Soledad O’Brien thrown from horse, injures knee

CNN anchor Soledad O’Brien was injured in a horseback riding injury on Sunday. The 44 yr. old author and journalist told BV Buzz that her horse “… got spooked by another horse and ditched me. I tore absolutely everything in my knee. My surgeon said ‘impressive!’ I am on crutches now and doing physical therapy. I’ll have surgery in two weeks [Oct. 22] when the swelling goes down.” The injury couldn’t come at a worse time for O’Brien as she was just starting a book tour to promote her upcoming book The Next Big Story: My Journey Through the Land of Possibilities.  Her rep told the New York Post “The reconstructive surgery will require six to eight weeks of recovery, but Soledad won’t cancel any upcoming reporting — she’ll be using wheelchairs and assistants to keep up.”  O’brien added- “I’m trying to figure out how to walk in crutches in a gown.”

The knee is essentially a modified hinge joint located where the end of the thigh bone (femur) meets the top of the shin bone(tibia). Four main ligaments connect these two bones:

  • Medial collateral ligament (MCL) — runs along the inner part of the knee and prevents the knee from bending inward.
  • Lateral collateral ligament (LCL) — runs along the outer part of the knee and prevents the knee from bending outward.
  • Anterior cruciate ligament (ACL) — lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.
  • Posterior cruciate ligament (PCL) — works with the ACL. It prevents the tibia from sliding backwards under the femur.

The ACL and PCL cross each other inside the knee, forming an “X.”

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The ACL is the most commonly injured ligament in the knee. It can be torn when a twisting force is applied to the knee while the foot is firmly planted on the ground or upon landing, or from a direct blow to the knee, usually to the outside of the knee, as may occur during a football tackle. The most common sports where ACL injuries occur are soccer, basketball, tennis, volleyball and skiing. ACL injuries are more common in women for a variety of reasons including anatomical difference and the effect of female hormones on the joints.

The posterior cruciate ligament is most often injured by a direct impact, such as in an automobile accident or football tackle. If a cruciate ligament is injured, you may hear a popping sound, and the leg may buckle when you try to stand on it.

The cause of collateral ligament injuries is most often a blow to the outer side of the knee that stretches and tears the ligament on the inner side of the knee. Such blows frequently occur in contact sports such as football or hockey. The medial collateral ligament is more easily injured than the lateral collateral ligament. When injury to the medial collateral ligament occurs, you may feel a pop and the knee may buckle sideways. Pain and swelling are common. In addition to the ligaments,  injuries can cause damage to the lateral and medial menisci- the cartilage pads that cushion the knee.

As with most such injuries, care immediately after the injury consists of RICE therapy- Rest, Ice, Compression, and Elevation. Medical attention should be sought to thoroughly evaluate the injury. If the injury is mild, conservative management including immobilization with a knee brace and physical therapy may suffice. If ligaments or menisci are torn, surgery may be required to repair or replace the ligaments. When the ACL ligament is badly torn, it is not “repaired”- it has to be replaced, usually by a substitute graft made of tendon. The tendon can be  taken from the patient’s own patella, hamstring or quadriceps tendon, or from a cadaver tendon. Patients treated with surgical reconstruction of the ACL have long-term success rates of 82 percent to 95 percent. Recovery from such an injury will take many months, up to as much as a year.

For more information, click here to go to the Resounding Health Casebook on ACL injuries.

Mark Boguski, M.D., Ph.D. is on the faculty of Harvard Medical School and is a member of the Society for Participatory Medicine, "a movement in which networked patients shift from being mere passengers to responsible drivers of their health" and in which professional health care providers encourage "empowered patients" and value them as full partners in managing their health and wellness.

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