Every athlete, whether professional or amateur, dreads hearing a trainer or team physician say three letters in an on-field or training room: “A – C – L.” Why? Any damage to the anterior cruciate ligament (ACL) will often mean the athlete’s career or at least his season is over. Such was the case recently with National Football League quarterback Carson Wentz.
According to the sports website Bleacher Report, the Philadelphia Eagles placed Wentz on season-ending injured reserve one day after he was diagnosed with a torn ACL. At the time of his injury, the Eagles were 11 – 2, had won the NFL East Conference and qualified for the NFL playoffs.
Wentz, who is 24, went down in the third quarter of a win over the Los Angeles Rams. He was injured on a touchdown scramble that was called back on a holding penalty and remained in the game for the rest of the drive, with his final play of the year being a touchdown thrown to Alshon Jeffery.
The touchdown was Wentz’s 33rd of the season, capping what was shaping up to be an MVP-level campaign.
ESPN’s Chris Mortensen reported that Dr. James Bradley performed the ACL surgery in Pittsburgh and believes Wentz’s recovery time should take nine to 12 months.
Another surgeon, Dr. Robert Klapper told ESPN that the recovery time will be shorter for Wentz based on the how he suffered the ACL injury.
“Wentz was hit with his leg fully straight, fully extended and not flexed,” Klapper said. “Because his knee was not bent, the MCL and LCL are taut. If you are hit when your knee is flexed, you can see there’s more redundancy, it becomes sloppy. When Wentz was injured his knee was fully extended. These ligaments were taut. That’s why he was able to play four more plays.
“Less injury occurred to the knee. That’s why he should be able to come back quicker than usual.”
Wentz is finished for this year but with rehabilitation will likely return to play next season. Some athletes are not that lucky. Every year, it is estimated that 200,000 ACL-related injuries occur annually in the United States approximately 95,000 of those are ACL ruptures. Approximately 100,000 ACL reconstructions are performed each year. The incidence of ACL injury is higher in people who participate in high-risk sports such as basketball, football, skiing and soccer. Many of these athletes are amateur and seek treatment from orthopedic experts such as Dr. James Walter, an orthopedic surgeon who specializes in shoulder and knee injuries.
An Expert Looks at ACL Injuries
“ACL injuries usually occur among athletes and, in most cases, it is not a contact injury,” Dr. Walter said. “It’s usually the result of an athlete planting his foot and cutting. They typically report feeling a ‘pop’ in their knee, and within six hours, they experience significant swelling in this joint and have instability in their knee when they try to walk.
“With an ACL tear, the ligament is torn because the force applied to it is greater than its strength. This is simple physics. Unfortunately, athletes put themselves in situations where the force on the ligament is greater than its tensile strength. Planting and cutting and contact injuries in sports, such as football, are common sources of ACL injuries.”
Prevention and Diagnosis of ACL Injuries
Increasing the strength of the ACL is the best prevention against this injury.
“Strengthening the muscles around the knee and hip, decreases the pressure on the knee and so decreases the likelihood of tearing the ACL,” Dr. Walter said. “Unfortunately, even this strengthening of the ligament does not always prevent this injury.
“We diagnose ACL injuries by physical examination. X-rays can sometimes reveal an ACL injury, but in most cases, we use an MRI scan to confirm or rule-out an anterior cruciate injury.”
Treatment for This Injury
There is bad news and good news about ACL injuries.
First, here’s the bad news.
“Generally, anterior cruciate ligament injuries cannot be repaired,” said Dr. Walter. “It is not possible to sew the tissue back together and expect it to heal. This approach was used 30 years ago and it had a very high failure rate.
However, there is good news for this procedure.
“Now, we reconstruct the ligament by building a new one. That involves removing the torn ACL tissue arthroscopically, drilling tunnels in the tibia and femur and inserting a graph that is secured by a screw.”
An Injury with a Gender Bias
Dr. Walter noted a difference in the incidence of the injury among the sexes.
“The literature suggests that ACL injuries are more prevalent among women than men,” he said. “For example, a female soccer player is six times more likely to tear her ACL than a male athlete playing the same sport. We don’t really know why this is the case, but research is ongoing, and female soccer players are one of our main targets for our injury prevention program.
“If the knee injury does not involve a tear in the ACL, the standard treatment includes rest, application of ice, over-the-counter or prescription anti-inflammatory medications and, in some cases, bracing is used to help the patient recover faster. Part of this rehabilitation involves at-home exercises that are typically taught by a physical therapist.
“Normally, we don’t allow the athlete to return to his or her sport until they have full strength and a complete range of mobility.”
If you or a loved one has experienced a knee injury and are concerned about damage to an ACL, contact us at the referral line of Texas Health Spine & Orthopedic Center and set an appointment with a participating physician member specializing in knee injuries.
Physicians who are members of the referral program practice independently and are not employees or agents of THSOC.