ACL-TRANSPLANT RETURNS MONTANA WOMAN TO MANAGING COUNTRY FAIR

A Case Study by AlloSource: Doing More with Life

Connie eagerly anticipated her adult son’s visit home for Christmas in 2009. During his visit, he teamed up with his former classic rock band for a reunion show at a local pub. Connie’s family, as well as the family of another band member, were excited to be together for the holidays and were enjoying the show. Suddenly, trouble broke out in the pub. “An argument erupted behind me,” Connie said. “I stood up to move to the other side of the table but my snow boot caught on the rung of the chair just as one man pushed another into me, knocking me over.”

Shortly thereafter, as Connie was still lying on the floor, a large man fell onto her legs. Connie sustained serious injuries: her left leg was broken and her right ACL was blown out. Aside from the pain and day-to-day struggles that dealing with two injured legs presented, Connie’s injuries also meant she could not adequately do her job, which she had a great passion for. After serving as Montana’s property tax supervisor for 30 years, Connie was at the time working as the local county fair manager. Although the work was taxing (including everything from negotiating entertainment contracts to cleaning horse stalls), she absolutely loved it.

As a full year passed after the injury, Connie’s broken leg was casted and healed. She wore a brace on her right knee with the injured ACL, and knew her options for that leg were either to live with the injury in a brace for the rest of her life, or try an ACL transplant, using donated tissue from a deceased human donor. Eager to resume an active lifestyle and work for the county fair, Connie opted for the transplant.

The surgery didn’t require any large incisions, only 4 small holes where instruments expanded the skin around Connie’s knee for viewing and working. Doctors performed meniscus reconstruction and then anchored the donated tendon diagonally from her tibia to femur. Following the surgery Connie was excited to get her leg back into working order. However, she was tired of the frequent doctor visits from the past year, and wasn’t pleased with the prospect of having to return again for physical therapy. Instead, she set up her own therapy routine at home.


“After a few harrowing days in a recliner I got on an exercise bike. I began slowly pedaling in front of the TV, an hour each morning and night. I had quite a setup. Morning Sudoku and coffee while pedaling to the Today Show, herbal tea and a sitcom at night,” she said.


And the training worked; Connie’s doctors were very pleased with her gradual improvement in range of motion. By Spring of 2010, after a year of working from home, Connie was elated to be able to get back to the fairgrounds and the work she loves. “It’s now been one and a half years since my transplant. I still get a little stiff if I don’t stay active, but I recently finished my second summertime county fair since surgery and reports from the public are that this was the best one in years,” she said.

Connie reflects on the gift of life that allowed her to return to work with earnestness and appreciation. “I believe the body is the human’s earthly vessel. Our deceased loved ones are hopefully in a wonderful place; their tissue is no longer needed by them. I honor whoever is selfless enough to understand that,” Connie said. “We offer an unused blanket to a shivering homeless man, food to a starving child, spare change to a simple benefit drive or money in the collection plate at church.

We give. It’s an odd feeling for me to be a recipient of any such gift because I’ve always been more of a giver, but I feel humbled in knowing someone gave tissue to me when I was in need.” Connie is a registered organ, tissue and bone marrow donor. “As the old saying goes, if one life can breathe easier because of me, then I’ve gained my own measure of success. If I could speak to my donor I would say: thank you for helping to make people at a small county fair smile. You’re a success.

Preventing ACL injuries: Brian Cole, MD, on Fox TV Chicago

Dr. Brian Cole, sports medicine surgeon at Midwest Orthopaedics at Rush, talks with FOX-TV Chicago’s Sylvia Perez about the increase in ACL injuries among youth athletes and how they can help prevent them with plyometric and strengthening exercises. Dr. Cole also suggests athletes visit http://www.kneesforlife.org for more injury prevention tips. (Athlete demo by Ava Cole)

Weight loss can slow down knee joint degeneration

MRIs of the right knee obtained with the coronal proton density-weighted fast spin-echo fat-suppression sequence at, A, C, baseline and, B, D, after 48 months. Patients were an obese 65-year-old woman with stable weight and mild knee pain (A and B) and an obese 64-year-old woman with weight loss over 48 months and mild knee pain (approximately 10.9 percent decrease in BMI).


