Dr. Collins is fellowship trained in sports medicine. A fellowship in any subspecialty is an intense year of training intended for a surgeon to master the treatment of a specific issue. During a sports medicine fellowship, Dr. Collins received intense training on the treatment of complex shoulder and knee injuries that occur during athletic performance. Only by repeating a surgery 100s of times can you truly master a procedure. This is specifically why Dr. Collins volunteered a year of his life to concentrate on complex athletic injuries of the knee and shoulder.
ACL (anterior cruciate ligament) injuries are common in people who play sports. The ACL serves a very specific function. It prevents the lower shin bone from sliding forward on the upper femur bone. It most commonly is injured during pivoting sports that require a sudden change in direction. It also can be damaged during a hyperextension of the knee or during a sudden forceful stop. Approximately 50% of athletes who tear there ACL will also tear the meniscus in their knee which serves as the secondary stabilizers.
When patients tear their anterior cruciate ligament, there is usually significant swelling and pain. With time, the swelling and pain may subside. Athletes may even be able to run in a straight line without difficulty. The problem occurs whenever they stop abruptly, plant or change direction. This can cause a feeling of giving way or instability and potentially do further damage. A completely torn anterior cruciate ligament will never heal on its own.
If an athlete wishes to return to sports, it is highly recommended that they undergo an anterior cruciate ligament reconstruction and address any torn cartilage in their knee. The procedure is primarily performed through an arthroscope. An arthroscope is a small camera that is inserted into the knee through small cuts to allow visibility and the ability to work.
How is the procedure performed?
Prior to beginning the procedure, Dr. Collins and the athlete will discuss the potential graft sources to replace the torn ligament. The most commonly chosen graft is to use 2 hamstring tendons from the inside of the knee. This will give an athlete a graft that can be up to 160% as strong as the anterior cruciate ligament he was born with. Another excellent graft source is the patella tendon. The middle one third of the athlete’s patella tendon is harvested with a small piece of bone from the patella and the shin bone and then used to reconstruct the ACL. This is also an extremely strong graft. The use of cadaver graft is rarely recommended secondary to a high rate of failure.
The first step in the surgical procedure is to address any torn cartilage. Most commonly a small portion of a torn meniscus may be removed or sutures may be placed if the tear is one that can heal. After that, the torn anterior cruciate ligament is removed. Dr. Collins then makes a drill hole (tunnel) in both the shin bone in the femur that specifically matches the size of the graft. The new graft is then passed through the tunnels and stabilized.
Patients are allowed to weight-bear immediately in a knee immobilizer and begin physical therapy concentrating on motion and strength. Many patients would be allowed to light jog in a straight line only 8 weeks after surgery. The graft must be allowed to mature. Therefore, it will take approximately 6 months before the athlete is ready to return to sports. Most athletes will require the use of an ACL brace during their first year of return to sports.
The surgery is highly reliable with an excellent success rate and a slight chance of reinjury. The data varies, most studies indicate that approximately 10% of athletes will injure their graft.
Dr. Collins has perfected his technique of anterior cruciate ligament reconstruction after completing a sports medicine fellowship and 21 years of private practice taking care of college and high school athletes of almost every sport.