Why is Bradford waiting to have surgery?

[Alan]

LACHAMP46 with this strange tidbit:
I've read the repair is stronger than the original ACL....I was actually surprised he re-tore the same one....

If this is true, then why are you more likely to re-injure the same ACL/MCL? I believe you're wrong about this. 97.4% sure.

Here's some stuff that might help:

Q: Is the ACL the most fragile knee ligament, or do sports fans just hear about those injuries more often?
http://sciencelife.uchospitals.edu/2012/05/01/qa-dr-martin-leland-on-acl-injuries/
The most commonly injured ligament in the knee is the MCL. But the MCL when injured in isolation, it heals very well non-operatively. So some people will be in a knee brace for six weeks and then get right back out there. Professional football, if it’s a mild injury, they might not even miss a game. People are injuring their MCLs all the time but we never hear about them, because it’s not nine months until you come back, it’s anywhere between two and six weeks.

Q: When the ACL is torn, is the treatment always surgical?

Assuming the ACL is completely ruptured, generally speaking with a cutting and pivoting athlete, especially a high level athlete, the treatment is always surgical. In patients that have a partial ACL tear where the cell fibers have been stretched but not completely torn and it’s just a little bit loose, they can usually be treated with rehab and then getting them back to sports. But if the fibers are completely torn, you usually recommend reconstruction because you can’t repair the ACL. If you try to put stitches in the ACL, they’ll just pull right through. You’ve got to actually pull that torn tissue out and put other tissue in its place, either from the patient’s patellar tendon or from their hamstrings. Occasionally, people will use a quadriceps tendon or tissue from someone who died, which is called an allograft or cadaveric tissue.

The reason why we recommend surgery is because 90-plus percent of people who have an ACL tear will continue to have instability, and if they try to get back into sports without having reconstruction, it’ll pivot out of place again. Every time the knee pivots out of place, you risk doing damage to the cartilage or the meniscus, and sometimes you can actually do damage that can’t be repaired. If you allowed Rose to continue playing, he probably wouldn’t be able to play, because every time he’d pivot on his knee, his knee would buckle, it would swell up, and he’d be done for the game. Then it will buckle again as soon as he went back on the court, and he might do more permanent damage that can’t be repaired and could lead up to shortening his playing days.

Q: What are the chances of re-injuring the knee after an ACL reconstruction? Will Derrick Rose ever be the same player again?

The treatment has changed a lot, it’s constantly changing. The way in which we do ACL reconstructions is very different, especially with where we put the ACL, from what we did even five years ago. However, it’s been a very successful surgery for quite some time. We frequently will tell patients that 90 to 95 percent of people will get back to complete activity with no problems from where they were pre-operatively. But what we’re finding now from the long-term literature is that with procedures from 10 to 20 years ago, maybe only 50 percent of people truly got back to that elite level of activity. But techniques are constantly changing, it’s been a very successful surgery for quite some time. I would even venture to say that when we look back 15 years from now, we’ll have even better results than what we had 10 years ago.

http://spectrumhealthblogs.org/you-me-and-pt/2014/02/13/dreaded-injury-olympic-athlete/
Lindsey’s re-injury to her reconstructed knee after many months of grueling rehabilitation is a perfect example of how devastating these injuries can be. It has been found that the risk of a second injury to the ACLR within the first 12 months is 15 times greater that an uninjured athlete. According to the research presented at the 2013 annual meeting of the American Orthopaedic Society for Sports Medicine, the risk of ACL injury is six times greater in the same or opposite knee for those who have already suffered an ACL reconstruction. In addition to this, a systematic review from 2011 reported that following ACLR the rate of tearing the opposite side ACL (11.8% injury rate) is double the risk of re-tearing the ACL graft (5.8% re-injury rate). That means that some studies suggest one in ten athletes are at risk of tearing the opposite side ACL following surgery – this is so eye opening!

