Key advances in ACL-related surgeries


There’s no doubt about it. People are busy: Busy with work; Busy with kids and family; Busy with life. 

When something happens, like damaging the anterior cruciate ligament, one of the four major ligaments of the knee that prevents people from moving freely around those busy lives, it impacts everything. 

“Motion is life,” says Dr. Boyd Haynes, a sports medicine fellowship-trained surgeon with the Orthopaedic & Spine Center in Newport News, Virginia. “If I can get you back to feeling better sooner, I can get you back to work and life activities sooner.”

That treatment philosophy, Haynes says, has helped define advances made in ACL-related treatments, surgeries and rehabilitation in the last decade. Prevent people from getting hurt in the first place, and then get them moving as quickly as possible after surgery.

That starts in the operating room, Haynes says, with advances that allow surgeons to make smaller incisions when going in to repair or replace an ACL.

“Decades ago, the reconstruction in knees were not done anatomically,” Haynes says. “They were done on the outside of the knee. They didn’t go in and fix the problem. Now, if we need to repair the ACL, we go in and repair the ACL.”

And when they are done, the surgeons are getting their patients into rehabilitation faster than ever. 

“Everybody wants to get back to their sports and their life,” Haynes says. “They don’t want to sit for months.”

So they get them moving.

Get moving quickly

A benefit of surgeons operating on a knee using smaller incisions is that “they cause less trauma than ever to fix a torn ACL. The surgery itself is damaging less of the surrounding areas of the knee,” says Steve Howell, PT, M.Ed., vice president and Peninsula regional director with Tidewater Physical Therapy. Howell treats patients in the practice’s Oyster Point Clinic in Newport News. 

What does that mean for patients? 

That they can get moving quickly after surgery. 

“By getting into rehab early, you are limiting the effects of immobilization including muscle atrophy, stiffness in the joint, swelling and pain,” Howell says. “Years ago, physical therapy was not initiated until four weeks or more postsurgery to protect the repair. Now the repairs are so stable that the surgeon isn’t as worried about the repair getting damaged.”

Today, patients are coming to physical therapy three to five days after their operations. 

“Motion and strength are the two most important factors in your knee,” Haynes says. 

“Early initiation of physical therapy is critical in helping the patient gain the confidence to begin to use the leg again,” says Howell. “The goal in the first weeks of therapy is to control swelling and pain and get the patient back to normal weight bearing.” Early comfortable weight bearing is the first step to return to normal life activities.

Once incisions are healed, Howell and the physical therapists at his clinic use aquatic therapy to allow more comfortable weight bearing and range of motion activities due to the bouyancy effects of water relieving pressure on the knee. The aquatic therapy pool at Howell’s clinic includes a submerged treadmill, used for early gait training activities and endurance training.

“Our facility allows us to do a combination of aquatic and land-based therapy. They really complement each other and help to speed recovery.”

Looking beyond the knee

A decade ago, if a patient had surgery on their knee, physical therapists treated the knee. 

“Now the focus is more global,” says Howell. “We take a whole body approach to rehabilitation including posture and body mechanics training, core, hip and ankle strengthening, as well as endurance training.” 

All are critical in returning the patient to pre-injury levels of participation, Howell says. 

 Fostering a Culture of Prevention

When it comes to injured knees, one of the key populations both surgeons and physical therapists have long treated are athletes. 

Today, a heavier emphasis has gone into prevention programs. 

“About eight years ago, I reconstructed about half of the Old Dominion University’s basketball team,” says Hayes. “They tore them right and left and sometimes in both knees. Today, there is more understanding in how they jump and how they land and how to strengthen and train.”

Samantha Davis, PT, DPT, a doctor of physical therapy who treats patients alongside Howell in Newport News with Tidewater Physical Therapy, was once one of those basketball players who needed surgery. 

Davis, who played for Christopher Newport University, ruptured her ACL in 2006. In 2008, she experienced another ACL injury to the opposite knee. 

Today, she runs an ACL injury prevention program at Tidewater that helps screen players for weaknesses in their movement and identifies how to better train and strengthen the muscles around the knee to help prevent injury. 

“The push at the college level are these prevention programs,” Howell says.
“It’s a heavy emphasis on preseason training and prevention screening. The goal is to identify certain risk factors in athletes and determine training programs for them that
are more customized.”

Catching it on video

Video analysis is perhaps one of the most interesting advancements in the last decade, Howell says, giving immediate feedback to patients and identifies areas of weakness for early correction and progression of rehabilitation activities. 

It has to do with showing them exactly how they move. 

Before, physical therapists and physicians could watch with their eyes how an athlete, for example, jumped and landed or how an older adult limped across a room, and tell them what they saw. 

“But if people are walking with a limp but feel as if they are walking correctly, they may not understand what we are seeing,” Howell says. “Now we can video it and show them.”