Do Torn ACL's really need surgery? (1 Viewer)

[Matt Waldman]

Link

I understand that time missed might influence NFL ramifications if this study bears out, but keep in mind that two years is generally when a player is back to "full health," so the time gap is virtually nil in that department. Interesting stuff.

I believe Hines Ward doesn't have an ACL in one knee.

 

[steelcityman]

true, Ward is without an ACL.

 

[Winky the tunnel ferret]

Interesting. I'm missing my acl in one knee but I'm not a professional athlete. I get around just fine for the most part.

 

[ATC1]

For lineman and less mobile QBs I have no idea why the surgery can not wait at least until after the season. Depending upon pain levels and ability to wear a brace.

However, there are a number of reasons to just have the surgery if you are relying on cutting.

1. It is not often that a knee has an isolated ACL tear only especially in high impact high velocity sport like football. A lot of ACL tears has meniscus tears or MCL tears as well.

2. If there is no support given by the ligament, so muscle needs to work twice as hard a stabilizer. That takes time to have your quads and hamstrings learn how to fire to completely stabilize the joint. I think Hines Ward has to work twice as hard in the off season to keep his lower body not only strong, but he must work on proprioception everyday even during the season. Most athletes are not willing to work that hard on a daily routine.

3. Braces are bulky and slow down an athlete at such a high level. There are times that the brace is not effective at all.

4. The chances of your knee buckling again on a route greatly increases. When it happens again you have no resistance from the femur sliding along the tibia, so the chance of damaging the other structures greatly increase. If this is ignored the chances of needing serious microfracture surgery increases and would either make you sit out longer or can end your career right there.

5. Psychologically athletes are different, but i would say players without the ACL and know the risks involved hold something back compared to when they return with a reconstructed ACL.

 

[jude]

too long didnt read.

 

[Doug B]

Brian Westbrook is another guy missing an ACL.

Aren't there some cases where players have been missing an ACL, but they didn't know it for some reason? And it's not diagnosed until the first time their knees really get looked at by a team doctor?

 

[Dexter Manley]

Interesting, although it appears that the people who went the non-surgical route have 3 times the chance of tearing a meniscus as the people who do the surgery.

 

[Ray_T]

Also of note, it is my understanding that an ACL will not heal the same way other ligaments do, so depending on how serious (ie. fully torn or partial tear) it is more likely that you will need surgery for an ACL than it would be for say... an MCL. Especially if other muscles/tendons are damaged because they would be counted upon to stabilize the knee when the ACL is gone.

Ward may well be playing without an ACL, but his knee problems will get worse with age. right now, he is young enough that he can work out his knee to keep the muscles strong to a point where the knee is stable. As he gets older, he will lose muscle mass (even if he works out) and the knee will become more unstable as time passes. The loss of muscle mass happens to everyone as they age and working out can slow it down, but will not prevent it from happening. The fact he has No ACL will make it substantially more difficult for him when this happens.

I would not be surprised to see him 15 years down the road walking with a cane or in a wheelchair unable to walk. Of course, another surgery may be able to help him at that time, but I cannot say for sure. for further clarification, you would likely need a doctor to explain it.

 

[GreatLakesMike]

Thanks Matt. That was interesting.

 

[Lash]

not if you are cutting a bunch

coach a HS team and many times the athlete will "Brace up" and try to make it through the season if they are not college bound athletes because it is their last hurrah,

but the scholly ones get the surgery every time, too much to risk not to

 

[ShaqAttaq]

not everybody's knee is stable without the ACL. as was already posted, the presence of other concurrent injuries complicates this as well.

 

[Matt Waldman]

For lineman and less mobile QBs I have no idea why the surgery can not wait at least until after the season. Depending upon pain levels and ability to wear a brace.

However, there are a number of reasons to just have the surgery if you are relying on cutting.

1. It is not often that a knee has an isolated ACL tear only especially in high impact high velocity sport like football. A lot of ACL tears has meniscus tears or MCL tears as well.

2. If there is no support given by the ligament, so muscle needs to work twice as hard a stabilizer. That takes time to have your quads and hamstrings learn how to fire to completely stabilize the joint. I think Hines Ward has to work twice as hard in the off season to keep his lower body not only strong, but he must work on proprioception everyday even during the season. Most athletes are not willing to work that hard on a daily routine. From what I remember, he didn't even know that he lacked one. Is that possible?

3. Braces are bulky and slow down an athlete at such a high level. There are times that the brace is not effective at all. I don't think the article implies that a player should just strap it up and play for two years. I think the research talks about those that rehab without surgery and the process takes about as much time as it does for a guy with surgery to get healthy enough to be back at a high level, not healthy enough just to play.

4. The chances of your knee buckling again on a route greatly increases. When it happens again you have no resistance from the femur sliding along the tibia, so the chance of damaging the other structures greatly increase. If this is ignored the chances of needing serious microfracture surgery increases and would either make you sit out longer or can end your career right there.

5. Psychologically athletes are different, but i would say players without the ACL and know the risks involved hold something back compared to when they return with a reconstructed ACL.

