John Rosemond: When it comes to manners, what is most important? 2D
Today
T U E S D A Y , S E P T E M B E R 21, 2004
-TALK ‘1776’ OPENING DELAYED BY IVAN Theatre Tuscaloosa’s planned opening of the musical “1776” has been delayed by Ivan, which caused cast and crew to miss technical and dress rehearsals. Instead of the anticipated opening this Friday, “1776” instead will open with a matinee
WWW.TUSCALOOSANEWS.COM
How surgeons put Brodie’s knee back together again For Alabama quarterback, procedure is becoming too familiar By Mark Hughes Cobb
performance at 2 p.m. Sept. 29. Other performances will be at
U
7:30 p.m. Sept. 29-Oct. 2, closing with a 2 p.m. matinee Oct. 3, all in the Bean-Brown Theatre at Shelton State Community College. Ticket-holders for this weekend
Semi Tendinosos
should call 391 -2277 to reschedFemur
ule.
Gracilis Tendon
END BOOK-BAG BURDEN Book bags that are too heavy
can cause muscle strain and back
pain, even sending some children
to the hospital. The September issue of
Backpacker magazine, which
reports that there were 7,000
The Gracilis Tendon can be used as a substitute for the ACL in reconstruction
Knee Cap Cartilage Patilla Tendon
The Patilla Tendon can be used as a substitute for the ACL in reconstruction
Menisci Joint
blamed on book bags in 2001,
50% of individuals who tear an ACL will damage the minisci Joint at the time of the tear.
offers tips on the correct way to
Tibia
U.S. emergency room visits
pack and wear backpacks: ■ Pack the heaviest items near
bottom of the bag, not the top. ■ Children should carry no
more than 15 percent of their
body weight. Remind children to
stash books in their lockers.
packs too low puts pressure on
the shoulders. Urge children to
Monday, Brodie Croyle underwent ACL surgery on his right knee.
Reconstruction
cinch the bag’s straps snugly
around their middle. ■ Look for backpacks with a
padded back panel, 2-inch-wide
shoulder straps and a hipbelt.
DENTAL-CARE DATES The sight of a baby’s first tooth
is exciting — at least for parents.
But now what?
Special screws with threads that insure no tearing of the tendon are used to secure the tendon once placed in the drilled holes of the bone. Some screws will dissolve in the body after the bone has filled in.
Microscopic video lens
Does the tooth get brushed?
Does the baby need to go to the
dentist? Pediatric dentist. Mina Elahi
worked with Reach Toothbrush to
develop a dental-care timeline.
She suggests a first visit to check
on tooth development when a
baby turns 1. Other important
Torn Anterior Cruciate Ligament There are two main causes for tearing the ACL. Hyperextension of the knee at more than 10 degrees past the straightened position, and an inward turn of the lower leg usually during some sort of athletic activity.
the spine — in the center and the
■ Use the straps. Wearing
SECTION D
Option 1
Semi tendinosos or gracilis tendons from the hamstring area can replace the torn ACL and be grafted into the bones. Tendons are much stronger than ligaments.
dates in dental development are:
Typical ACL reconstruction is done as orthoscopic surgery using a camera and a video screen to do most of the work. It leaves very little scarring. Tunnels are drilled into the middle of the femur and tibia bones where the tendons can be placed as a substitute ACL. As the bones fill in, the tendons become more secure.
