ACL Questions

[MilfordHusky]

Both Azzi and Aubrey have had 2 ACL tears. Do we know if the tears were both to the same leg or to different tears? If a surgical repair is done perfectly, is the new ACL more susceptible to another tear, less susceptible, or the same? Is anyone familiar with the medical literature on multiple ACL tears?

 

[cancontent]

No idea as to how many tears, same leg, etc., but these are a bunch of hard questions to answer if you ask me.

This could be a thread that goes off the rails really quickly with a lot of guesses that leads to nowhere.

 

[HuskyNan]

No idea as to how many tears, same leg, etc., but these are a bunch of hard questions to answer if you ask me.

This could be a thread that goes off the rails really quickly with a lot of guesses that leads to nowhere.

Ya think?

 

[cancontent]

Ya think?

Ya, I know I'm stating the obvious but these threads never seem to go well.

 

[BBallF]

Well, there is a lot of information on the internet. According to one study, non-contact injuries to a prior ACL graft area accounts for 55% of all reruptures which may or may not include Aubrey. The incidence of the injury in general is highest amongst football players, female gymnasts and female basketball players. The recurrence rate is between 1-11%. The data used to show that the incidence of recurrence was significantly higher among women athletes but a recent study disputes this since football players were included. My daughter had 3 of them, 2 contact ones in basketball and a third non-contact one in lacrosse. The rehab is very difficult. Not enough is being done about prevention though. The focus should not just be on treatment when some careers may already have ended.

 

[MilfordHusky]

Well, I referenced medical literature. I’m giving the Boneyarders the benefit of the doubt on this one.

 

[DocStressor]

There is substantial literature on the "recurrence of ACL injury".

Just Google the terms in the quotation.

In short, the incidence of reinjury following ACL repair is quite high.

 

[Centerstream]

Well, there is a lot of information on the internet. According to one study, non-contact injuries to a prior ACL graft area accounts for 55% of all reruptures which may or may not include Aubrey. The incidence of the injury in general is highest amongst football players, female gymnasts and female basketball players. The recurrence rate is between 1-11%. The data used to show that the incidence of recurrence was significantly higher among women athletes but a recent study disputes this since football players were included. My daughter had 3 of them, 2 contact ones in basketball and a third non-contact one in lacrosse. The rehab is very difficult. Not enough is being done about prevention though. The focus should not just be on treatment when some careers may already have ended.

Personally, I believe everything I read on the internet, especially when it comes to medical information.

 

[Jeff H]

When my daughter tore her acl when she was 19 the doctor who repaired it said it would be stronger than the original ligament ( he took the graft from her hamstring). 16 years later she's still playing competitive soccer. I always wondered if he was just being positive or was that confident in his work.

 

[HuskyNan]

Well, I referenced medical literature. I’m giving the Boneyarders the benefit of the doubt on this one.

 

[Twelve]

FYI only. No assumptions being made. No conclusions being made.

Gabby Williams tore ACL twice in right knee in high school. Practiced and played 2 games on second ACL injury.

Article from February 1, 2014 when in high school.

Knee injury worse than feared for Gabby Williams, whose high school career has ended


Article from October 16, 2014 when at UConn. Gabby thankfully did not re-injure her right knee while at UConn.

Freshman Williams Battles Back From Injury

 

[Twelve]

Well, I referenced medical literature. I’m giving the Boneyarders the benefit of the doubt on this one.

 

[Puppy Love]

Not an MD and not pretending to be one. Sue Bird tore hers once. Shea tore hers five times. I think it depends on the person and just plain luck.

 

[Twelve]

Not an MD and not pretending to be one. Sue Bird tore hers once. Shea tore hers five times. I think it depends on the person and just plain luck.

Speaking of Sue. Yikes.

she had a “loose bone” the size of a golf ball in her knee.

https://www.seattletimes.com/sports/storm/sue-bird-has-arthroscopic-surgery-on-left-knee/

 

[BRS24]

When my daughter tore her acl when she was 19 the doctor who repaired it said it would be stronger than the original ligament ( he took the graft from her hamstring). 16 years later she's still playing competitive soccer. I always wondered if he was just being positive or was that confident in his work.

My surgeon said the same. Probably the same confident dude.

 

[housekeys]

You have come to the right place for answers.

 

[maple]

I can only speak to my own opinions shaped by personal experiences. I tore my ACL during softball practice in high school (back in 2004). It was a non-contact injury. I had an MRI done and got opinions from two different doctors, both who said they could only determine if it was a partial or complete tear. Back then I know they could not determine the size of the tear if it was only a partial tear — perhaps they can now, 20 years later.

Because it was only a partial tear, it was recommended I delay surgery and just do PT and strength training for 4 months. I also had to wear a brace on my leg while doing anything athletic. I was told that that would suffice in lieu of surgery. I still haven’t had surgery to this day. I’ve never re-injured my knee, and that was with playing sports all through college.

Long story short, I assume nowadays players are just immediately having surgery done on their knees regardless of whether or not it is a complete tear. Perhaps that matters — or maybe not. I know back in 2004, I was told I should try to avoid surgery as the doctors (correctly) predicted that better surgical procedures would come along in the next decade.

I suspect that the degree of the original tear does affect the chance of re-injury, though.

 

[hoopsnloops32]

Both were two their left legs which were the legs where they had their first ACL tears in high school.

 

[AzzisBraids]

Maya Moore, Breanna Stewart, Napheesa Collier, Megan Walker and Diana Taurasi were all relatively healthy all throughout their UConn careers. No major injuries and not alot of issues. Caitlin Clark is another non-UConn example, she has just been able to stay healthy.

