Recent Forum Topics › Forums › The Rams Huddle › what IS the timeframe on ACL recoveries?
- This topic has 13 replies, 2 voices, and was last updated 10 years, 2 months ago by InvaderRam.
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August 25, 2014 at 8:25 pm #5114znModerator
Everything I read about knee rehab before now said that they had revolutionized it. That the prognosis was they come back sooner. In fact, one analysis of RG3 said that part of the problem there was that Shanahan didn’t believe it and held him back when he shouldn’t have.
Now for the first time in this entire process we are hearing that coming back before 18 months is a MAJOR RISK?
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Do a search. I challenge people to find anyone saying that about Bradford or RG3 BEFORE this week, going back months.
In fact, don’t you think someone would have picked up on that if THAT were the discourse? A reporter, national or local; a poster here or there on at least one of the many boards out there? Don’t you think we would have noticed someone saying that and kicked it around?
There was nothing. The idea that him coming back in the time frame he did was a MAJOR RISK is all completely new.
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August 25, 2014 at 8:28 pm #5115InvaderRamModeratori believe the nfl wants us to believe that it has been revolutionized. and it may have.
but i have every reason to believe that the nfl brings back players earlier than they really should.
every single article i read has said that the first year back carries a huge risk for a re-tear. why is that? probably because it’s in its initial healing period. wait two years. and the probablity goes down. there’s a reason for that.
- This reply was modified 10 years, 2 months ago by InvaderRam.
- This reply was modified 10 years, 2 months ago by zn.
August 25, 2014 at 8:31 pm #5116znModeratori believe the nfl wants us to believe that it has been revolutionized. and it may have.
but i have every reason to believe that the nfl brings back players earlier than they really should.
every single article i read has said that the first year back carries a huge risk for a re-tear. why is that? probably because they’re coming back too soon. wait two years. and the probablity goes down. there’s a reason for that.
I didn;t get that from the NFL, invader! Those of us who read up on knee rehab were bringing it in from all kinds of sources.
That is the discourse that was out there, believe me, and the NFL did not control it.
August 25, 2014 at 8:35 pm #5118znModeratorInvaderRam wrote:
i believe the nfl wants us to believe that it has been revolutionized. and it may have.but i have every reason to believe that the nfl brings back players earlier than they really should.
every single article i read has said that the first year back carries a huge risk for a re-tear. why is that? probably because they’re coming back too soon. wait two years. and the probablity goes down. there’s a reason for that.
I didn;t get that from the NFL, invader! Those of us who read up on knee rehab were bringing it in from all kinds of sources.
That is the discourse that was out there, believe me, and the NFL did not control it.
Heck this is the discourse as of just a week ago…from a 101 post:
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injury expert says Jake Long’s return is normal
http://theramshuddle.com/topic/injury-expert-says-jake-longs-return-is-normal/edit/It’s here, at about 7:50 in. ACLs used to take 12-18 months and are now 6-8.
This is completely normal now, and the innovation was rehab. They’ve completely revamped the rehab process. So there is nothing new about this.
Long is ready to go, it’s real.
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Will Carroll joined Kevin Wheeler to talk about a new break through to prevent arm injuries like Tommy John, biomechanics increasing around MLB, the Cards having yet to adopt biomechanics, recovery from ACL injuries, and shoulder injuries with QB easier than pitchers.
August 25, 2014 at 8:36 pm #5119InvaderRamModeratorthen why are re-tears so frequent in the first year?
why?
you really think if the majority of re-tears happen in the first year that the knee has fully healed? it may have been revolutionized, but we know for a fact the nfl brings back players when they’re not completely healthy.
August 25, 2014 at 8:40 pm #5121znModeratorthen why are re-tears so frequent in the first year?
why?
you really think if the majority of re-tears happen in the first year that the knee has fully healed? it may have been revolutionized, but we know for a fact the nfl brings back players when they’re not completely healthy.
So far, this is all we have. ONE ARTICLE said that, and then didn’t provide any examples. One that came out AFTER Bradford. (And I challenge anyone to find one that says it BEFORE. If that was part of the sports medicine discourse on this, no one from informed fans to local and national reporters knew it before Saturday.)