 

[ATC1]

For lineman and less mobile QBs I have no idea why the surgery can not wait at least until after the season. Depending upon pain levels and ability to wear a brace.

However, there are a number of reasons to just have the surgery if you are relying on cutting.

1. It is not often that a knee has an isolated ACL tear only especially in high impact high velocity sport like football. A lot of ACL tears has meniscus tears or MCL tears as well.

2. If there is no support given by the ligament, so muscle needs to work twice as hard a stabilizer. That takes time to have your quads and hamstrings learn how to fire to completely stabilize the joint. I think Hines Ward has to work twice as hard in the off season to keep his lower body not only strong, but he must work on proprioception everyday even during the season. Most athletes are not willing to work that hard on a daily routine. From what I remember, he didn't even know that he lacked one. Is that possible?

3. Braces are bulky and slow down an athlete at such a high level. There are times that the brace is not effective at all. I don't think the article implies that a player should just strap it up and play for two years. I think the research talks about those that rehab without surgery and the process takes about as much time as it does for a guy with surgery to get healthy enough to be back at a high level, not healthy enough just to play.

4. The chances of your knee buckling again on a route greatly increases. When it happens again you have no resistance from the femur sliding along the tibia, so the chance of damaging the other structures greatly increase. If this is ignored the chances of needing serious microfracture surgery increases and would either make you sit out longer or can end your career right there.

5. Psychologically athletes are different, but i would say players without the ACL and know the risks involved hold something back compared to when they return with a reconstructed ACL.

RE:#2 - I suppose, but as an athlete I find it hard to believe he has not felt a difference. What I do know is that some people are born with loose ligaments. This is the people that can pull their thumbs back to their wrist. If you are born with an unstable knee from lose ligaments your muscles can adjust at a very early age to help stabilize the joint better. Or he might have torn his at a very early age. RE#3 - There are braces that claim that it does support the knee like an ACL. I have not been convinced. If the rehab in the article takes the same time both ways I don't understand the point of the thread then. If rehab is the same time it would make sense to have the reconstruction for reasons stated above.

 

[vandyt]

Elway played his entire career without an ACL in one knee, correct?

 

[Soaring Eagle]

this study looked more short term than long term - unable to tell what happens after 2 years

 

[FreeBaGeL]

While I know everyone hates the "I know a guy" routine, one of my buddies tore his ACL years ago and couldn't afford the surgery and his knee is nowhere near the same. He's fine walking around and doing any day to day activities, but when playing sports he can only move in a straight line. Cutting is out of the question.

 

[JetMaxx]

Just had ACL replacement surgery 2 weeks ago Friday. I injured my knee playing football last October, got the MRI which showed the ACL tear but no damage to the other components of the knee, including the meniscus. The doctor said I was very fortunate in that repsect as most often there is meniscus damage in an ACL tear. Over time the swelling went down, I regained strength in the knee, and was able to do 90% of normal activity without issue. It felt somewhat unstable running but I was able to play inline hockey without any problem, even the demanding position of goalie and not have any apparent pain or subsequent swelling. But definitely no cutting sports. As I said, I finally went through with the surgery and while in there the surgeon found that I had damaged my meniscus in the time since the MRI, likely from the other activities I had subjected the knee to without a structurally sound ACL.

Point is that who knows how much more damage I would have done to the joint without the ACL over time. The meniscus tear surely was a precursor to long term continued issues with the knee if I didn't get the ACL repaired. I know it's worse case/hypothetical scenario but I didn't want to have to get knee replacement surgery in 20 yrs knowing that it could have been prevented by having the ACL repaired. That fear is what motivated me to get it repaired and the surgeon's finding once in there confirmed to me that I made the right decision.

 

[twheeler]

While I know everyone hates the "I know a guy" routine, one of my buddies tore his ACL years ago and couldn't afford the surgery and his knee is nowhere near the same. He's fine walking around and doing any day to day activities, but when playing sports he can only move in a straight line. Cutting is out of the question.

I can do better (worse?) than "I know a guy" with "I am a guy". I tore my ACL celebrating after a triple play in a non-competitive co-ed softball game (ugh, ugh, double ugh). I was back to playing basketball with a lame brace about 4 weeks later. My legs muscles were in excellent shape, and I could go weeks without problems, but occasionally would cut just the wrong way, my knee would wobble, and I'd be out of commission for a week or two. The torn ACL wasn't even diagnosed for the first year, and I kept that up for almost 6 years ... but by the end of that time, my knee would give out just walking around the house if I stepped off to the side at all. After ACL replacement, I was in decent shape 6 months later, but didn't feel fully recovered for well over a year.So from one guy's anecdote: I was able to keep playing athletically for 6 more years, but eventually had no real choice but to get surgery. That said, playing rec-level basketball isn't quite the same at running around with (and getting hit by) pro athletes.

 

[zed2283]

Elway played his entire career without an ACL in one knee, correct?

I believe this is true. I also remember hearing that Thurman Thomas didn't have one either.