Roy A. Meals's "Ligaments"

Roy Meals, MD, is an orthopedic surgeon and a clinical professor of orthopedic surgery at the University of California Los Angeles. He is the author of Bones: Inside and Out and Muscle: The Gripping Story of Strength and Movement.

Means applied the “Page 99 Test” to latest book, Ligaments: Appreciating the Bands That Bind Us, and reported the following:

Ligaments has nine chapters, and the fifth one is titled Growth, Damage, Repair. It runs from page 90 to 102. On page 99 I describe phases two through four of wound healing, which is integral to understanding how nearly all tissues heal from injury. We have some intuitive understanding of the phases from watching skin abrasions, cuts, and incisions heal. Phase one (page 98) is where a blood clot forms to stop the bleeding and to initiate the chemical and cellular cascade that leads to phase two, inflammation, characterized by marked tenderness, swelling, warmth, and redness. Phase two may continue for 10 days and overlaps with phase three, repair, which lasts as long as three months. It begins by sealing the skin and continues with prolific scar formation causing the wounded area to become thickened and raised. Phase four, remodeling, overlaps with the third phase and lasts six to twelve months. During this time, the wound softens as the scar matures, the redness resolves, and near normalcy returns.

At the bottom of page 99 I write, “Nearly all ligaments heal by going through identical phases that I have described for skin where the process is easily visible. The same occurs unseen for muscle, intestine, liver, bladder, and every other tissue except bone.”

Hence, the material on page 99 is in the dead center of the book and is critical to understanding how ankle sprains and torn ligaments from head to toe heal. Leading up to this, Chapters One through Three provide the approach to this summit by describing ligaments’ discovery and their myriad functions. Chapter Four clarifies this key connective tissue’s molecular and cellular organization, which brings us to Chapter Five and the epitome on pages 98 and 99. Then on the “downslope,” Chapters Six and Seven describe common injuries, most notably ACL tears that plague many athletes, followed by other conditions, including hyperlaxity syndrome and cellulite. Chapter Eight covers ligament maladies in other animals, famously ACL tears in dogs and lameness in horses. Chapter Nine closes the book with discussions of extraordinary ligaments, such as those in contortionists, in individuals who have had artificial replacements, and exciting advances on the horizon.

Ligaments is for general readers who are curious about science and medicine--its history, present state, and future possibilities. It is intentionally non-technical and filled with case examples and analogies to make the learning palatable, even fun. So by no means is page 99 characteristic of the book’s overall light-hearted approach to the subject, yet the material it contains is critical to the overall understanding of these bands that bind us, and somebody has to do the heavy lifting. That’s page 99.

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--Marshal Zeringue