Given the recent ACL tears of Iman Shumpert and Derrick Rose and their projected multi-month recoveries, a quick review of ACL tears may be in order. We first discussed ACL tears and their rehabilitation here, here and here.
The ACL runs from the medial wall of the distal femur to the lateral wall of the femoral condyle. Its primary function is to prevent anterior translation. Should excessive translation occur, the shear stress along the ACL, the patellar ligament (also called the patellar tendon due to quirk of anatomy) would be enormous and could lead to tears or ruptures causing structural failure of the knee and leading to secondary damage of surrounding structures, most commonly the MCL and medial meniscus. Given this importance, while one can easily live with a partially torn ACL or partially torn patellar ligament, a complete tear generally leads to immediate collapse, pain & loss of power, and loss of balance & control on that side (as can clearly be seen in both videos). While this is unfortunate, it protects the athlete from further stressing the already damaged structure and risking more damage.
In the event of a total tear, surgery is the only option as no amount of rehabilitation can cause the tissue to grow together. Surgeons have two options. They can take a segment from the patient’s own hamstring or patellar ligament and graft it where the ACL used to be. The other choice would be to harvest an ACL or patellar tendon from a cadaver. Factors include the health and lifestyle of the patient. It will be interesting to see what choices the surgeons make here and how their treatments arcs follow similar or different paths.
Post-surgery, the patient is sent within 24hrs to rehabilitation. Passive range of motion is begun immediately to preserve joint function and help with tissue healing. As soon as can be tolerated, the patient is partial weight bearing (with crutches) but within 2 weeks (and hopefully less) is walking. The main goals of rehab will be to maintain terminal knee extension, increase quadriceps strength, increase strength throughout the limb (hamstring, ITB, calf, adductors), as well as balance, agility and power until the patient is capable of returning to everyday activities. Clearly Mr. Shumpert and Mr. Rose have longer rehab times given their everyday activities include jumping 10ft in the air.
While a total tear generally is associated with a 6-9month recovery time, over 90% of cases end favorably and as such, this is not necessarily the end of either’s career. Stay tuned.