Luke McCown, ACL injuries, and Podiatry

This past weekend, the Jacksonville Jaguars lost their quarterback for the season due to a torn right ACL. The ACL refers to the anterior cruciate ligament, found in the knee, and tearing it is a relatively common injury in football. (Anterior means front or forward, and cruciate simply means it runs diagonally instead of straight up and down.) So why would a foot doctor be interested in a knee injury? As I discussed here, podiatrists are more than just foot doctors. We study the entire lower extremity. While knee surgery is technically outside of our legal scope of practice, many of our patients are athletes and will suffer this injury. Besides, anatomically speaking, the knee is one of the coolest joints in the body.

The knee is marvelously complex. Unlike other joints, it is held together entirely by soft tissue—ligaments, cartilage, and muscles. The ACL is one of these ligaments, and its job is to prevent the lower leg from sliding forward on the thigh by connecting the top of the shin bone (the Tibia) to the bottom of the thigh bone (the Femur). In fact, one of the ways to test for an ACL rupture is for the doctor to pull on the shin of a person lying back to see if it slides forward.

Surgical repair is often necessary for an ACL rupture, since it will not heal on its own. This is where the podiatrist needs to pass the patient on to the orthopedic knee specialist. The repair is performed arthroscopically, meaning a tiny camera is inserted into the joint, minimizing the invasiveness of the procedure. Despite that the procedure is minimally invasive, the patient will still have many months before returning to 100%, and this is why Mr. McCown will spend his season on injured reserve.

One of the clichés of our profession is that podiatrists and orthopedists have an adversarial relationship, fighting over which group is the final authority over which region of the body. However, the truth is that we can work together to our mutual benefit. The podiatrist refers out the patients with knee injuries to the orthopedist, and the orthopedist refers out to the podiatrist patients with the foot and ankle issues. While this is an idealized picture, this sort of multi-specialty cooperation results in much better patient care.