Returning to Sport after ACL Injuries

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MRI image of a ruptured anterior cruciate ligament (ACL)

As an orthopaedic surgeon in Louisville, KY, I try to keep up with any injuries to local sports figures for many reasons.  I am a fan and I have the same concerns as most other fans:  How will these injuries affect the team and, more importantly, how will they affect my chances of being able to celebrate and gloat later in the season?  Since sports medicine is a large part of my practice, people often ask me for my input or my insight into how long I think they will take to recover.  If you live in Louisville, then you probably know that most conversations eventually find their way to the topics of University of Louisville football or basketball, depending on the time of year.  There have been many notable injuries here in Louisville in recent seasons, and it seems that there has been an epidemic of anterior cruciate ligament (ACL) ruptures.  Since ACL injuries are a particular interest of mine, I wanted to discuss a few of these from a sports medicine point of view, because they each have unique qualities that make them different from one another.

Let me say that I am in no way involved in the medical care of any of these athletes and I have no special inside knowledge of their specific injuries.  All of my information comes from released reports regarding their injuries.

Let’s start with Kyle Bolin, the high school senior QB at Lexington Catholic who has committed to the University of Louisville. He was injured in his game on Friday, and he confirmed through his twitter account today that his left ACL was torn. This is a first time ACL injury for Bolin, so what are his chances of returning at full strength?  There is a lot in the orthopaedic literature on this topic, and the numbers are not as promising as I’d like to see. Depending on the study, most show that somewhere between 60-70% of players at the high school, college, or professional level return to their previous level of play.  About 40% of athletes after an ACL reconstruction perceive that they are not functioning at the same level as before their injury. Obviously, it is difficult to quantify things such as work ethic, drive, etc. that can factor into an athlete’s outcome, and today’s ACL reconstruction techniques are better (at least we believe they are) than they were just 10-15 years ago when most of these studies were performed. There are numerous examples of players who return and seem to never miss a beat, for instance Adrian Peterson for the Minnesota Vikings who came back only 9 months after his ACL injury to start in Week 1 of the NFL season. I have no doubt that Bolin will work extremely hard in his rehab and I hope he comes back as strong as ever.

The other player in the news this week is Mike Marra, the UofL shooter who was only minutes into his first full-speed team practice since tearing his ACL last fall, when he re-injured the same knee. Coach Rick Pitino confirmed on his radio show this week that Marra in fact had torn the ACL in the same knee and was likely finished with his basketball career. There have been players who return from multiple ACL injuries in the same knee, but the percentages are low.  The most recent and notable of which that comes to mind is Robbie Hummel, the Purdue Boilermaker who, much like Marra, re-tore his ACL very early in his return to practice after his ACL reconstruction the year before.  He was able to return for a successful senior season and is currently playing professionally in Spain.  Unfortunately, Hummel is the exception and not the rule. Just as I said earlier when discussing Bolin’s ACL injury, the chances of returning at the same level are not as close to 100% as anyone wants them to be, and it is clear from studies that the outcomes of revision ACL reconstruction (a second procedure for a re-torn ACL) are worse than after a first time surgery.  Marra will have several factors to consider in his decision of whether or not to return to basketball, such as the severity of his injuries, his long-term goals, and his willingness to submit himself to another round of rehab.

A teammate of Marra’s, Rakeem Buckles, has had a different kind of ACL experience.  Buckles tore his ACL in his right knee in February of 2011, and then shortly after coming back tore the ACL in his left knee in January of 2012.  A similar but slightly more involved case is the Louisville WR Michaelee Harris, who worked through non-operative ligament injuries in both knees at different times, missing a full season, only to subsequently tear the ACL in both knees in less than a year’s time as well. The statistics show that after tearing an ACL, there is an increased risk of not only re-tearing the same ACL but an increased risk of tearing the other ACL.  A year or more after the initial surgery, the rates of tearing the ACL in either knee are almost equal. Why is that?  There are many contributing factors, but the clearest are anatomic pre-dispositions that are the same in both knees, biomechanical factors (type of jumping and landing, pivoting, etc.) that affect both knees equally, and relying on the “good” knee more after an ACL injury in the opposite knee.

ACL injuries are unfortunately a common occurrence in sports at all levels. As a fan, they can ruin your year.  As an athlete, they can threaten your career.

For more information about ACL injuries and their treatment, visit my ACL page.