In fact off the top of your head name a single NFL player who had a re-tear in the last few years.
So right now, as two lay people not medical people chatting about sports, we actually really don’t know to what extent that’s true or not.
August 25, 2014 at 8:43 pm #5122InvaderRamModeratorand to be completely honest, doctors have an agenda too.
let’s take professional athlete x.
he goes to doctor a who tells him yes i can do the surgery and get you back on the field within a year.
he then goes to doctor b who tells him yes i can do the surgery but it will take two full years before you see any competitive action.
they then see adrian peterson come back in less than a year.
who do you think they’re gonna take their business to?
people rarely take the time to do the real research. most times they probably don’t even want to hear it.
August 25, 2014 at 8:51 pm #5123znModeratorand to be completely honest, doctors have an agenda too.
let’s take professional athlete x.
he goes to doctor a who tells him yes i can do the surgery and get you back on the field within a year.
he then goes to doctor b who tells him yes i can do the surgery but it will take two full years before you see any competitive action.
they then see adrian peterson come back in less than a year.
who do you think they’re gonna take their business to?
people rarely take the time to do the real research. most times they probably don’t even want to hear it.
I think there’s something to that, and this all bears discussing.
It could be that the knee industry in sports medicine re-tuned its message after Saturday. Because it was different before Saturday, at least near as I could tell. I am not THE most informed Rams geek in the universe, but I do hear stuff when it’s out there. And before Saturday, the message was different.
BTW the guy who say re-tears happen in year 1 also said this about Bradford:
http://theramshuddle.com/topic/acl-re-tears-are-more-common-in-the-first-year-back-on-bradford/
Given this injury is likely isolated, I believe Bradford still has an excellent chance to return despite the longer odds.
Now remember that’s the same guy who said that a 2nd operation leaves a higher risk of re-injury (though he did not put a number on it…and he said that recovery from a first ACL was the case 95% of the time).
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August 25, 2014 at 8:57 pm #5124InvaderRamModeratorwell this is an article on second acl surgeries and why they fail.
one other thing i want to add. a lot also depends on the extent of damage. bradford’s was isolated meaning the other ligaments and cartilage were apparently intact. so he has that going for him. alexander’s injury i believe was not isolated. it probably looked like a plate of spaghetti in there.
http://news.wustl.edu/news/Pages/22661.aspx
Sports medicine specialists at Washington University School of Medicine in St. Louis are leading a national study analyzing why a second surgery to reconstruct a tear in the knee’s anterior cruciate ligament (ACL) carries a high risk of bad outcomes.
More than 200,000 ACL reconstruction surgeries are performed each year in the United States, and 1 percent to 8 percent fail for some reason. Most of those patients then opt to have their knee ligament reconstructed a second time, but the failure rate on those subsequent surgeries is almost 14 percent.
The Washington University group has received a $2.6 million grant from the National Institute of Arthritis and Musculoskeletal and Skin Diseases and is leading dozens of surgeons across the nation in one of the largest orthopedic, multicenter studies ever conducted. The MARS study (Mutlicenter ACL Revision Study) is comparing surgical techniques and analyzing outcomes for patients undergoing ACL surgery to learn why a subsequent reconstruction is more likely to fail than an initial ACL repair.
“If I reconstruct the ACL in your knee, and you go back to sports, and three years later you pivot on a basketball court and tear it again, that subsequent surgery often does not have results equal to the original surgery,” says Rick W. Wright, MD, the MARS study’s principal investigator. “In a previous study, we found that the strongest predictor for a bad outcome after ACL surgery was whether that surgery was the initial reconstruction or a subsequent procedure.”
Wright, professor of orthopaedic surgery, co-chief of Washington University’s Sports Medicine Service and an orthopedic surgeon at Barnes-Jewish Hospital, has helped recruit 87 surgeons from 52 centers to participate in the MARS study. All are sports medicine specialists who are members of the American Orthopaedic Society for Sports Medicine. Surgeons involved in the study include both academic physicians and those in private practice.
During ACL reconstruction, surgeons sometimes replace the torn knee ligament with a ligament transplanted from a cadaver. In other cases, the surgeon will move a piece of the hamstring muscle or the patellar tendon and attach it in place of the torn ligament.