More shockingly, a recent article published in the American Journal of Sports Medicine reported that patients younger that 20 years who undergo ACLR are at significant risk for graft re-injury or opposite leg ACL injury. They found that “1 in every 3.5 patients who underwent ACL Rand were younger than 20 years sustained a further ACL injury to either knee within a 5-year period.” These statistics are alarming!

ACL re-injury is affected by so many factors including surgeon experience, graft placement, graft type, gravest harvest site, age, physiological factors, rehabilitation and fear avoidance. I believe that more research also needs to be dedicated to look at ACL prevention programs. If we can lower the rate of injury, we will lower the rate of re-injury. Stay tuned over the next couple months for advice on joint protection and ACL prevention exercise.

 

[blackbart]

It was reported there was no swelling so that does not seem to be the reason for the delay. If he is going to come back and play next year I think it would be better to get it done as quickly as possible so that the knee has more time to heal. I don't get the delay unless he isn't sure he is going to play next year. If that is the case the Rams are screwed for another 2 or 3 years while they try to find a QB. I'm really hating that possibility.

 

[DCH]

What would be the point of doing it RIGHT NOW OMG DO IT DOITDOIT rather than in a week, or even a month? The difference is minor at that point. Let him get mentally ready, and let him deal with his shredded knee on his own terms.

 

[Thordaddy]

.

can't he just wrap some duct tape around the knee and play in week 2?

.

It's banned as a PED,performance enhancing device, NASCAR is considering a ban as well

 

[PrometheusFaulk]

When you retear the graft, sometimes they wait to see if the bone density around the graft site is strong enough to hold the new graft. If it isn't, then the surgeon has to do a bone graft first, which can delay the ACL procedure by up to 6 months. It is the main reason why ACL revision surgery only has a 60% success rate compared to 90% for the initial procedure.

Nice share, thank you.

Plus, I think I've read somewhere that a big part of the revision surgery is inspecting to see if anything went wrong with the first one before you go in.

 

[blackbart]

What would be the point of doing it RIGHT NOW OMG DO IT DOITDOIT rather than in a week, or even a month? The difference is minor at that point. Let him get mentally ready, and let him deal with his shredded knee on his own terms.

The difference is that amount of time to heal. Obviously he was not ready to play this year and a second surgery on the same tendon will likely take even more time to heal.

And your attitude can go back to the PD with you

 

[DCH]

The difference is that amount of time to heal. Obviously he was not ready to play this year and a second surgery on the same tendon will likely take even more time to heal.

And your attitude can go back to the PD with you

Aww. Didn't mean to be rude. And I disagree - I don't think a few weeks worth of healing make any meaningful difference. If Bradford had put off his return to live action until week 1 rather than preseason week 2, the threat of re-injuring his knee would be roughly the same. The only major difference is the number of snaps taken between mid-August and early September. And of course, more snaps = more chances to hurt himself, but the three weeks of extra healing is more or less irrelevant.

Edit: Just re-read my first post... what, exactly, did you perceive as "PD attitude"?

 

[Orchid]

The current course of treatment is to wait 2-4 weeks to allow swelling to go down AND to build up the muscles in the leg. Building up the other muscles is significant in excellerating tha recovery.

 

[blackbart]

Aww. Didn't mean to be rude. And I disagree - I don't think a few weeks worth of healing make any meaningful difference. If Bradford had put off his return to live action until week 1 rather than preseason week 2, the threat of re-injuring his knee would be roughly the same. The only major difference is the number of snaps taken between mid-August and early September. And of course, more snaps = more chances to hurt himself, but the three weeks of extra healing is more or less irrelevant.

Edit: Just re-read my first post... what, exactly, did you perceive as "PD attitude"?

I think the difference between the first and second surgery recovery time could be enough to make him miss the start of next season depending on how long it take for recovery. It seem obvious that he was not ready to play in the NFL when he came back the hit that took him out was about as light as they get in the NFL.


RIGHT NOW OMG DO IT DOITDOIT

 

[DCH]

I think the difference between the first and second surgery recovery time could be enough to make him miss the start of next season depending on how long it take for recovery. It seem obvious that he was not ready to play in the NFL when he came back the hit that took him out was about as light as they get in the NFL.


