Undoubtedly one of the worst sports injuries that someone can have is a
torn ACL. The ACL is the stabilize of the knee. It runs up
and down in the front middle of the knee.
Years ago, this injury was career ending. However,
surgical advancements have led to a remarkable 98% return to sports.
While many are not 100% afterwards, they do get back to the point where
they can play.
Such a recovery rate is not without its price. The price
is
a long and grueling recovery period. Those who have gone through
it
claim it is the most difficult thing they have done. HOWEVER,
with
proper therapy and rehab, the knee can become functionally sound and
athlete
can return to playing. So if you were injured, be prepared for a
long
recovery, but remain confident that you will make it back.
ACL injuries most commonly happen to football or basketball
players who are hit from the side of the knee. The injury is also
too common in skiers and soccer players who make abrupt cuts.
Perhaps the most famous in Western New York is the Bob Lanier injury
when St. Bonaventure was in the Final Four in 1971. In April of
2000 my brother Pat tore his ACL. I put these links together for
him, but thought that they might
be of interest to others as well so posted them. The very large
number
of hits suggested that there was a great deal of interest so I
left it up. However, from Danny Manning to Willis McGahee
to Shaun Bryson to Lee Evans to my brother Pat, one need not look far
to see someone who has had the
injury and has come back.
As Drew Cartersaid after rehabbing
his torn ACL: "The thing about it that people forget is that torn
ACLs don't
really take your speed away," said Carter. "Speed doesn't come from
your knees. It comes from your hamstrings. It comes from your quads,
your hips. So basically, my speed never went away. It was just a matter
of getting my knee strong."
Things to remember
It is not a preferred injury! No one want to
tear their ACL. If it happened to you, I offer you my
sincere
sympathy. If it happened to someone you care for, please realize
that
this is a hard time for him/her. However, it is not
a
death sentence! Reread the above: 98% return to sports! New
procedures
(for both the surgery and the rehabilitation) are making dramatic
improvements
in the ability to recover from this injury. If you listen to your
doctor
and do the rehab, the odds are that you will make it back. However, be
forewarned, it will not be a fun experience.
Causes
Almost all ACL injuries are caused by severe trauma (either
a sharp cut, fall, or twist) of the knee. This often happens when
you go one way and your knee (often due to someone falling on it) goes
the
other way. That said, some people seem more prone to the injury.
Research into the causes of ACL tears suggest that a small area
between the bones
of the knee (a small notch) may be a strong predictor of the injury,
but
that said there appears little that can be done to prevent the injury
from
occurring. Additionally there is evidence that
females may be more prone to the injury . This may be because
of the
angle of the knee, improper technique , and/or
undeveloped quadricep muscles . For this reason, I would
strongly urge all athletes to
strengthen quads in a way of reducing your risk.
For more on what causes the injury check out
Informationtherapy.org .
After the Injury
Doctor selection
While you will know you damaged your knee, you may
not know the severity. So you will need to go to the doctor.
My best advice in this area (indeed in all areas of any injury)
is to get a
good doctor. Ask around. Go to local gyms, races, or local
sports
teams and ask who is the best at knee surgery. You want someone
who
is both up-to date on the injury, experienced, and willing to work with
you
to get you back to your normal activities.
Tests and should you have surgery?
Your doctor will determine the severity of the
injury and prescribe a course of action.
InformationTherapy has the best description of what to expect when
you are examined by the doctor. The tests (CRI, MRI, and XRays)
are all designed to determine what happened inside of your knee.
Once that is determined, then alternative treatments can be
considered. You may or may not need surgery. It depends on
what you want from your
knee.
Both WebMd
as well as
Information Therapy do a great job of laying out your decision by
giving the risks of having the surgery versus the risks of doing
nothing.
Nutshell view: if the injury is severe and/or if you plan on stressing
the knee later, you will likely want the surgery. However, others (see
Thurman Thomas) have experienced great success without the surgery.
If surgery, then when?
If you do opt of surgery, the first decision
you and your doctor will have to decide upon is whether to have surgery
immediately or to wait until after a period of pre-surgery rehab.
As this WebMD
article suggests good things sometimes comes to those who wait:
"according to
K. Donald Shelbourne, MD, an orthopedic surgeon at the Methodist
Sports
Center in Indianapolis, the main key to quick recovery from an ACL
injury
is to not rush into surgery. "It's important for the patient to
prehabilitate
first," Shelbourne tells WebMD. The patient must then begin physical
therapy
immediately after surgery, including repetitive knee motion. Shelbourne
describes his program for quick recovery from ACL injuries in...The
Physician
and Sportsmedicine."