Wright and his colleagues are recruiting patients for the MARS study who have a second tear of the ACL. They plan to enroll 1,000 patients at the various centers around the country and follow them for at least two years to identify predictors of problems after surgery.
Surgeons will note the condition of the knee and how the original surgery was performed to see whether that predicts problems with a subsequent operation. They also will make note of the surgical technique initially used and whether the ACL graft used in the initial reconstruction came from a cadaver, from the hamstring muscle or from the patellar tendon.
Surgeons also will compare rehabilitation techniques and whether particular approaches are related to better, or worse, outcomes. Patients also will be surveyed about their knee function, the general state of their health and their quality of life before and after a second ACL surgery.
Those participating in the MARS study must be older than 12, but there is no upper age limit.
“By definition, most of the people in the study will be active,” Wright says. “ Most are athletes who want to continue to compete, but the study also is open to those who just need knee surgery so they can get back to work.”
The ACL plays a crucial role in our ability to cut, jump, twist and change directions. Even in people who don’t compete in sports, ACL tears are related to having a knee give out, and when that happens, says Wright, it can damage the knee’s meniscus, the rubbery disc that cushions the knee and keeps it steady. If the knee gives out it also can tear cartilage in the joint, contribute to arthritis and increase the risk that an individual will someday require total knee replacement surgery.
August 25, 2014 at 9:00 pm #5125InvaderRamModeratorhere’s some more articles. i think the basic gist is they don’t know much. which is often the case in science. they just don’t like to admit it.
and these kinds of injuries are hard to study because there are so few athletes like professional ones who are constantly subjecting their joints to undue stress.
adrian peterson is the exception. not the rule.
http://www.sciencedaily.com/releases/2013/07/130711084135.htm
August 25, 2014 at 9:16 pm #5127znModeratorhere’s some more articles. i think the basic gist is they don’t know much. which is often the case in science. they just don’t like to admit it.
and these kinds of injuries are hard to study because there are so few athletes like professional ones who are constantly subjecting their joints to undue stress.
adrian peterson is the exception. not the rule.
http://www.sciencedaily.com/releases/2013/07/130711084135.htm
Well the question is, though, what were people saying about the rehab process, risks, and time to recovery around BRADFORD.
And again I am not the best informed Rams fan out there, but I am pretty decent, and I never once saw anyone offer anything but strong endorsements of the new rehab process.
No one that I ever saw picked up on the more cautious view of it.
And that was whether or not the people talking were associated with the NFL or not.
Now let’s say your one article is the be all and end all. Why weren’t those considerations part of the discussion?
Go back to any and all discussions of OTAs here or elsewhere. Anywhere, really. It was all yeah he’s on schedule yeah he has no effects from the knee etc. No one said “but he’s at risk for another 10 months.” Not fans, not reporters, not the team, not anyone in sports medicine who spoke up within my hearing.
On top of it, the guy I posted today you keep referring to said that recovery works 95% of the time.
I am not sure how AP is an exception if it works 95% of the time.
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August 25, 2014 at 9:34 pm #5129InvaderRamModeratorthose discussions weren’t part of the consideration because doctors in the end are businessmen. they’re interested in their bottom line. their interests are often in making the patient feel as positive about their experience as they possibly can. did the doctors go over all the possible scenarios with bradford? did they tell him the risks of a re-tear and the prognosis if it did happen?
the professional athlete. and any patient for that matter. wants better treatment. they want it faster. and they should. but doctors are always going to tow the line between acceptable risk and getting as many patients and cash as they can.
my sense is that they still don’t know a lot about acl surgeries. the wash u article is from 2011. this second article is from 2013. and the sense that i get is that they are still learning about the rehab process. what is most effective? what is the recovery time? they have an inkling. but no concrete answers. my guess is that after 3 years, they still don’t know much. they know more. but still learning.
now is this what they want the public to know? is this what they want the patient to know? that they still don’t know a lot about it? most likely they’d rather keep the patient in the dark and be as positive and reassuring as they can. it’s in THEIR best interests to be that way. and pretty soon we’ll all hear about another success story, and we’ll forget about all the risks of coming back too early.
i’m being too harsh i realize. i’m not trying to paint some dark evil picture. i’m sorry if it’s coming across that way.
and that statement about ap. that was overboard. but i still stand by my opinion that it sounds like to me. the recovery period should be longer. but the public and the athletes want faster and better and doctors and trainers probably feel obliged to comply.