According to the National Institutes of Health, obesity is a risk factor for osteoarthritis. Being overweight or obese can place extra pressure on joints and cartilage, causing them to wear away. In addition, people with more body fat may have higher blood levels of substances that cause inflammation in the joints, raising the risk for osteoarthritis.


“For this research, we analyzed the differences between groups with and without weight loss,” said the study’s lead author, Alexandra Gersing, M.D., from the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. “We looked at the degeneration of all knee joint structures, such as menisci, articular cartilage and bone marrow.”

The research team investigated the association between weight loss and the progression of cartilage changes on MRI over a 48-month period in 640 overweight and obese patients (minimum body mass index [BMI] 25 kg/m2) who had risk factors for osteoarthritis or MRI evidence of mild to moderate osteoarthritis. Data was collected from the Osteoarthritis Initiative, a nationwide research study focused on the prevention and treatment of knee osteoarthritis. Patients were categorized into three groups: those who lost more than 10 percent of their body weight, those who lost five to 10 percent of their body weight, and a control group whose weight remained stable.

The results showed that patients with 5 percent weight loss had lower rates of cartilage degeneration when compared with stable weight participants. In those with 10 percent weight loss, cartilage degeneration slowed even more.

Not only did the researchers find that weight loss slowed articular cartilage degeneration, they also saw changes in the menisci. Menisci are crescent-shaped fibrocartilage pads that protect and cushion the joint.

“The most exciting finding of our research was that not only did we see slower degeneration in the articular cartilage, we saw that the menisci degenerated a lot slower in overweight and obese individuals who lost more than 5 percent of their body weight, and that the effects were strongest in overweight individuals and in individuals with substantial weight loss,” Dr. Gersing said.

Light to moderate exercise is also recommended to protect against cartilage degeneration in the knee.


“Our study emphasizes the importance of individualized therapy strategies and lifestyle interventions in order to prevent structural knee joint degeneration as early as possible in obese and overweight patients at risk for osteoarthritis or with symptomatic osteoarthritis,” Dr. Gersing said.


Related Study: Osteoarthritis and Cartilage

American Association for the Advancement of Science (AAAS)

7 Common Youth Basketball Injuries

By Sean Leninger, PT, DPT for Athletico

Basketball is a popular sport among youth athletes, but the duration of the season inyouth-basketball-injuries combination with the athleticism required by players can lead to injury.

Some of the most common injuries experienced by youth basketball players include muscle strains, ankle sprains,  Jumper’s knee and shin splints. Fortunately there are ways to prevent these injuries from happening. Read below to learn more about seven types of injuries that young basketball players are at risk for, as well as some injury prevention tips to help keep young athletes on the court.

  1. Muscle Contusions

One of the most common acute injuries suffered by young basketball players is a muscle contusion, which occurs secondary to impact. In basketball, it is not unusual for a player to accidentally ‘knee’ another player in the thigh causing a bruise to develop. Although painful, this type of injury is typically not serious.

With acute muscle contusions (less than 72 hours after injury), typical treatment includes rest, ice and compression. Once beyond the acute phase of injury, gradual return to activity is recommended and may include light stretching, progressive strengthening, and eventual return to sport once pain has subsided and full function is regained.

  1. Muscle Strains

In addition to muscle contusions, many young basketball players experience muscle strains, or ‘pulled’ muscles. The hamstring, calf and adductors (inner thigh) are common sites for muscle strains to occur given the functional demands of a sport like basketball. Strains can vary in severity from mild (Grade I) to serious (Grade III). Grade I strains occur when the muscle/tendon is overstretched. Small micro-tears in the muscle may or may not occur and the integrity of the muscle remains intact. Grade II strains involve a greater amount of torn muscle fibers and require longer recovery than a Grade I strain. Lastly, Grade III strains occur when the muscle tears or ruptures completely. This type of strain may require surgical intervention for full function to be restored.

