E7: How to prevent ACL injures with Dr. Paul Sethi

In this episode, Todd and Mike are joined by Dr. Paul Sethi to discuss anterior cruciate ligaments (ACL) of the knee.  Dr. Paul Sethi is a board-certified orthopedic surgeon at the Orthopedic and Neurosurgery Specialists center in Greenwich, Connecticut who specializes in sports medicine, particularly the knee joint as well as the elbow and shoulder.  Dr. Sethi graduated from Cornell University and went to medical school at Mount Sinai School of Medicine and has served as a team consultant and assistant team physician to the Los Angeles Dodgers, Lakers, and the University of Southern California football team. He is now a leading orthopedic surgeon in his field, regularly speaking at academic and medical conferences. 

Transcript

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Introduction of today’s episode (1:05)

Dr. Paul Sethi Introduction (1:20)

Orthopedic and Neurosurgery Specialists (1:32)

Cornell University and Mt. Sinai School of Medicine and Yale residency (2:01)

Dr. Paul Sethi has been a consultant and an assistant team physician for the Los Angeles Dodgers, Los Angeles Lakers, and LA Kings (2:10)

What is an ACL injury? It is a major central ligament in the knee and maintains stability and not buckle (3:08)

When you cut like in tennis, it can give out and the knee will buckle (3:40)

ACL injuries often involve other structures like the meniscus (3:55)

Q-Angle (4:45)

Females are more likely to tear ACL (4:56)

Feel or hear a “pop” (5:55)

Difficult to return back to sport after you tear your ACL (6:15)

Diagnosis is confirmed by MRI (6:30)

What happens after an ACL tear (6:45)

Decreasing non-contact injuries (7:01)

Mitigating injury risk (7:10)

PEP program or Santa Monica Program was performed in soccer athletes (Prevent injury enhance performance) (7:20)

Lunges, inchworms, other exercises for strength to prevent risk of ACL tear (8:00)

Dynamic warmups (8:15)

FIFA 11 program among soccer athletes (8:45)

ACL injuries are prevalent in soccer players (9:00)

Females are higher risk than males for an ACL tear (9:34)

Prevention programs work and are real (9:49)

Weaknesses can be improved (10:01)

Athletes should be involved in one of these programs (10:12)

Ways to prevent an ACL tear (Balancing hamstring and quadriceps muscles) (10:21)

FIFA 11+ (https://www.fifamedicalnetwork.com/lessons/prevention-fifa-11/) (11:20)

Surgery or non-surgery and differences between the 2? (11:45)

Can I play through my torn ACL? No, it is not typically recommended (12:30)

Pre-surgery after an ACL tear and the need for range of motion and strengthening (13:32)

What is the recovery time for an ACL tear? 9-12 months (14:33)

Which type of ligament should be used to repair my ACL? (15:32)

Using the torn ACL as the new ACL does not have positive outcomes based on a Harvard study (15:45)

Most commonly used graft comes from the patella tendon (16:41)

Allograft vs autograft in the ACL (17:10)

Educating timelines and explaining importance of proper rehabilitation (18:00)

Is it okay to not repair my torn ACL? It depends on the goals but yes its possible (19:35)

How long is ACL recovery? 9-12 months is the most realistic timeline (21:45)

Returning too soon can risk a re-tearing of the ACL (23:12)

Rehabilitation of the ACL repaired knee (25:10)

Phase 1: Post-operative phase where we restore range of motion, decrease swelling, increase quadriceps function and get rid of crutches. (25:10)

Phase 2: longest and hardest phase and foundational strengthening. Hip and core strength and discovering what caused ACL tear in the first place. (26:15)

Phase 3: Return to sport which means more dynamic and plyometric exercises, being on a field in a controlled environment (27:02)

Using athletic trainers and strength coaches to training and returning to sport (27:44)

Psychological testing and how comfortable an athlete is with going back to sports (28:31)

Importance of setting realistic timelines and testing regularly before allowing clearance (29:06)

All ACL tears needs to have proper testing before being cleared (31:15)

Listening and understanding the patient is key (33:00)

Pre-habilitation and mitigating risks in the young athlete is where sports medicine should be going (35:07)

Wrap-Up (36:09)