Robert G. Marx - The ACL solution: prevention and recovery for sports most devastating knee injury

The ACL Solution

Prevention and Recovery for Sports' Most Devastating Knee Injury

Robert G. Marx, MD

with

Grethe Myklebust, PT, PhD

and

Brian W. Boyle

Visit our website at www.demoshealth.com

All patient anecdotes in this book are factual. Names have been changed to protect patient privacy.

All photos appear courtesy of ninadrapacz.com.

ISBN: 9781936303335

e-book ISBN: 9781617051135

Acquisitions Editor: Noreen Henson

Compositor: Diacritech

2012 by Robert Marx. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher.

Medical information provided by Demos Health, in the absence of a visit with a health care professional, must be considered as an educational service only. This book is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure or therapy for a given patient. Our purpose is to provide you with information that will help you make your own health care decisions.

The information and opinions provided here are believed to be accurate and sound, based on the best judgment available to the authors, editors, and publisher, but readers who fail to consult appropriate health authorities assume the risk of injuries. The publisher is not responsible for errors or omissions. The editors and publisher welcome any reader to report to the publisher any discrepancies or inaccuracies noticed.

Library of Congress Cataloging-in-Publication Data

Marx, Robert (Robert G.), 1965

The ACL book : prevention and recovery for sports' most devastating knee injury / Robert Marx, Grethe Myklebust.

p. cm.

Includes index.

ISBN: 978-1-936303-33-5

1. Anterior cruciate ligamentWounds and injuriesPrevention. 2. LigamentsWounds and injuriesTreatment. 3. Sports injuriesTreatment. I. Myklebust, Grethe. II. Title.

RD561.M37 2012

617.5'8044dc23

2012013707

Printed in the United States of America by Bang Printing.

12 13 14 15 / 5 4 3 2 1

Foreword

The simple title of this book belies an epidemic that is taking place in schools, on basketball courts, and within families across the country. As the head women's basketball coach at Yale University for the past seven years now, I can tell you firsthand that ACL injuries wreak havoc on seasons, self-esteem, athletic careers and physical health. During the 20122013 season, 4 players out of thirteen on the roster will be former victims of ACL injurieswhich sadly, is not an unusual ratio on a college women's basketball team. Call any basketball coach and they will tell you that the threat of the injury floats in the back of their minds during every practice and game of the season. When any of us coaches see a player crumple to the floor in the telltale response to an ACL injury, our hearts sink. For me personally, it doesn't matter if the player is on our team or the opponent's, the sadness is the same as I know the pain, frustration, and long months of recovery ahead.

For coaches, players and parents, the injury that is so prevalent also remains largely a mystery. For years I have wondered about the injury and ways to prevent it from occurring, often switching up off-season training routines or lifting regimens. Some years, we would get lucky and have a team that is ACL-injury free for an extended time. I would find myself thinking back on those seasons trying to somehow pinpoint what we did right or better than in the years we had injuries. It seemed to always be a guessing game. In this book, Dr. Marx has finally laid out, in an easy to understand and entertaining way, how these injuries occur and, most importantly, possible methods of prevention. This book is a must-read for athletic trainers and strength coaches across the country. Parents and players should also take note, as in the desire to be the best, the importance of knowing your body's functions and limits should come into play, so that beyond the college quest, there can be a healthy and mobile existence for years to come.

Women's athletics have come a long way over the last several decades and more women are getting involved in sports, not just in school, but also as a lifetime pursuit. As this number continues to increase, understanding how ACL injuries happen and how to best prevent and treat them will be critical to ensuring competitive and healthy play. The next evolution of women's athletics is going to include taking control of an injury that devastates athletes and prevents them from reaching their full potential. Dr. Marx is fulfilling an important role in this evolution, by identifying the ACL epidemic for what it is, and providing a guidebook for athletes to take back control of their own destiny. As a coach AND a mother of a female basketball player, I can tell you this education is long overdue.

Chris Gobrecht

Joel E. Smilow Head Coach of Women's Basketball

Yale University

New Haven, Connecticut

Acknowledgments

I would like to thank my wife Rena for her unwavering support, guidance and understanding over many years and whose love has been a source of inspiration to me. I am also thankful for the encouragement of my daughters Ella and Hannah, who are now somewhat expert in this field as well. Dr. Grethe Myklebust was a fantastic partner in this project and her knowledge and expertise were essential to bring forward the critical elements of injury prevention. Brian Boyle was a pleasure to work with, and if he becomes half as good of a doctor as he is a writer, he will help many people for many years. I thank Nina Drapacz for her patience and expertise as a photographer. Our close friends Jamie and Sam Lipman were fantastic models for the photographs, not only for their good looks, but their physical condition that allowed for the many re-takes needed to get the images just right. I am grateful to my good friend Richard Ellenson who encouraged me to start the writing process and whose creative genius helped me get going. I am thankful for the excellent work of my research assistant Lana Verkuil who put the book together. I am also grateful to her predecessor Kaitlyn Lillemoe who helped with the initial stages. I appreciate Dave Allen's work helping write the book proposal that got us started. I thank Lauren Hirshowitz who allowed us to use her photograph (wearing number 6 on the cover) which was taken nine months after I did her ACL reconstruction, now over ten years ago. I thank my office manager Maria Dedvukaj and my surgical coordinator Candice Miller who keep my life organized. I appreciate the work of the staff at Demos including Tom Hastings and Dana Bigelow, and particularly thank Noreen Henson for her support and flexibility. Last, but certainly not least, I am very grateful to my agent Marilyn Allen. Without her enthusiasm for the prevention of injury, this book may have never found a publisher.

Robert G. Marx, MD

New York, New York

I would like to thank Dr. Robert Marx for inviting me take part in this project. Meeting Bob at a conference in Israel some years ago was the start of this project for me. To meet an orthopedic surgeon who was so interested in the prevention of ACL injuries was fantastic. The fact that many ACL injuries can be prevented was something he wanted everyone to benefit from, and knowledge translation is what this book is really all about. I also thank all my colleagues and co-authors at the Oslo Trauma Research Center for a great and inspiring environment.