Health
Dissecting the Torn ACL, Sports’ Most Devastating Injury
From Derrick Rose to Markelle Fultz, here’s why the injury is gruesome and took the career of many.
Due to the nature of the game, injuries are almost inevitable in the NBA and one of the most common injuries is an injury to the ACL. In a span of one week, Thomas Bryant and Markelle Fultz suffered a torn ACL injury and are likely to miss the rest of this season. Plenty of NBA athletes have suffered ACL injuries since the 1970s. For some athletes, it can be career-ending; for others, it can delay their progress and create a sense of insecurity regarding their future.
What is an ACL injury?
The anterior cruciate ligament, or ACL for short, is one of the ligaments in the knee. The knee joints are formed between the thigh bone (Femur), the shin bone (Tibia), and the kneecap (Patella). All the bones are connected to each other by four primary knee ligaments and the ACL is one of them. The ACL holds the knee from too much back and forth motion and prevents the tibia from sliding out in front of the femur.
ACL injuries happen when the ligament is stretched beyond its capacity and results in a sprain or tears to the tissue. There is a varying degree of severity in ACL injury, measured from grade one to three. Grade one means the ligament has sustained mild damage and is slightly stretched but can still keep the knee stable. Grade two stretches the ligament to the point where it becomes loose, this is often referred as a partial tear of the ligament. Grade three is most commonly referred to as a complete tear of the ligament, the ligament split into two pieces and the knee joint becomes very unstable.
Why is it common in the NBA?
ACL injuries are common in the NBA due to the nature of the game, the mechanism of the injury is often associated with sudden deceleration combined with cutting, sidestepping, pivoting maneuvers, and awkward landings. The majority of ACL injuries occur through non-contact mechanisms and rarely happen from contact with another player or object. When the ACL tears, an immediate pop sound will occur followed by pain and swelling will begin to occur after three to six hours following the injury.
Can NBA players come back after an ACL injury?
The prognosis of ACL injuries depends on the severity of the tear. ACL injuries can potentially have a lasting effect on an individual’s career and force players to change their style of play. For example, Derrick Rose’s main asset was his athleticism and after recovering from his ACL injury, his shots around the rim dropped and he wasn’t getting to the free throw line as much.
There is some study about how ACL injury affects the future of NBA players. The 2009 study by Busfield et al. compared the player efficiency rating (PER) of NBA players before and after an ACL reconstruction. Twenty seven players were included in this study. From the 27 players studied, six players didn’t return to play in the NBA, four players had an increase in PER, five players had their PER change by less than one point, and 12 players had their PER decrease by more than 1 point.
The study of Mai et al. in 2019 demonstrated the average number of days NBA players take to return to play after an ACL reconstruction is 424 days, longer compared to NHL and MLB players. 85% of NBA players returned to play after an ACL reconstruction. This study also showed that NBA players’ performances decreased significantly in one year post-reconstruction but their performance tends to increase in season two and three post-injury.
In the Kahlil et al. case control study in 2020, 11.8% of 68 NBA players re-rupture their ACL after the primary reconstruction. The main finding in this study was that NBA players who did not sustain a re-rupture had significant reductions in workload after returning to play, while players with revision surgery post-ACL reconstruction maintained or increased workload from their baseline preinjury. Workload management after an ACL reconstruction may be an important consideration for NBA players to take and warrants additional evaluation.
Treatment of ACL Injury
Like every other muscle and ligament injuries, the RICE (rest, ice, compression, and elevation) treatment should be followed. The grade of severity can only be examined through an MRI test. If the ACL is torn then surgery is the most common option. The ACL can’t heal completely on its own or be sutured because the ACL has a very limited blood supply and the suture procedure has a high post-op recurrence. Surgery is required for the reconstruction of the ligament by grafting another tissue. The most common grafts are autografts using another part of the body, such as the tendon of the kneecap (patellar tendon) or one of the hamstring tendons. Sometimes the quadriceps tendon from above the kneecap is used. Another choice is allograft tissue, which is taken from a deceased donor. ACL surgery is usually done by making small incisions in the knee and inserting instruments for surgery through these incisions, known as arthroscopic surgery. In some cases, it is done by cutting a large incision and performing open surgery on the knee. Post-ACL reconstruction, the patients need to wait for the swelling to disappear, regain knee motion, and rehab the leg muscles that suffered muscle atrophy from the lack of use.
Notable NBA players who suffered ACL injuries
Derrick Rose
Derrick Rose became the youngest MVP at 22 years and 6 months old in 2011 and joined Michael Jordan as the only Chicago Bulls player to receive the award. In the 2012 playoff game against Philadelphia 76ers, Rose injured his left knee while trying to jump and an MRI later revealed that Rose tore his ACL. After the injury Rose sat the entire 2012–13 season despite already returning to full contact practice in Jan. 2013.
Rose never became the same player again after the injury, his stats decreased and later he was injured multiple times in multiple locations, never playing more than 70 games a season. Despite his decreased production, Rose is still an above average player when healthy and averaged 16.8 points and 4.7 assists per game in 317 games since the 2013 season.
DeJuan Blair
DeJuan Blair began his professional career with the San Antonio Spurs in 2009. He was a rare case in the NBA because he didn’t have any ACL, the result of two surgeries in high school. The going theory is that the doctor wanted to repair the partial damage in the ligament but failed then over time his ACL deteriorated to the point of it disappearing. DeJuan Blair can perhaps adapt because it was a gradual change in his body that slowly happened so the other muscles and ligaments adapted to the added strain.
Blair played in 424 games in the NBA from 2009 to 2016 and averaged 6.8 points and 5.1 rebounds per game. He had a good start in his career but his role was reduced in the 2012–13 season because of the addition of Boris Diaw and the emergence of Tiago Splitter.
Kyle Lowry
Kyle Lowry suffered a torn ACL during his college career at Villanova but Lowry still has an excellent career in the NBA. In his NBA career, Kyle Lowry never suffered any other major injury and has played 914 games in the NBA since the 2006–07 season. He was also selected for six 6 All-star games. Lowry was also selected as an All-NBA third team in 2016. Kyle Lowry’s biggest achievement was when he helped the Raptors win their first NBA championship title.
References
Busfield, BT, Kharrazi, FD, Starkey, C, Lombardo, SJ, Seegmiller, J. Performance outcomes of anterior cruciate ligament reconstruction in the National Basketball Association. Arthroscopy. 2009;25(8):825–830.
Khalil, L., Matar, R., Rahman, T., Franovic, S., Abbas, M., Hessburg, L., Mehran, N. and Okoroha, K., 2020. Effect of Workload After ACL Reconstruction on Rerupture Rates in NBA Players. Orthopaedic Journal of Sports Medicine, [online] 8(11). Available at: <https://journals.sagepub.com/doi/epub/10.1177/2325967120964467>
Mai HT, Chun DS, Schneider AD, Erickson BJ, Freshman RD, Kester B, Verma NN, Hsu WK. Performance-Based Outcomes After Anterior Cruciate Ligament Reconstruction in Professional Athletes Differ Between Sports. Am J Sports Med. 2017 Aug;45(10):2226–2232. doi: 10.1177/0363546517704834. Epub 2017 May 16. PMID: 28510477.
