Maureen's Medical Moment: monitoring progress of ACL surgery

ACL injuries have increased 400-percent among teens and adolescents in the last ten years, but it may come as a surprise that they are also on the rise in the baby boomer generation as well.

To make sure patients do not have to pay out-of-pocket to fix the injury, doctors are using a new tool to prove that surgery works in order to continue providing coverage when new health care laws are put in place.

Dr. Mike Maloney says surgery gets patients back to near-normal, but healthcare reform may change whether it is covered by insurance. Doctors will soon need to prove the knee surgery helps in order to get the coverage.

"There's a huge challenge that a lot of the procedures we do have not gone through that rigor and therefore, third party payers may say, 'we're not going to pay for them anymore,’” said Dr. Michael Maloney, an orthopedic surgeon at the University of Rochester Medical Center.

That is why doctors have developed the GAITRite system-a 26-foot carpet that contains sensors to assess a person’s gait after an injury and then again after surgery to show how patients are doing.

"We will have seen that their gait has been restored to what we consider normal and safe and allow them to progress,” said Maloney.

The system also identifies those who are not recovering well. While it is beneficial for patients to see their progress, it is really a way to curb potential problems with insurance coverage when new healthcare laws go into effect.

A few months ago, Chris Spinelli had ACL surgery after damaging his knee during a soccer game. Spinelli says another player ran into him and hit his knee at a funny, “I just went right down,” he says.

The surgery worked well for Chris, but it would not have been possible had he not had insurance, "There's just no way I would have been able to do the surgery and then I'd be like, 'what am I gonna do'?” Chris hopes the research will save people from asking that question in the future.

Of the roughly 200,000 ACL injuries sustained every year, nearly 100,000 are fixed with surgery. The cost can range from $20,000 to $50,000, and is then followed by months of rehab. Doctors say it typically takes six to 12 months after surgery for patients to get back to normal activity.

BACKGROUND: The anterior cruciate ligament, also called the ACL, is located in the middle of the knee and it stops the shin bone (tibia) from sliding in front of the thigh bone (femur). In an ACL injury, there is either a complete or partial tear to the ACL or the ligament has been overstretched; this can happen if someone is hit very hard on the side of the knee, overextends the knee joint, or changes direction quickly while running, turning, or landing from a jump. ACL injuries are often considered sports injuries because ACL tears are linked to sports like basketball, soccer, football, and skiing. (Source: www.nlm.nih.gov)

SIGNS: Some symptoms that may signal an ACL injury include:
* Knee swelling within 6 hours of the injury
* Pain in the injured area, especially when putting weight on it.
* A popping sound at the time of the injury. (Source: www.nlm.nih.gov)

TREATMENT: ACL injuries can be very painful and can prevent people from carrying out their usual activities, especially if they are an athlete. The two main treatment options for this type of injury are rehabilitation therapy or knee surgery. Rehabilitation therapy may involve using a knee brace, exercises to help the knee's range of motion, and muscle strengthening and stability exercises. Sometimes the rehabilitation therapy alone is enough, but depending on the damage to the knee and the individual person's needs, surgery may be necessary. Two common procedures for ACL injuries are arthrocentesis, where a needle is inserted to remove excess fluid from the knee joint which will lower swelling, and surgical reconstruction, where a piece of tendon from another part of the leg is put in place of the ACL. (Source: www.mayoclinic.com)

INSURANCE COVERAGE: Many times treatment for sports injuries are not covered by insurance or are only partially covered, leaving large bills for the patient to pay. Proving the necessity of correcting the injury with surgery or some other form of treatment is key in getting insurance to cover some of the costs. Some universities have even begun to offer insurance coverage for their athletes because of the issues with excessive costs and continued injury. (Source: www.nytimes.com)


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