• Wes Blackett

The Curious Case of the Surgery-Free ACL Injury

You probably don't even have to be a big sports watcher to know just how significant an anterior cruciate ligament (ACL) tear can be to a person. There are a variety of famous names which could be thrown around as examples of careers that have been affected following this injury:


Nic Naitanui

Michael Owen

Tiger Woods (That guy again!)

Tom Brady

Wayde van Niekerk


...The list could go on. Typically a player rupturing their ACL causes the athlete to be out for 9-12 months, in a typical situation. In that time, a player will typically go through a pretty significant surgery followed by gruelling rehab that looks to improve knee flexibility and strength, before going on to balance work designed to improve the way the athlete lands, changes direction etc.


I'm not going to be focussing on that side of things too much today - rather, I thought I would look at a journal article that I came across, which paints a very different picture.


The Anterior Cruciate Ligament


There are 4 main ligaments we tend to focus on in the knee: The medial collateral ligament (MCL), lateral collateral ligament (LCL), the posterior cruciate ligament (PCL) and of course, the anterior cruciate ligament (ACL).


All of these ligaments are important, but you might have heard more about the MCL and ACL simply because they are more likely to be injured and have a far greater impact on an athlete's physical abilities.


Have a look at the animation below to see how the 4 ligaments work to give stability and support to the knee - you can stop watching at 1:30:


As the video briefly states, ACL injuries tend to occur following a twisting force over a bent knee; there does not need to be a huge amount of impact with another player in fact, the more innocuous that the injury looks, it is generally a pretty good predictor that the injury is an ACL rupture (and therefore serious). Have a look at the video of Brodie Smith injuring his ACL playing Ultimate Frisbee:


Around the 30 second mark you see the "perfect" combination of a bent knee, twisting over a fixed foot whilst attempting to change direction. Looks minor, but these movements put a huge amount of stress on the ACL and in Brodie's case, clearly took the ligament beyond breaking point.


Athletes typically descibe a popping sensation, before saying that the knee feels very unstable and "just doesn't feel right" when walking.


What Happens in the Study?


Published in 2015, the case study I am discussing today describes a 32 year old international footballer playing in the English Premier League. It is mentioned that this player was playing a significant role for one of the bigger clubs in the league.


During a league match, they suffer a complete ACL rupture and are sent off to see 2 separate surgeons. Both surgeons tell him that he needs surgery in order to repair the ligament (seems reasonable!).


Rather than taking the surgical route and losing a year towards rehab at the end of his career, this player decides he does not want to do this but rather wants to treat the injury conservatively (without surgery).


Following 8 weeks of dedicated rehab, the article describes how this player was able to return to full sporting activity with no noticeable side-effects to his playing ability. The authors note that they did an MRI after 18 months, just to be sure the ACL hadn't repaired itself!


Who is Yossi Benayoun?


I want to make this clear - I actually don't really know who this journal article is talking about, because the authors keep the case study anonymous (as they should). However, by working backwards from the date of journal publication to the approximate time that the injury might have occurred, I found that Yossi Benayoun sustained a knee injury halfway through a premier league match for West Ham whilst on loan from Chelsea. He was 32 at the time of the injury.


Time away because of the injury? 8 weeks.


An Israeli International, at his peak Benayoun was really good. As a Newcastle United fan, I certainly didn't enjoy watching him play against us! Have a quick look at the video below (just ignore goal 19!):


Needless to say, Benayoun was a phenomenal player and to think that he may have suffered a completely ruptured ACL and continued to play for years afterwards flies in the very face of what we tend to think of when it comes to these kinds of knee injuries!


What Can We Learn From This?


Does this all mean that the next person you know who suffers a serious ACL injury should just ignore the surgical option and play C2 grade basketball again next week? Of course not.


What I think we can take from this case study though, is the importance of not treating any one injury the same as the next. Do not think that because you have the same diagnosis as someone else, that you should expect to be treated the exact same way.


Another point to take away is the incredible power of an individualised, relevant exercise program in rehabilitating from even the most serious injuries. The author of the research paper makes a point where he says that they think that because the player had such a big role to play in the exercises he was doing, it likely improved his results in the program!


If you feel like your previous injury never really recovered fully, but at the same time you know you never really stuck to the exercises program prescribed, this may be something you want to think about! Have your physio look over the program and tweak it so that is specific to what you want.


Before making big decisions in regard to surgery and rehab, I would encourage anyone reading this to consider all their options and to weigh up the pro's and con's of each. Just because one path is easy or hard, does not necessarily make it the right or wrong path to choose!


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If you would like to have a read of the article that I have been referring to for yourself, it is available free through the link below:


http://europepmc.org/articles/pmc4422908



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