Depending on the severity of the muscle strain (Grades I and II), return to sport may take anywhere from 2-6 weeks in most cases. As mentioned previously with muscle contusions, treatment for a muscle strain may include modalities (e.g. ice or heat), stretching, gradual strengthening, eventually progressing to advanced therapeutic exercises, along with sport specific activities such as drills, running, cutting, jumping, etc.

  1. Ankle Sprains

Most people have experienced the classic ‘low’/lateral ankle sprain that is the result of rolling/inverting the ankle. In basketball, ankle sprains can occur when cutting, accidentally stepping on an opponent’s foot or landing awkwardly.  Lateral ankle sprains involve over-stretching of the ATFL (Anterior Talofibular Ligament) and/or CFL (Calcaneofibular Ligament). Much like muscle strains, sprains are graded on a scale from I through III, with Grade I sprains being mild and Grade III sprains being considered severe.

Acute ankle sprains (Grades I-II) are typically treated with RICES (rice, ice, compression, elevation, stabilization). Once beyond the acute phase of healing, gradual pain-free restoration of range of motion, strength, ankle stability, balance and functionality is addressed in order to facilitate safe return to play.  Improper progression or returning to play too quickly may place the athlete at an increased risk of re-injury.

  1. Concussions

Many parents worry about concussions in their young athletes. While most associate concussions with aggressive contact sports like football, hockey, lacrosse and rugby, this type of injury can also occur in basketball players. Such mechanisms of injury may include a player going up for a rebound and getting elbowed in the head, diving for a loose ball and hitting their head against the court, or during the process of defending or executing a layup if contact is involved. Concussions can be a complicated injury and may require rest, follow up with a physician, as well as a proper plan of care under the guidance of a Physical Therapist that specializes in vestibular rehabilitation for safe return to activity.

  1. ACL Injuries

The Anterior Cruciate Ligament or ACL is one of the four main ligaments providing stability to the knee. ACL injuries typically occur in sports that involve quick changes of direction, pivoting, cutting and jumping. Although ACL sprains can be managed conservatively with physical therapy, an ACL tear/rupture requires surgical intervention to reconstruct the torn ligament. It is also important to note that there are multiple predisposing factors (e.g., gender, bony structure, landing mechanics, playing surface) for ACL injuries. Athletes can take steps to reduce the risk of ACL injuries by engaging in a comprehensive strength and conditioning program.

  1. Overuse Injuries

Overuse injuries such as Patellofemoral Pain Syndrome (PFPS), Jumper’s knee/patellar tendinitis, shin splints and stress fractures tend to develop over the course of a season. Many athletes are hesitant to bring up injuries to their coaches because they don’t want to miss playing time. That being said, overuse injuries tend to get worse as the season progresses. This is because overuse injuries can be linked to repetitive jumping, hip/ankle weakness, muscle imbalances (e.g. quad dominance), and running/playing/practicing while not allowing for a proper rest and recovery period. Because of this, coaches and parents should encourage young athletes to speak up when they are feeling unusual pain and discomfort.

  1. Apophyseal Injuries

Apophyseal injuries are specific to the pediatric population. These types of injuries occur at sites where tendons attach to bony prominences and include inflammation and soreness to avulsion fractures. Common sites of apophyseal injuries in youth basketball players include the calcaneus/heel (Sever’s disease) and the tibial tuberosity/shin (Osgood-Schlatter’s disease). Apophyseal injuries are typically associated with skeletal immaturity, flexibility deficits, repeated trauma (e.g. repetitive jumping and running) and muscle imbalances. Conservative treatment is usually effective in managing such conditions, making physical therapy an excellent treatment option.

The Importance of Injury Prevention

Injury prevention is important because it lessens potential healthcare costs and keepsathletico300x250 athletes playing their respective sports at a high level. As such, many chronic and even some acute injuries may be mitigated or prevented through a proper “pre-hab” exercise program along with incorporating a sport-specific warm up routine. For example, youth basketball players may benefit from balance training, dynamic and static stretching, hip/ankle stability exercises, as well as strengthening of the core and lower extremities.

Should an injury linger, further follow up with a physician and formal physical therapy treatment may be the best route for optimal outcomes.

Athletico also provides complimentary injury screens at a location near you. Click here to get started.