, swelling, and a feeling that the knee may buckle or give out,” says Dr. Augustin. “An ACL injury may develop into chronic (long-lasting and recurrent) ACL deficiency (also called insufficiency), resulting in greater knee looseness and sliding of the bones. This abnormal sliding can lead to premature osteoarthritis.”
For the majority of these patients interested in returning to the sports arena, surgery is often the best option. This can involve reconstructing or repairing the ACL. According to Dr. Augustin, “ACL reconstruction is not an ACL repair. A repair implies that you can fix something that is broken. If the ACL is completely torn, it will not heal back together, even if the torn ends are sewn together. What does work well is to remove the torn ends of the ACL and replace the ligament with a different structure (a graft). To secure the graft into the position of the normal ACL, tunnels are made in the shin bone (tibia) and thigh bone (femur), and the graft is passed through these tunnels to reconstruct the ligament.”
The most common grafts are autografts using tissue from the patient’s own body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Other good choices include allograft tissue, which is donor material. “The choice of an autograft or allograft is mostly dependent upon the patient,” reports Dr. Augustin. “In younger patients, an autograft is commonly used. Older patients may require donated tissue.”
Today, arthroscopically-assisted ACL reconstructions are the standard of care. During an arthroscopic ACL procedure, the orthopedist makes several small incisions—usually two or three—around the knee. With the use of fiberoptic technology, an arthroscope allows the surgeon to visualize the inside structures of the knee. Using one incision for the arthroscope, the image is then displayed on a video monitor. Water is pumped through the arthroscope which inflates the knee and allows more ease in maneuverability. Another portal is used for instruments that are designed to remove damaged tissue or repair damaged tissue.
According to Dr. Augustin, “Arthroscopic surgery offers many benefits over the traditional open method. For the orthopedist, it is easier to see and work on the knee structures, and surgery can be performed at the same time as diagnostic arthroscopy (using arthroscopy to determine the injury or damage to the knee). For the patient, the arthroscopic procedure has fewer risks than open surgery, smaller incisions, and perhaps most important, rehabilitation is often faster.”
While repairing and reconstructing the ACL arthroscopically is one of Dr. Augustin’s specialties, it is by no means the only one. He is also adept at repairing the rotator cuff, a network of our muscles and several tendons that form a covering around the top of the upper arm bone, using minimally invasive surgical techniques. Such injuries are usually the result of overuse of these muscles and tendons over a period of years, and those suffering from this injury include tennis players, quarterbacks, baseball players and swimmers, as well as non-athletes.
For more information on these procedures, please call Christ Hospital’s Marketing, Public Relations and Physician Liaison Services Department at 201-795-8619.