August 25, 2014 at 9:57 pm #5145InvaderRamModeratorbut yeah. going back to my ap statement. that was wrong. 95% are a success. so that’s not the exception. i was going overboard. but again. maybe not enough attention was focused on the possibility of failure. what is the recovery rate then? i’m sure the doctors went over this with bradford.
in the end. sam is a competitor. and he was probably thinking i can do it. 5% is an acceptable risk to me. well now. he’s that exception. now what is the prognosis for recovery for that second tear?
the one article said 14%. but again. most people don’t get the best surgeon to do their reconstructive surgery so maybe it’s even lower than that. and that doesn’t take into account if the injury was isolated or not. and most people probably don’t go through the extensive rehab process that these athletes do. but if sam wants to be sure of a complete recovery. he better take the two full years to recover. which seems to be the best option at this point. anytime you have to go in a second time. you’re doing more damage. healing of that area is going to take longer than before. so if two years is ideal for first reconstructive surgery, then second reconstructive surgery should be longer than that. and even then. how long is that joint going to last? i read somewhere that acl surgeries last on average about 10 years. well. is that for professional athletes or just the general population? if it’s for the general population, then for professional athletes, it goes way down i’m sure.
August 25, 2014 at 11:05 pm #5161InvaderRamModeratorhere’s another article i found interesting. i’ll just include one part but provide the link. i wonder if bradford has narrow notches. i wonder in general how strong his ligaments are. he’s had three severe ligament injuries already in 5 years.
http://www.txsportsmed.com/acl.php
Are certain athletes predisposed to the injury?
Dr. Souryal: My study was the first to describe the link between bony anatomy and ACL tears and to describe the way of measuring it. We found that a certain segment of the population has a bone structure that predisposes them to an ACL tear. The ACL and posterior cruciate ligament (PCL) live in a tunnel at the end of your thigh bone. If that tunnel is very narrow (which you can detect by X-ray), then there’s no room for the ACL to maneuver in cutting activity, and those people are at 26 times more risk of tearing an ACL.
In 1992, we took X-rays of 1,000 high school athletes’ knees and followed them for the next two years. Whenever a player went down with an ACL injury, we looked at his notch. And it was phenomenal: The kids who were blowing out their ACLs all had those narrow notches. We stopped the study early because the numbers were so dramatic. I’m sure that there are a lot of factors that go into ACL injuries — the notch is just one of them — and the biggest question right now is, what lives inside the narrow notch? Does a small ACL live in a narrow notch and tears because it’s never had the room to grow properly? Or does a normal-sized ACL live in the small notch and ruptures because it doesn’t have the room? We don’t have answers because we’re not doing surgery on uninjured people and measuring their ACLs.
As a next phase, we’re waiting for MRIs to get a bit clearer to allow us to measure the normal ACLs in the notches. Maybe in the next couple of years, we’ll be able to answer the question. If it is a normal-sized ACL in the notch, then maybe we can go in there surgically and widen the notch, and perhaps save that person from an ACL rupture. But if it’s an underdeveloped ACL in that narrow notch, you can widen the notch all day long and you’re not going to fix it. Once we get this question answered, maybe we can do something about people with the predisposition.
In ’92, we found that girls have proportionally narrower notches than boys. Does that have anything to do with the fact that ACL injuries are epidemic among females? I don’t know, but I certainly do think that it’s one factor. Other factors have to do with muscle development and neuromuscular coordination, because the boys are encouraged to be active athletically almost from birth. They may develop better neuromuscular coordination and therefore are somewhat protected as they get into high school and college. Girls are not necessarily directed into athletics early in life, and as they become more athletically active in their teens, they may not have the neuromuscular coordination that boys have. The bottom line is that nobody knows for sure. But there’s definitely a higher incidence of ACL ruptures in female athletes than in male athletes.
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