By Paul Ohanian
Led by a panel of medical experts, US Lacrosse and MedStar Sports Medicine produced two educational webcasts Wednesday, aimed at providing guidance for lacrosse players and parents on the topics of ACL knee injuries and head injuries. The two, 30-minute webcasts have been archived and are available for viewing at www.uslacrosse.org/healthwebcast2014.
Moderator Dr. Richard Hinton opened the ACL presentation by noting that knee injuries continue to rank as the leading cause of missed game and practice time for the lacrosse athlete. The assembled panel outlined the signs and symptoms to help athletes and parents recognize ACL tears, explained some of the evolving concepts of treatment, and discussed various contemporary ideas in injury prevention and rehabilitation.
“The ACL ligament is one of four ligaments in the knee, but it’s the most common ligament that’s operated on. That’s why we care so much about it,” said Dr. Karen Sutton, orthopedic physician for the U.S. women’s national lacrosse team and an attending physician at Yale New Haven Hospital.
She noted that some athletes, such as those with weaker hamstrings, may have a greater risk of potential ACL injury. Gaining an understanding of the circumstances involved with the injury is also very helpful in the diagnosis process.
“I ask them if they heard a pop, or encountered swelling, or have a decreased range of motion,” Sutton said. “When I see them, I also ask if they trust their knee. Could they walk down off a curb?”
While a small minority of athletes that sustain an ACL injury may be able to avoid surgery, the experts agreed that most will need reconstruction of the ligament.
“The majority of the athletes, if they want to get back to participation, they will need surgery,” said Dr. Milford Marchant, orthopedic surgeon for MedStar Sports Medicine and sports medicine physician for the Chesapeake Bayhawks of Major League Lacrosse.
The panelists noted that recovery from ACL reconstruction surgery can range from six to 12 months before athletes are able to return to play. Significant work and commitment is required of the recovering athlete to regain the strength in the injured leg and develop the confidence to trust the knee again.
The second presentation focused on a topic of great attention in today’s sports culture - head injuries and concussions.
The experts agreed that concussion injuries should be managed in a holistic way, and outlined recognition signs and diagnosis. They also discussed neurocognitive testing and treatment, and return to activity steps.
“We do know that if you’ve had one concussion, there is a higher likelihood that you’ll have another, but we don’t understand why that is the case,” said Ruben Echemendia, PhD, director of the National Hockey League’s Neuropsychological Testing Program and a member of the US Lacrosse Sports Science and Safety Committee.
Dr. Andrew Lincoln, another Sports Science and Safety Committee member and a research specialist for MedStar Sports Medicine, noted that concussions are caused by different mechanisms of injury in the men’s and women’s games.
“Virtually all the concussions in boys’ play, specifically at the high school level that we have studied, are a result of direct, player-to-player contact,” Lincoln said. “Almost all of it is based on intentional checking.”
The unique rules of the women’s game indicate a far different mechanism of injury.
“We find that the main mechanism of concussion in the girls’ game is stick-to-head contact. It’s unintentional and it’s incidental,” Lincoln said.
Using that data to help in rule and equipment interventions is important.
“For us, as the national governing body, there is no single intervention approach,” said Ann Carpenetti, vice president of game operations at US Lacrosse. “Increasing the penalties associated with dangerous play is one approach, but education and equipment are also important factors.”
The panel noted that prevention is the key, and that requiring trained and certified lacrosse coaches and officials and using age appropriate rules can greatly help offset the risk of head injuries.