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.

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