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Speaker 1: It is that time of the week again.

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Speaker 2: We talk with one of the experts from Ortho Sincy

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Speaker 2: Orthopedics and Sports Medicine. The great thing about Orthosincy is

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Speaker 2: they've got specialists, specialist locations and services all over the

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Speaker 2: tri State. That includes walk in orthopedic urgent care at

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Speaker 2: five locations with extended evening and weekend hours in Edgewood

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Speaker 2: and Anderson. You can learn more at Orthosincy dot com.

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Speaker 2: That's orthos ci Ncy dot com. Doctor Adam Metzler from

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Speaker 2: orthos since he is with us, I want to start

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Speaker 2: by talking about two non bangals, Patrick Mahomes and Michael Parsons,

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Speaker 2: both with season ending ACL tears. Patrick Mahomes has already

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Speaker 2: had surgery. We're going to talk about that. But this

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Speaker 2: type of injury, how long does it take to determine

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Speaker 2: whether or not something like this is a sprain or

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Speaker 2: a tear.

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Speaker 3: Well, the reality is understanding a little bit of the

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Speaker 3: difference and what that the meaning of those terms, and

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Speaker 3: they kind of can be used interchangeably, but the reality

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Speaker 3: is on the sideline. Most of the time, we can

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Speaker 3: tell whether one's ACL is completely torn or not based

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Speaker 3: on the test we call the Lockman test and at

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Speaker 3: the time of injury time zero the time they do it,

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Speaker 3: they're not super swollen, they're not guarding too bad. You

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Speaker 3: can get a pretty good exam, so usually we know

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Speaker 3: pretty quickly with a high probability. If you're a sports

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Speaker 3: medicine surgeon and a sideline doc, I've been on the

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Speaker 3: sidelines nineteen years now and done fifteen hundred ACL surgery.

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Speaker 3: Most of the time we can feel right away on

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Speaker 3: the sideline.

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Speaker 4: They have a torn AHL. Now sometimes you use the.

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Speaker 3: Word sprain, but a generically sprain is very interchangeable. So

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Speaker 3: a Grade three sprain is a complete tear. So if

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Speaker 3: it's a partial tear, you'll still feel an end points

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Speaker 3: or a firm points to their ACL. But beyond the

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Speaker 3: physical examine MRIs confirmatory for the diagnosis of an ACL tear.

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Speaker 2: So Patrick Mahomes had his surgery within twenty four hours

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Speaker 2: of suffering the injury. Micah Parsons hasn't had his yet.

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Speaker 2: So what factors determine when to have surgery.

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Speaker 3: That's a great question, and we evolved and gotten better

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Speaker 3: at this, and the reality is is an isolated ACL

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Speaker 3: tair without other significant maniscus or cartilage involvement or other

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Speaker 3: ligaments involved.

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Speaker 4: We typically will put patients.

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Speaker 3: In two to three weeks of rehab before their surgery,

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Speaker 3: called pre rehabilitation or prehab for shorts. What that does

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Speaker 3: is allow the swelling to go down, allows the range

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Speaker 3: of motion to be normalized, regain a little bit of

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Speaker 3: their native strengths back trying to get their knee to

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Speaker 3: move and look normal, and then somewhere around two to three,

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Speaker 3: sometimes up to four weeks, will do their definitive ACL surgery.

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Speaker 3: The purpose of that is the better their knee moves

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Speaker 3: before surgery, the better the post operative outcomes. There was

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Speaker 3: an old term, the quicker we got some of the surgery,

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Speaker 3: the quicker they got back to sports.

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Speaker 4: We've the data proved that wrong. Where we needed patients

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Speaker 4: needs to be less slow and.

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Speaker 3: Have better range of motion, and that helped them nine

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Speaker 3: to ten months down the road and they were getting

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Speaker 3: back to sports. So if they come into surgery stiff,

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Speaker 3: the bottom lines will come out.