Sue Bird, Paige Bueckers, Kaleena Mosqueda Lewis, Katie Lou, and Aubrey Griffin battled injuries all throughout in some capacity. Some just freak accidents like Sue, Paige and Kaleena falling on her arm. Some longstanding like Lou's back and ankle and Aubrey back and knee.

Azzi Fudd is in another category. She has battled injuries since she picked up the basketball. From high school to college and that fall on her knee last season I suspect did damage that she battled through until it compounded. Her mother tore both of her ACL's and her mothers mother had knees issues.

It's a cocktail combination of genetics, luck and just plain happenstance. There are the Lebron's of the world and then the Kawhi's.

 

[LGITB]

Gonna dip my toe into this pool.... Just short background before - my wife is a physiotherapist that specializes in sports injuries and works in the Olympic clinic (ie - the main hub for rehab and research for elite Olympic sport athletes). She is also doing a PT certificate with the International Olympic Committee and, funny enough, just finished a module on ACL and knee injuries.

1. Once there is an ACL tear, the chances of a retear are high. High does not mean it will happen, but there knee is not the same, obviously. The surgically repaired is not stronger or less likely to re-tear.

2. Also important to remember, when shaving a graft from the athletes hamstring or patella tendon, you need to rehab both - the knee and the muscle/tendon that was surgically cut to provide the graft. And of course, as in an surgery, there is always a risk of added issues. For example, I know of an elite Judoka that had her ACLR surgery about 2 months ago, and now had to reopen the knee because of blood cluttering that hindered full range motion,

3. The current school of thought around ACLR (rapture) rehab is to do a conservative rehab, ie - not an operation, but let the ligament heal. There is a new procedure in Australia where the knee is kept at an ideal 90 degree angle to allow the ligament to attach, and the rehab is actually to rebuild strength and full range of motion. However, North America (and the USA in particular) is very pro operation and there was even a case of a volleyball player who had a scholarship to Div1 college, and arrived there post conservative rehab with full strength and range of motion. However, the insurance (college) would only cover her if she did the operation and she was sort of forced into doing it to maintain the scholarship.

4. While there are several empirically proven programs in sports to reduce the risk of ACLR like FIFA11 (soccer) or Boksmart (Rugby), they actually are not proven to reduce risk in basketball.

5. The length of rehab required is the same, by the way, and research has proven that the chances of successful rehab are higher the more time is given for rehab. ie an early return, specifically earlier than 9 months, would significantly hinder the chance to avoid a re-tear. Anything shorter than 9 months is not recommended (and in fact, 8 months and 4 months are similar, meaning that returning at either point has the same impact, whereas 9 months is the minimum recommended for a FULL return to play and contact).

6. Not empirically proven but is my personal opinion - ACLR is just . In all sports!

If you're very interested in learning about ACLR, I would recommend the British Journal of Sports Medicine (BJSM), or following Mick Hughes, an Australian physiotherapist that shares great stuff on ACLR (and more).

 

[BBallF]

Personally, I believe everything I read on the internet, especially when it comes to medical information.

I suppose I deserved that for the first sentence but I was summarizing a study from the Orthopedic Journal of Sports Medicine so it wasn't internet information per se. In any event, the issue is whether there will be enough rehab time for Aubrey to be cleared to play for next season. It will also depend on when the surgery takes place.

 

[cancontent]

3. The current school of thought around ACLR (rapture) rehab is to do a conservative rehab, ie - not an operation, but let the ligament heal. There is a new procedure in Australia where the knee is kept at an ideal 90 degree angle to allow the ligament to attach, and the rehab is actually to rebuild strength and full range of motion. However, North America (and the USA in particular) is very pro operation and there was even a case of a volleyball player who had a scholarship to Div1 college, and arrived there post conservative rehab with full strength and range of motion. However, the insurance (college) would only cover her if she did the operation and she was sort of forced into doing it to maintain the scholarship.

That sucks. Wouldn't think insurance would require a surgery to provide coverage. You'd think it would be the other way around, but I know that's naive of me to think that.

 

[BJLfromBK]

Work in Sports and Ortho PT myself, we are affiliated with a d1 (not at UConn level competitive) school. The previous post made a lot of statements generally regarded in the field (length of rehab, specific focus of rehab). One thing I will argue (at least in the case of my organization is that ACL repair/reconstruction isnt always "pro operation". It is suggested when the patient has intention to keep level of intensity of specific sport/activity. We instruct many non athletes that life can be perfectly lived without an intact ACL provided proper strengthening is maintained.

In an ideal world, you work for a period of time prior to surgery ("pre-hab") to strengthen and go into the surgery in a stronger/more prepared state. When dealing with scholarship athletes who want to get better as soon as possible, they are typically in great shape going in as well as knowledgeable of what needs to be done/how to do it. Its still something we focus on even with how short of a timeframe we are given.

As for Return to sport, the poster (and wife) is spot on with 9 month range minimum. There is always an extensive test performed and I imagine multiple times given the status of Uconn's program to determine the readiness of the athlete to go back to training with the team. PTs will clear the athlete based on their performance during this RTS evaluation.

You can never give a proper answer as to why the frequency of ACL injuries in the UCONN program occurs. Even if you are working with the team, there is always the possibility and "things can happen" with human bodies unfortunately. I would venture to guess their resources have provided them a phenomenal quality of care and personally would not point fingers. Rehab is never the same, even with the same injury of the same patient. Just have to address it day by day and motion by motion.

My prayers go out to these athletes and anyone recovering from injury. Its a wild journey.

 

[UconnFanDC]

My friend is the much older brother of a top 20 recruit. I am very much aware that Uconn has attended her games and have expressed interest. He informed me yesterday, that he will not allow his sister to attend Uconn because the injuries are a concern to he and another parent of a top 40 recruit. He's now leaning to SC, Maryland, VT and others over Uconn.

 

[AmeriConn]