Saturday, January 31, 2015

The evolution of ACL injuries

Not long ago, ACL tears were the greatest fear of an athlete. In 2012, Adrian Peterson of the Minnesota Vikings nearly broke the NFL rushing record less than one year after the injury. How has surgery and rehabilitation come so far?

The evolution of ACL injuries

There are several theories as to why this may be the case, some of which may not be so obvious.
There are several theories as to why this may be the case, some of which may not be so obvious.

We all have heard someone talk about their ‘trick knee’ they hurt in high school football, or the stories of players losing their college scholarship due to a knee injury. So how does Adrian Peterson return in less than a year and just miss the NFL rushing record?  Let's look back and see how we've gotten from there to here—from career-ending setbacks to near-record setting comebacks.

An online search reveals little specifics when looking for career ending knee injuries. This may be because the injury kept players from ever having a recognizable career. Joe Namath was one of a few players to have a successful career in early days of ACL injuries. Namath had a brace made especially for him that allowed him to continue to play without surgery. Back then, surgery was almost always career ending due to the procedure itself and the poor rehabilitation afterwards.

It wasn't until the 1970s when Temple physician Dr. Joe Torg first discussed the Lachman's test for assessing an ACL injury. In the 1980s the MRI helped us to diagnose an ACL tear. Around this same time, arthroscopy was first used for knee injuries. Since then there has been an evolution in both the surgery itself and the subsequent rehabilitation.

Surgery has gone from using a button outside the skin as an anchor for the ACL graft to bioabsorbable screws for anatomical reconstruction. Rehabilitation has also progressed from being casted for 6 weeks to riding a stationary bike the next day following surgery. These advances in surgery and rehab are what allow exceptional athletes the opportunity to return to same level of play in such a short period of time.

But players like Adrian Peterson are the exception and not the norm. In reality it takes a year or more to fully recover from ACL surgery. And even Peterson has not fully recovered as evidenced by some physical measurements and teammates' reports. Now when players suffer career ending injuries it is not solely due to the ACL, but multiple ligament injuries or articular cartilage damage.

New surgical and rehabilitation techniques are allowing players to return to pre-injury levels of competition—but only through months of hard work. In the past, surgery ended careers. Now it allows extraordinary athletes to return in such short periods of time, and average athletes to eventually return to the sports they love.

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Justin Shaginaw, MPT, ATC is an assistant athletic trainer for the U.S. Men’s National Soccer Team. Arthur Bartolozzi, MD, is Director of Sport Medicine at Aria 3B Orthopaefic Institute.

Read more Sports Doc for Sports Medicine and Fitness.

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J. Ryan Bair, PT, DPT, SCS Founder and Owner of FLASH Sports Physical Therapy, Board Certified in Sports Physical Therapy
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Ellen Casey, MD Physician with Drexel University Sports Medicine
Desirea D. Caucci, PT, DPT, OCS Co-owner of Conshohocken Physical Therapy, Board Certified Orthopedic Clinical Specialist
Michael G. Ciccotti, M.D. Head Team Physician for Phillies & St. Joe's; Rothman Institute
Julie Coté, PT, MPT, OCS, COMT Magee Rehabilitation Hospital
Peter F. DeLuca, M.D. Head Team Physician for Eagles, Head Orthopedic Surgeon for Flyers; Rothman Institute
Joel H. Fish, Ph.D. Director of The Center For Sport Psychology; Sports Psychology Consultant for 76ers & Flyers
R. Robert Franks, D.O. Team Physician for USA Wrestling, Consultant for Phillies; Rothman Institute
Ashley B. Greenblatt, ACE-CPT Certified Personal Trainer, The Sporting Club at The Bellevue
Eugene Hong, MD, CAQSM, FAAFP Team Physician for Drexel, Philadelphia Univ., Saint Joe’s, & U.S. National Women’s Lacrosse
Julia Mayberry, M.D. Attending Hand & Upper Extremity Surgeon, Main Line Hand Surgery P.C.
Jim McCrossin, ATC Strength and Conditioning Coach, Flyers and Phantoms
Gavin McKay, NASM-CPT Founder/Franchisor, Unite Fitness
Kevin Miller Fitness Coach, Philadelphia Union
Heather Moore, PT, DPT, CKTP Owner of Total Performance Physical Therapy, North Wales and Hatfield, PA
Kelly O'Shea Senior Health Producer,
Tracey Romero Sports Medicine Editor,
David Rubenstein, M.D. Team Orthopedist for 76ers; Main Line Health Lankenau Medical Center
Robert Senior Event coverage, Sports Doc contributor
Justin Shaginaw, MPT, ATC Athletic Trainer for US Soccer Federation; Aria 3B Orthopaedic Institute
Thomas Trojian MD, CAQSM, FACSM Associate Chief of the Division of Sports Medicine at Drexel University
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