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The Mount Everest of Injuries: The ACL tear

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Tiger Woods did it. So has Tom Brady. Rob Gronkowski just did it last Sunday. The list is a "who's who" in the sports world. Adrian Peterson, Michael Redd, Ricky Rubio, Derrick Rose, Lindsay Vonn, and of course....myself

It's the ACL tear, and it's the worst of the worst when it comes to injuries

What is the ACL?.... The Anterior Cruciate Ligament (ACL), is one of the four ligaments in one's knee that connect the femur to the tibia. They allow knee movement side to side and back and forth. The ACL provides 90% of the knee's stability and allows for dynamic movement such as cutting, pivoting, and lateral movement. It really isn't all that big, just over an inch in length and half inch in width. It really is amazing how something so small could be the reason so many careers end.

What happens in an ACL tear?.... How the ACL tears is really pretty common. The leg is moving in one direction while the foot is planted. This process puts undue strain on the ACL, and the ACL tears. It is most common in football, basketball, rugby, soccer, and gymnastics. The ACL tear is happening more and more to the general population and not just top tier athletes. It is becoming more and more of a "common" injury, with nearly 400,000 of them performed a year. Why so many? According to Dr. James Cole, who performed the surgery on Derrick Rose of the Chicago Bulls:

"You are seeing more high risk activities in younger people, and the amount of athleticism now is on a much higher level"

When one tears his or her ACL, one knows it. Many have said they hear a "pop" (I did) following by almost an intolerable level of pain. Within minutes, one's knee is swelling to almost the size of a grapefruit, which is the result of the blood leaving the ligament when it tore. Not only is the ACL the weakest of the four ligaments in the knee, it's the weakest ligament in the entire body. Oh.....the irony.

The Surgery.... The only way to repair a torn ACL is through surgery. The good news is that there has been great advancements in the surgery, cutting down one's rehab time. The bad news is, there is no way to guarantee that the athlete will return to his or her form they had before the surgery. In a University of Pennsylvania study, nearly 20% of NFL players who have the surgery never return to the playing field. To see the improvements in the surgery, one only has to look at the procedure in general, and the differences that have occurred over the last 30 years:

  • The "Graft".....For many years, this was the most common way to treat the ACL injury. It involved opening up the knee on both sides. A sliver of the patella tendon, which is located between the knee and the tibia, was shaved off and inserted where the ACL was. It involved drilling holes in both the femur and tibia, and weaving the graft through both holes where it was held in place with two screws. While it did stabilize the knee, there were many drawbacks. First, it created scars that resembled "racing stripes" on each side of the knee (which I proudly show off), and the screws can actually be felt under the skin. Second, it was wrongfully assumed that the entire leg had to be immobilized. Three to four months on crutches with very small movements was the preferred rehab method. What it actually did, was weaken the quad muscles and other muscles around the knee, and made recovery even longer and harder.
  • The "Mesh".... About 20 years ago, a new procedure, which is now commonplace, was adapted. It was similar to the grafting procedure in that holes were still drilled in the tibia and femur, but now it could be done with minimal scarring. Doctors make a small incision, and using the help of a camera, remove the damaged ACL and "mesh" either a silver of the patella tendon, OR the ACL from a cadaver with bone "blocks". This allows the "new" ACL to take on the traits of a true ACL in both flexibility, support, and movement. Patients are encouraged constant movement, and some are even riding an exercise bike as little as 10 days after surgery.

The Rehab.... The most brutal rehab for sports related injuries. Recovery times vary depending on the extent of the injury. Minimum of six months, with the average time being 9 to 12 months, if at all. If just the ACL is torn, then the recovery is shorter. If one has the "terrible triad" of ACL ,MCL, and meniscus tearing, the recovery will be longer. The physical rehab might be tough, but it pales in comparison to what it does to your mind.

The Mental Game.... Imagine waking up and seeing one leg being half the size of the other one. Imagine being on crutches and having to watch your teammates play the game you love. If you are young, imagine having to have someone carry your books for you and have to leave class early so you can move through the halls without getting trampled. Whatever level of athletics one may be on, or even if you aren't an athlete at all, it's the voices in your head that provides the torture of rehabbing. In my case, there was a hole in my bedroom wall from chucking one of my crutches when laying in bed. Is the reason why Adrian Peterson came back in nine months, and Derek Rose took over a year because the surgeries were different? According to recent studies, the answer is not physical, but psychological. It's killing the little voice of doubt in your mind.

What can be done to prevent ACL injuries?.... In all honesty, not much. Athletes are bigger, faster, and stronger. The torque they put on their joints and knees are greater than ever. One thing the NFL tried to do was move away from artificial turf, to either a grass field, or "field turf" because of the increased flexibility of the playing surface. With the new NFL rules of not targeting above the shoulders, the increase of defenders "going low" and diving at an opponents legs have increased, and may have led to actually more ACL injuries. It is what happened to both Dustin Keller of the Miami Dolphins, and to what happened to Rob Gronkowski last week. Matter of fact, the amount of season ending ACL injuries in the NFL this season is quickly approaching 32, which is the high for ACL injuries within one year.

The ACL injury is the Mount Everest of injuries. It is as tough mentally as it is physically



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