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ACL Injury

In Sunday’s week 3 game against Miami, Darrelle Revis, all-pro cornerback for the Jets, injured his left knee. He fell awkwardly then grabbed his knee during a play in the 3rd quarter. Today, an MRI confirmed the injury: he has a torn anterior cruciate ligament, or ACL, in his left knee. Unfortunately, he will be out for the season, as he will reportedly undergo surgical reconstruction followed by a lengthy rehabilitation program.

The ACL plays a critical role in knee stability, and injury to it is of great concern to athletes. The ligament’s role is to resist forward movement of the tibia (shin bone) in relation to the femur (thigh bone), as well as to provide rotational control. Many reports note that Revis’s injury was a “non-contact” injury, meaning there was no impact from another player. ACL ruptures have a non-contact mechanism of injury about 70% of the time. They usually occur during deceleration, pivoting, changing direction or landing from a jump. The athlete commonly hears or feels a “pop” in the knee, which is accompanied by pain and swelling.

There is some debate about treatment for an ACL rupture, depending upon age, activity level, type of sport, associated injuries, etc. Some individuals can regain some amount of stability with rehabilitation, and can avoid surgical reconstruction. However, given the nature of professional football, an NFL player should have his ACL reconstructed if he wishes to play again. The type of activity (e.g., pivoting, cutting, changes in speed) required in football is not amenable to non-operative treatment; an ACL-deficient knee would likely have too much instability to endure these activities. That being said, it should be noted that ACL reconstruction is not a guarantee that he will be able to return to sport.

The surgical procedure for an ACL rupture involves forming a new ACL from another tendon graft. It is performed arthroscopically. Which tendon graft to use as the “new” ACL is also a subject of debate in the literature, however, the most commonly used tendons are hamstring, patellar, or allograft (cadaver tissue) tendons. The timing of the surgery after the injury depends on other factors, such as the amount of swelling or the presence of concomitant injuries in the knee, such as a meniscus tear. It is common for an athlete to undergo rehabilitation before the surgery (“prehabilitation”) to address swelling, quad strengthening, and range of motion. Post-operative rehabilitation protocols, including weight-bearing status, depend upon the type of graft used and concomitant injuries.  Goals again include reducing swelling and maximizing range of motion, strength, and balance. Lastly, the athlete needs to demonstrate readiness with functional and sport-specific activities. Progression through rehab should be individualized to each athlete, so timeframe for return to sport is variable. Maturation of the tendon graft alone takes up to 6 months. But barring any complications, Revis should be ready for football again in 6 to 9 months.

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