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Speaker 4: Of surgery stiff.

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Speaker 3: So they're going to probably do to two to three

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Speaker 3: weeks of rehab in advance get their ACL surgery done.

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Speaker 3: For parsons, like many of our other patients and he'll

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Speaker 3: do great. For Patrick Mahomes, he had other associated injuries

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Speaker 3: such as the Lottle clatter ligament tear, So not only

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Speaker 3: did the injury of ACL, but his louder clatter ligament,

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Speaker 3: and those patients have to have surgery quicker. They don't

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Speaker 3: have the luxury of being in prehab. Before surgery, we

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Speaker 3: got to attack and repair the lout spotter ligament or

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Speaker 3: for exampit a bucket handle or flipped maniscus tear in

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Speaker 3: addition to the ACL. Those patients need to go much

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Speaker 3: sooner than they need to be put on much quicker.

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Speaker 3: So unfortunately they don't get the luxury of having the

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Speaker 3: prehab because the other associated injuries dictate quicker treatment.

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Speaker 4: As the bottom line for him.

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Speaker 2: Let's talk about the big picture of timeline here, because

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Speaker 2: I think a Joe Burrow suffered his knee injury in

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Speaker 2: the twenty twenty season. It was the last Sunday of

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Speaker 2: November and he was back. He played the season opener.

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Speaker 2: He had multiple tears, if my memory serves me correct.

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Speaker 2: Are we talking about something here that at least allows

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Speaker 2: for the possibility that both these guys could come back

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Speaker 2: to start the season on time?

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Speaker 3: You know, pending nothing else else else crazy, spending nothing

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Speaker 3: else crazy.

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Speaker 4: The reality is is that.

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Speaker 3: A nine month window for you know, genetically gifted professional

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Speaker 3: athletes is very reasonable. The reason nine months is the

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Speaker 3: magic term though, and magic numbers because that's when you

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Speaker 3: get the ACL that we reconstruct to get a good

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Speaker 3: blood supply, and by getting good blood supply helps reduce

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Speaker 3: that risk of RETAAR. And again learned all this through data,

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Speaker 3: and so that's still be going to be a typical

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Speaker 3: timeline you're going to see a professional athlete or collegiate

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Speaker 3: athlete return. So if you kind of march backward in time,

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Speaker 3: that does put us kind of near that start of

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Speaker 3: the season season openers for both of them, pinning, no

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Speaker 3: step backs, no other major complications.

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Speaker 2: Doctor Adam Metzler from Ortho CINCI is with us. Let

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Speaker 2: me ask you about Trey Hendrick said, and this has

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Speaker 2: been a saga now for weeks where you know, we've

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Speaker 2: heard back injury, we've heard pelvic injury, we've heard sports hernia.

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Speaker 2: His season is over because he has had core muscle surgery.

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Speaker 2: I don't know that I have ever heard of this procedure.

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Speaker 2: What is core muscle surgery?

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Speaker 3: Yeah, and there's a little bit of variation to these,

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Speaker 3: but there's a lot of semantic terms that go along

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Speaker 3: with this, and so just to kind of dispel some.

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Speaker 4: Of the myths, So core core muscle surgery is really the.

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Speaker 3: Term that the surgeons that we like to use for

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Speaker 3: sports hernia, and that's the term more frequently used. This

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Speaker 3: is not an abdominal hernia or an enguinal hernia where

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Speaker 3: something is bulging through. Most people know are familiar with

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Speaker 3: england or hernias. These are spots hernias. But the term

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Speaker 3: they want us to really use and promote is core

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Speaker 3: core muscle injury or core surgery when necessary. So what

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Speaker 3: this is is essentially for high level athletes like hockey

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Speaker 3: players and basketball and football players are doing a lot

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Speaker 3: of twisting and cutting essentially get whole of their abominal muscles.

