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ACL Injuries and Re-Injuries

Graft in place running from 10:00 to 6:00 position.
Graft in place running from 10:00 to 6:00 position.

We recently tweeted about Lindsey Vonn’s re-injury of her surgically reconstructed ACL (anterior cruciate ligament). It’s still too early to tell how she will bounce back from this latest injury, but it gets harder and harder every time that joint is injured. Unfortunately, this is an all too common story. And worse yet, it’s even more common in high school athletes.

Women are 8 to 9 times more likely to tear an ACL than men are and they are also more likely to suffer a re-injury after surgery. Variations in surgical technique and rehab protocols make it difficult to quote accurate numbers, but best estimates put the rate of re-injury at about 10 percent taking all comers. There are many factors that can lead to re-injury after ACL surgery, but the most likely is just bad luck. No surgeon is perfect and reconstructed knees, while pretty close, are never as good as they were before the injury. That means that athletes are at least as likely to re-injure a knee as they were to tear the ACL in the first place. And those factors are beyond the control of the surgeon, trainers, therapists, coaches and athletes. Its the nature of sports.

But recent research has shed some light on certain factors that can contribute to the rates of re-injury. As ACL surgery became more commonplace around 25 years ago, it quickly became fashionable to try to shorten the rehabilitation following surgery. Accelerated rehab programs became very popular and based on the success of these programs, patients were eager to return as quickly as possible. New research has recently shown that return to sports in less than 6 months is associated with higher rates of re-injury to the ACL graft, whereas return after 9 months reduces that same risk. Additional studies have shown that smaller graft size and the use of allografts (cadaver donor tissue) also increase re-tear risks.

Another important factor to keep in mind is that most of us are not Adrian Peterson or Robert Griffin! In other words, AP and RGIII can bounce back incredibly quickly, but you probably can’t. Why (besides the obvious fact that they are in the top 1% of the best 1% of athletes in the world)? Because it is rare to have access to the constant attention of trainers, therapists and doctors that these elite athletes have. It is even harder to devote the time that paid professionals can to their rehab. They are able to cram 1 year of typical rehab into 6 months because they don’t have to worry about things like work, school, chores, and other obligations.

Finally, partial ACL tears are a tough problem to deal with. The ACL is really an all or none ligament. It either works or it doesn’t. If it doesn’t work, it usually needs to be reconstructed in high level athletes. That doesn’t mean that everyone who suffers an ACL tear needs to have surgery. But the instability associated with a torn (even partially) and non-functional ACL can cause other problems in the long run for that knee.

Good luck to Lindsey! We hope she can bounce back quickly!

If you have questions about your ACL or need an opinion on how best to handle your injury, call our office to make and appointment at 201-493-8990

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