Option 2
If a doctor chooses the patilla tendon, he will have to extract the middle two thirds of the tendon with pieces of the top and bottom bones, which will help to graft it in the reconstruction. STAFF GRAPHIC | ANTHONY BRATINA
Staff Writer
niversity of Alabama quarterback Brodie Croyle entered Saturday’s game knowing more about the anterior cruciate ligament than most folks. He left the game knowing he was about to get an updated lesson. His right knee underwent the same ACL surgery Monday that his left knee did in high school. The earlier injury, surgery and rehabilitation made Croyle miss his senior year at Westbrook Christian High School in Rainbow City. Croyle went down with the new injury while scrambling on the first Crimson Tide possession of the second half of Saturday’s 52-0 win over Western Carolina. The junior is out for the season. “Brodie’s surger y went well,” Dr. Lawrence Lemak of HealthSouth Medical Center in Birmingham told the Associated Press Monday. “I expect a full recovery and return to football.” Procedures have improved greatly since similar injuries left another Tide quarterback, Joe Namath, hobbled and in life-long pain, said Dr. H. Chester Boston Jr. of University Orthopaedic Clinic. With successful surgery and rehab, Croyle could be back for the 2005 season. “The anterior cruciate ligament is one of the primary stabilizers of the knee,” Boston said, providing about 80 percent of the knee’s stabilizing force. When an ACL breaks down or tears, the knee is prone to collapsing, causing the sufferer to fall. “If not treated, it can lead to falls and pretty serious arthritis pain,” Boston said. “Joe Namath’s probably the best, most famous example of that.” But now, with improved surgical and rehabilitation techniques, a performance athlete can sit out a season and come back strong. The torn ACL typically is replaced, although some older patients may choose to change lifestyle to avoid recreational athletics rather than have surgery. Synthetic replacements have been attempted, but the two more common methods are using the patient’s own tendon to replace the ligament, or applying an ACL taken from a cadaver. “Cadaver replacements seem to be working fine,” Boston said. “There’s no risk of rejection; it’s not like an organ, a kidney or a heart.” Equally or more common is the patellar tendon bone graft. The central third of the patellar tendon (attached to the kneecap) is harvested from the patient, and the remaining tendon is repaired. Drill guides place holes into the the bone above the knee and the bone below the knee at the attachment sites of the original ligament, which is deep in the center of the knee joint. The anatomical path is about 1.5 inches long. It’s called a cruciate because, when the ACL crosses the posterior cruciate ligament, the pair resembles an X. The harvested patellar tendon then moves into place as the new ACL. The graft is held in place with bio-absorbable
FIRST THE LEFT: Brodie Croyle missed his senior season in high school with a torn ACL in his left knee.
AND NOW THE RIGHT: Croyle will miss the rest of his junior season at Alabama with a torn ACL in his right knee. screws or metallic screws. New blood vessels can grow into the transferred graft and start the healing. A patient can start bearing part of his or her weight on crutches for the first seven to 10 days after surgery. Supervised physical therapy starts quickly, often in the second or third day after surgery. A continuous passive motion device can be applied to the post-operative leg for about two weeks. Patients use the device, which moves the knee ver y slowly, decreasing the risk of stiffness and loss of motion, while sleeping. After six to 10 weeks of supervised physical therapy, patients generally move to a self-directed program. A typical reconstructed ligament takes about nine months to heal. Of course, any and all sports involving rapid direction changes must be avoided during that period. Despite the fact that Croyle suffered similar damage a few years back, there’s no evidence of a genetic predisposition to ACL injuries … unless you count the predisposition to contact sports. “The knee is very vulnerable, particularly to football injuries,” Boston said. ACL injuries aren’t a product of cumulative stress; they generally happen quickly. “You can’t predict a tear,” Boston said. The most common ACL injuries come from a direct blow from an oncoming player, or a planted foot with most of the body thrown forward. “From what I saw, [the planted foot] is what happened to Brodie,” Boston said.
■ 18-month-olds to 3-year-
olds: Canine and first and second
baby molar teeth erupt. Parents
can begin teaching proper brush-
ing techniques. ■ 3-to-5-year-olds: All baby
teeth should be grown in, and
permanent teeth are preparing to
erupt. Continue to oversee brush-
ing of children’s teeth. Arrange an
appointment with a general prac-
titioner dentist. ■ 5 -year-olds and older:
Children lose baby teeth, and
permanent teeth begin to come
in, starting with molars. Make
sure children are brushing their
teeth thoroughly.
Nickelodeon sitcoms focus on the foibles of school By John Rogers
The Associated Press
LOS ANGELES | There’s no middle ground in Nickelodeon’s two new sitcoms set in middle school. Airing back-to-back on Sundays beginning 6:30 p.m. CDT, “Ned’s Declassified School Survival Guide” and “Unfabulous” each portray a kid making the jump from grade school — only each have diametrically opposed expectations. Ned Bigby (Devon Werkheiser) knows he will ace this new environment, armed with a survival guide he’s spent all summer preparing, while the “Unfabulous” Addie Singer (Emma Roberts) is as terminally klutzy and insecure as she is cute.
Actress Emma Roberts, as Addie Singer, appears in a scene from Nickelodeon’s “Unfabulous” in this undated promotional photograph
Although it’s hard to imagine the poised and pretty actress, who’s the daughter of actor Eric Roberts and niece of Julia Roberts, tumbling face-first into a back-to-school party punchbowl, the 13-year-old insists she really isn’t all that much different from Addie. “I can relate to how she goes through typical teen stuff, has to deal with school and, you know, crushes and family and friends,” she said recently on the set of the show. And what 13-year-old Werkheiser particularly likes about his show is “it’s so related to real-life school — except it’s exaggerated maybe 15,000 times.” Exaggerated but not unreal, said Cyma Zarghami, president of Nickelodeon SEE SITCOMS | 3D THE ASSOCIATED PRESS