The University Of Kansas Health System - ACL Tears Often Require More Than Physical Healing

Bryan Vopat, MD, an orthopedic surgeon and sports medicine physician at The University of Kansas Health System Sports Medicine and Performance Center, discusses how an ACL injury can affect an athlete psychologically – along with the importance of talking about it.

Q: You have researched the psychological aspects of healing from an anterior cruciate ligament (ACL) injury. What interested you in this topic and how did you notice this could be an issue?

A: I tore my ACL in high school and even then, I realized that it was more than just a physical injury. There was an important psychological component, as well. As a high school or college athlete, being an athlete is such a strong part of your whole identity. It's almost like you can lose a part of yourself.

Just by talking about it and making athletes aware of these psychological issues – as well as the chance of depression – patients do better.
Q: When do you bring up the psychological or emotional challenges to an athlete with this type of injury?

A: I talk about it with my patients from day one, as soon as I suspect an ACL tear. I want my patients to realize what's happening and make them aware that the psychological impact is almost as important as the physical.

They need to be aware they're not the only ones who go through these types of feelings and frustrations – that this is a problem for a lot of people. I give them articles to read and make sure to talk to all of my patients, especially the younger ones.

Just by bringing it up and acknowledging it as a problem, you can see people who were down start to smile. Just talking about it and identifying it as a problem, you can see the difference in how they respond and their physical body gestures.
Q: This injury can take a long time to heal. What's the most difficult part of the process?

A: The waiting is the hardest part. For the first three months, at least, the athlete has to wait. It takes that long for the graft to mature inside of the knee. Athletes, especially younger athletes, often feel ready and can't understand why they can't be active or do anything yet. But this is an injury that just takes time.

Just because you were planning to be at a certain point in 6 to 8 months – that might not happen. Patients then start to wonder "Why am I not back to where I was?" or "Will I ever be back to where I was?"

Unfortunately, we see professional athletes who have a specific genetic makeup often being back in shape and perfect in six months. In reality, that is not the case. In fact, it's more protective to be out of sports a bit longer than when you might be ready to return – there's less of a likelihood of re-tearing that ACL.
Q: Do different patients heal in similar ways? Does age make a difference?

A: A very active 36-year-old is similar to an active 16-year-old – the surgery is much the same. But there's a higher re-tear rate in young people because they're so much more active. You really have to slow them down until everything is healed in their knee.

Really except for the very young – 10 or 11 years old – the surgery is similar.

The biggest difference is the psychological aspect. It's the difference in how much more sports are integrated into everyday life as a high school or college athlete. Sports and athletics are usually much more important to the identity and life of a 16-year-old.
Q: What's different about the way you treat your patients? What's different about the health system?

A: We work with specialists in all fields, including athletic trainers and physical therapists. We're a close-knit group and there's always open communication. They can communicate with me at any time – by email, text or phone. We want to know if there's a problem so we can jump on things quickly.

I think it's important that we're all moving in the same direction and speaking the same language. This way, we can make sure we're doing the best thing for the child or the patient who has the injury.
Q: Does your background as a high school athlete affect you as you treat your patients?

A: I think being a high school athlete helps me identify more with my patients. I do have experience as an athlete and I've been injured myself – a lot of different injuries. It helps me understand what's going on. I can see what my patients are going through and talk to them about it. I guess I can empathize with them because I do understand.

I might tell them, "This is our goal. And this would be my goal." Or I might say, "This is what I might do." Motivated types of people usually have very similar mindsets.
Q: Do the typical traits of an athlete work with or against them as they recover from an ACL tear?

A: Generally, the same psychological traits that make the athletes effective as an athlete can hurt them as they recover from an injury. Athletes are motivated people. And when they lose their identity as an athlete that can work against them, leading to depression. Just being aware of what is going on and talking about it can really help.
Q: Why do you conduct research and why do you consider it important?

A: Just like athletes, I'm motivated to always get better. How can we improve surgeries? How can we improve player performance? And through research, we can make sure that what we're doing is working – that we're actually doing the right thing.

Without performing research, we assume everyone is doing well. But when we go back and analyze the results, we can improve what we're doing.

I just think you should always be looking to improve what you're doing – no matter what it is that you do.

Orthopedic surgeon Bryan Vopat, MD, discusses the psychological aspects of recovery from anterior cruciate ligament reconstruction.

I actually tore my ACL when I was in high school. It made me realize that there's more to it than just the injury, that there's a such a large psychological component. And if we can make people aware of that and that we can treat it all that our patients will do much better. I think any person who's in high school or college and who's an athlete that such a large aspect of who they are as an athlete that when they tear their ACL, they feel they lose part of themselves.

Bryan Vopat, MD, talks about ACL injury and depression.

The psychological aspects that make an athlete very effective and very motivated actually hurts them sometimes after they have an injury, because they're ready to go and they just can't, their body's not responding. And that's the psychological aspects that we see. That they lose their identity of being this motivated person because all of the sudden they really can't be. And they try to, so it works against them and it can kind of lead into this depression and stuff if they're not careful, if we don't identify it just make them aware of what's happening. I think just being aware of what's going on, it really helps people out.

Bryan Vopat, MD, talks about why younger athletes have a higher ACL tear rate.

If you have a very active 36-year-old, it's gonna be very similar as treating someone who's, like, they're 16. But there's a higher re-tear rate in the younger people just because they're so much more active and you have to, kind of, slow them down for a little bit until things to heal in. But, unless you have the very young, they're like 10, 11-years-old, everything is -- this surgery is fairly similar. The biggest aspect is the, kind of, treating the psychological aspect, again, of how important these sports are to their everyday life. More so than, usually, a 36-year-old.

Bryan Vopat, MD, talks about how long it takes for an ACL tear to heal.

The first three months is just allowing everything to, kind of, heal in before they can really get moving. And I think that's the hardest part. Their knee is -- they just have to wait for everything to heal in because it takes that long for the graft to actually mature inside their knee. And I think that's a big psychological aspect that they're like , you know, we feel ready why can't I do anything yet? And then so they just have to take time. And I think that's something, a psychological aspect as well, that why aren't they back where they want to be yet? Or will they ever get beck there? And I think we have to reassure them that takes long. And just because they're playing even at six to eight months, it can take a year to 18 months to get better. Unfortunately, we just see young players in the NFL who have their, this genetic makeups where they think we should be perfect in six months. And, in reality, that's just not the case. And we've actually seen studies recently showing that it's protective to be out of the sport seven, eight months and every month after six months that you are actually less likely to tear your ACL.

ACL Tears Often Require More Than Physical Healing

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