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Speaker 3: There's six pack muscles if you will, off of the

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Speaker 3: pelvis or off the pubis and we can get these

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Speaker 3: partial tears. And the reality is that a short period

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Speaker 3: of physical therapy is tried, but oftentimes if unsuccessful, we

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Speaker 3: go in and try to repair those directly back down

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Speaker 3: to the bone and the pubis there.

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Speaker 1: What sort of timeline are we looking for for Trey.

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Speaker 3: You know, if you look at what they said six weeks,

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Speaker 3: six weeks is when the initiation of you can try

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Speaker 3: to do sports specific function.

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Speaker 4: But most of the time it's close to the three months.

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Speaker 3: For an athlete, it's full go, full participation and can

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Speaker 3: do whatever they want. Sometimes, again, very genetically gifted athletes,

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Speaker 3: they can have a little bit increased recovery or decrease

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Speaker 3: recovery time, I should say, But you know, somewhere between

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Speaker 3: eight and twelve weeks I think is not unreasonable. So

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Speaker 3: obviously they're not going to see him this year at all,

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Speaker 3: but moving forward, whether he's with the Bengals or not,

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Speaker 3: he should be ready to go for you know, spring

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Speaker 3: back to.

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Speaker 2: All right, one more, and this might be kind of

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Speaker 2: a stupid question. So the Bengals had five players have

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Speaker 2: to leave the game on Sunday with different injuries. I

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Speaker 2: don't know that any of them are being looked at

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Speaker 2: as serious. But the common denominator on Sunday was it

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Speaker 2: wasn't just cold, I mean it was it was obscenely cold.

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Speaker 1: Right, And so again this may be a stupid question, but.

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Speaker 2: Is there a greater risk of for lack of a

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Speaker 2: better way of putting in typical football injuries when the

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Speaker 2: temperatures are in the single digits and wind chills are

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Speaker 2: below zero.

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Speaker 3: I think there's there's not a great study that says

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Speaker 3: that except for the skiing world.

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Speaker 4: Because we've looked at this before.

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Speaker 3: The professional skiers have a higher risk of even recreational

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Speaker 3: skiers have a higher risk of atl injuries associated with

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Speaker 3: colder temperatures and different snow conditions. But there is an

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Speaker 3: increased risk overall of injuries in colder weather because you

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Speaker 3: have decreased muscle elasticity and the temperature effects the joints

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Speaker 3: where you don't quote field a joint as well, you

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Speaker 3: harmy would. So in general, there is an increased risk

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Speaker 3: of overall injuries muscle sprain, strains, tears. You know, coldest

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Speaker 3: game and what I think was the coldest game in

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Speaker 3: Bengals history that we just had this past weekend, So

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Speaker 3: definitely see what can happen with that too, with the

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Speaker 3: number of injuries we had. The other caveat to that

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Speaker 3: is we're at the end of the seasons. We do

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Speaker 3: see increased injuries towards the end of seasons in professional

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Speaker 3: sports as there's a fatigue factor that plays in as well.

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Speaker 1: Makes sense.

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Speaker 2: Awesome insight is always Doctor Adam Mesler from Worthos Sincy.

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Speaker 2: Appreciate the time, man, thanks so much.

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Speaker 4: Always a pleasure, Thanks for having me.

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Speaker 2: All right, there you go, Doctor Adam Mesler from Orthos Sincy.

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Speaker 2: I say it every week because it's true. The great

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Speaker 2: thing about Ortho Sincy is they have specialists and locations

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Speaker 2: all over the Tri State. This includes walk in orthopedic

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Speaker 2: urgent care weekdays from nine a m. To nine pm

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Speaker 2: and Saturdays nine am to one pm at both Edgewood

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Speaker 2: and Anderson. It's easy because you do not need an

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Speaker 2: appointment and it's most definitely cheaper than going to an

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Speaker 2: r Whenever you have an urgent orthopedic injury God orthosinc.

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Speaker 1: Dot com. That's Ortho c I n c Y dot

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Speaker 1: com