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An injured ACL isn't a death knell for athletes anymore

Ligament damage is more repairable these days. And the best results are seen in those who doggedly do the rehab.

July 11, 2011|By James S. Fell, Special to the Los Angeles Times
  • Gymnast Aliya Mustafina of Russia suffers a torn ACL in her left knee at an event in Berlin earlier this year.
Gymnast Aliya Mustafina of Russia suffers a torn ACL in her left knee at an… (Gero Breloer, Associated…)

Most athletic types would rather spend a month watching "Teletubbies" while reading Snooki's blog than suffer an injury. And when it comes to getting hurt, the knee is one of the worst things you can damage.

The most commonly injured knee ligament is the anterior cruciate ligament in the middle of the joint. The ACL is responsible for keeping the knee stable by preventing the shin bone from sliding in front of the thigh bone. If torn, it usually requires surgical intervention, according to Dr. Robert Bray, an orthopedic surgeon at Calgary's Peter Lougheed Hospital. It's also the injury that requires the most rehabilitation to overcome.

Unfortunately, many types of athletes are vulnerable to this dread injury, Bray told me. Usually caused by hyperextension or excessive inward turning of the knee, it affects those who play sports that involve collisions with other players or the ground — including soccer, football, basketball, volleyball and baseball — as well as sports that involve a lot of rotational motion, like tennis, skiing and gymnastics. According to the American Academy of Orthopaedic Surgeons, about 95,000 people in the U.S. tear their ACLs every year, and 60,000 to 75,000 of them end up having surgery to repair them.

The bad news, experts agree, is that there's no such thing as a full recovery from an ACL injury. But the good news is that doctors have been doing a better job of getting patients prepared for reconstructive surgery and have made the surgery as minimally invasive as possible. The result is that athletes can come out of the process nearly as strong as they were before their injuries.

Dr. Kelly Brett, the team physician for the Calgary Flames of the National Hockey League, told me that, "from my standpoint, hockey players have a 100% return rate to the NHL after knee surgery." Though there may be a dip in performance during their first year back as they adjust to their reconstructed joints, they continue to improve and still play at the elite level of their sport.

And it's not just true for hockey players. Dr. Mark Heard, the consulting physician for the Canadian Alpine Ski Team and Canadian Freestyle Ski Team, told me that the success rate for knee surgery "is in the 95% area" for all patients, from elite athletes to amateurs. "They generally return to the same level or higher after recovering from their reconstruction," he said.

One of the reasons for this is that patients now start with a "pre-habilitation program" of simple exercises and stretches to strengthen their leg muscles and get them optimized for ACL surgery, Bray told me. Cycling on a stationary bike is often recommended too.

The other big change is that technological improvements, especially in imaging technology, have made it possible to perform the surgery with extreme accuracy. Surgeons make an incision to insert a small camera into the joint, then inspect the inside of the knee on a high-resolution monitor. Surgical tools go in through other incisions, allowing doctors to remove damaged tissue and repair the ligament with a graft, which is usually a piece of tendon taken from the front of the knee or the hamstring or harvested from a cadaver. (Yuck!)

Once the surgery is over, there is a period of progressive rehabilitation exercises that start with simple bodyweight movements, progressing to things like a stationary bike and stair machines, then on to more advanced weightlifting. The length of time to recover depends on fitness prior to injury, genetics, age and determination to follow the program and persevere, but it usually takes athletes a full 12 to 18 months, Heard said.

"Going through the rehab process is very maturing for athletes," Heard told me. "It's ironic that it is often a blessing in disguise. I can think of many elite skiers who actually started training harder and they got stronger than they were pre-injury because of the experience."

I know some regular people who've not let knee surgery slow them down either. One of them is Chris Frolek, a 35-year-old registered nurse in Calgary who was playing competitive tennis when he tore his ACL in a doubles match in 2008.

Like many facing a long rehab, being off his game had a depressing effect. "I was feeling very down, but I did everything they told me to do," he said. "Staying active by doing the stretching and exercises they gave me, along with lots of time on a stationary bike, had a positive effect on my mood."

And he's keeping his spirits up with ambitious recovery goals. "I want to get into the top 100 tennis players in Canada," he told me. "I was on my way before the injury, and it's a goal I haven't given up on." He also intends to do a full Ironman triathlon before he turns 50. Completing a 2.4-mile swim, a 112-mile bike and running a full marathon is not the ambition of a man who intends to let knee surgery slow him down.

Again, the success rate for the surgery is 95% for those from all walks of life, but sticking to the rehabilitation program is key. Bray told me some patients go MIA not long after surgery, and they're only shooting themselves in the foot, er, knee.

So if you don't want your ACL injury to come between you and what you're passionate about, adopt a positive attitude and stick to your rehab.


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