I know people who have had surgery immediately and also others
(including my brother who is an MD) swear by waiting. Best
advice? Ask your
doctor.
The Surgery
For you, the actual surgery will be the easy part.
You can sleep through it :)
But seriously, what will happen? More than likely your injured
ligament will be replaced (sometimes they are fixed, but that is much
less common). It will be replaced with either a part of your hamstring,
a part of recycled from somewhere else in your body (patella tendon),
or even from a cadaver. Newer treatments are also trying synthetic
ligaments . Stay tuned.
WebMD has a great description of the surgery. Highly
recommended!
Recovery and rehab
Now the fun begins! Or something like that.
Generally you will be laid up for a few days at
home. Most doctors recommend you start rehab as soon as possible.
Even
if it just means moving your feet in small circles. Again, bets
advice: ask you doctor but be ready to do things from the beginning.
Rehab
DO IT!!! Do your rehab. It
infuriates me when people do not. Yes it will hurt, yes you will
get
bored, yes it takes time. That said, do it!!! It is your leg and
nothing
will influence your recovery more than this rehab. You will need
to
get motion back and rebuild strength.
Your mileage may vary, but within 3-4 months you should be
jogging, biking within a month or two after that. Playing
sports will be a while longer (at least 6 months, probably 9 months),
but be patient. Take the time to learn more about your sport,
or
take up another sport (swimming, lifting, etc) to keep you active when
you
are on the sidelines.
NFL scouts have a general rule say it takes a year to get
back and two years to be back to full speed. That said, each case
is unique but it does take time.
Personal Stories
So what will it be
like? What way better to find out than to ask some who
have had it.
A very complete
site from a professor in Florida (Stetson). It has many links
and a Chat board
(recommended) to have others answer your questions as to what to expect
in both surgery and recovery. And links to
others who have had the surgery .
Geff (yes with a G) has an interesting journal and also
some other links.
Crista gives us a look at the
first few days after her surgery along with the difficulties faces
(including trouble standing up from
toilet)
"
Dr. Gary " shares his surgery (even with a video!) and recovery.
He stresses the importance of visualiization in his recovery.
Interestingly this is
a case where his doctor did want the surgery, but it was very
successful.
Ron seems
to be getting good at it. He has had three knee surgeries.
(no he does not have three knees!) GREAT SITE!
Jimbo has a great knee site that includes many more links to
personal stories!
Pat (my brother). No he does not have a site, but
several people have asked. He is doing fine. He is back to
playing basketball and bikes or runs daily. Now lives in
Ohio so I do not see him as much but whenever we do get together we run
and he is in excellent shape.
Professional Advice and Coverage
This article from WebMD
contains a good description of what happened and how it will be
repaired and why preoperative waiting seems to speed recovery.
This WebMD article has probably the best
graphics of what is torn and how it fits in with the rest of the
knee.
ACL injuries more common in athletes with
narrow notch by Allan Liew, MD.
Long term study that updates prior work in field of meniscus and post
operative arthritis. Good news , previous studies appear too
gloomy. That said, doctors should try to save as much meniscus as
possible. (note the meniscus is also torn in approximately 60% of
ACL tears.) By Donald Johnson MD.
Surgery to save the Meniscus has come a long ways. Now some
doctors are doing meniscus grafts and allografts. (a review article by
Ira Kirschenbaum, MD and Alan Liew, MD)
Bob Lanier
Jerry Rice NFL Hall of Famer Bonzi Wells NBA Willis McGahee of the Bills (first round pick 2003)
Carson Palmer-NFL star QB of Bengals
Jamaal Anderson of the Falcons
Danny Manning fomer NBA
Baron Davis NBA Nene (Hilario) NBA
Al Harrington (NBA)
Danny Earl formerly of Penn State
Lee Evans WR, Buffalo Bills (#1 pick of team in 2004, top receiver 2006-2007)
Manny Martin, Shaun Bryson, Tony Driver Former NFL
Jarrett Stephens of Penn State (soon to be NBA)
Bernard King formerly of the Knicks (who was first player to come back and make All Star team)
Floyd Wedderburn
Ron Harper Former NBA
Philadelphia Flyer Defensman
Eric Desjardins
Many many others, but I am out of
time. Email me
others and I will include them. I know the list is enormous.
USAToday reports that 80,000 people tear their ACL each year!