Epidemic of ACL Repairs, Dr. Timothy Kremchek

Click here to read the full article by Paul Daugherty on Cincinnati.com.

Dr. Tim Kremchek of Beacon Orthopaedics serves as head physician for the Cincinnati Reds.  Known widely as the leading Tommy John surgeon in the area, he also performs many anterior cruciate ligament (ACL) reconstructions.  And that number is on the rise.  In a couple of days he had five ACL reconstructions scheduled in a single day.

Dr. Kremchek agrees that the frequency of ACL repairs is increasing.  “It’s almost an epidemic,” he summarized.  Then he clarified, “The re-tears. That’s really the epidemic.”

The “epidemic” seems to be hitting high school athletes the hardest. According to Dr. Kremchek, they are rarely caused by contact injuries.  There are football players, but there are also girls soccer players, basketball players, and seemingly every other type of athlete.

The efficiency with which an ACL can be repaired is reminiscent of an assembly line these days.  Although Dr. Kremchek has repaired close to 300 ACL ligaments the past two years, he would like to do less.  He blames overuse as the primarily culprit.

Educating young athletes is important, but educating parents about the dangers of ACL tears may be more important.  Sadly, the days when student athletes played one or two sports for fun are long gone.  It seems now that the desire for scholarships or simply parental over-involvement is driving many youth athletes to overuse injuries requiring surgeries such as Tommy John and ACL repairs.

“One of the best things athletes can do is cross-train,” Kremchek suggested, but noted that due to the level of competition, most athletes won’t.  He also cautioned that once an athlete has surgery, it is important for their parents and coaches to give them adequate time to rest and recover.  If tears are on the rise, re-tears are even more so.

The latter is generally caused when athletes try to play at their previous level too soon after surgery.  The pressure to “turn it back up” can come from teammates, but usually it comes from coaches and parents.  There are rivalries, tournaments, state championships, and scholarships to win. Now.

The term “ACL repairs” is a bit of a misnomer, though, explained Kremchek.  A torn ACL cannot simply be stitched up.  The process for ACL repairs involves making a new ligament.  More specifically, it requires grafting from a tendon.  Using a hamstring or patella tendon is common practice.  Although the procedure itself is fast (sometimes it can be done in as little as twenty minutes), the rehab and physical therapy are anything but quick and easy.

Most orthopedists don’t foresee a decrease in frayed knee ligaments anytime soon, try as they might to warn parents, coaches, and athletes of the dangers of overuse.  “I’ve never seen it like this,” Kremchek concluded.