RIGHT NOW OMG DO IT DOITDOIT

Simple sarcasm. Sorry if it came across as an attack.

Edit: I still disagree with you. We're talking about a few weeks. If he'd gotten his original surgery three weeks earlier, I can't imagine there would have been any significant difference in his injury this year.

 

[VegasRam]

Simple sarcasm. Sorry if it came across as an attack.

Edit: I still disagree with you. We're talking about a few weeks. If he'd gotten his original surgery three weeks earlier, I can't imagine there would have been any significant difference in his injury this year.

I

It was obviously sarcasm.

 

[blackbart]

Simple sarcasm. Sorry if it came across as an attack.

Edit: I still disagree with you. We're talking about a few weeks. If he'd gotten his original surgery three weeks earlier, I can't imagine there would have been any significant difference in his injury this year.

Blue font is the sarcasm format. Appology accepted

3 weeks probably would not have had much affect on this year but if he waits much longer to have this surgery done he will be in no better shape next year.

 

[DCH]

Blue font is the sarcasm format. Appology accepted

3 weeks probably would not have had much affect on this year but if he waits much longer to have this surgery done he will be in no better shape next year.

If it wouldn't have had much of an effect this year why would it next year? And I'd like to think obvious sarcasm would be recognized without the use of font colors.

 

[LACHAMP46]

Yeah it makes me think that the site where the graft is attached might not have healed up as strong as it should. Not much Bradford can do about that.

Kobe route...go sweeden or go home....

 

[iced]

That's my guess. What a grueling process. He could start any time in the next couple of months and still be ready for camp, I'd imagine.

2 surgeries back to back is brutal, especially when its the same area...granted ACL is much worse, but i had an acromioplasty done on my right shoulder (cut open my shoulder,shaved the bonespurs out and supposedly a minor rotator cuff tear)...that was about a year recovery or so...rejoin command, deploy - 1 month in I tore the bursa sack in the same shoulder..least that surgery was quicker since it was arthroscopic (and a much better surgeon)...but that downtime and rehab process twice sucks, but not as bad the second time because you have a better idea of whats coming.

really feel for bradford

 

[Alan]

DCH having learned something new:
I'd like to think obvious sarcasm would be recognized without the use of font colors.

There are a lot of things I'd LIKE to think.

Sarcasm: the use of words that mean the opposite of what you really want to say especially in order to insult someone, to show irritation, or to be funny.

The purpose for having and using blue font is twofold.

1) It's unmistakable that you don't mean what the words say.
2) (This one is even more important) That you're not really trying to say that what the other poster is saying IS stupid and you are HUMOROUSLY disagreeing with him/her.

Sarcasm by itself is usually NOT complimentary or funny but using blue font, while not necessarily funny, can never be mistaken as derogatory.

 

[LACHAMP46]

If this is true, then why are you more likely to re-injure the same ACL/MCL? I believe you're wrong about this. 97.4% sure.

Here's some stuff that might help:


Q: When the ACL is torn, is the treatment always surgical?

Assuming the ACL is completely ruptured, generally speaking with a cutting and pivoting athlete, especially a high level athlete, the treatment is always surgical. In patients that have a partial ACL tear where the cell fibers have been stretched but not completely torn and it’s just a little bit loose, they can usually be treated with rehab and then getting them back to sports. But if the fibers are completely torn, you usually recommend reconstruction because you can’t repair the ACL. If you try to put stitches in the ACL, they’ll just pull right through. You’ve got to actually pull that torn tissue out and put other tissue in its place, either from the patient’s patellar tendon or from their hamstrings. Occasionally, people will use a quadriceps tendon or tissue from someone who died, which is called an allograft or cadaveric tissue.

Q: What are the chances of re-injuring the knee after an ACL reconstruction? Will Derrick Rose ever be the same player again?

The treatment has changed a lot, it’s constantly changing. The way in which we do ACL reconstructions is very different, especially with where we put the ACL, from what we did even five years ago. However, it’s been a very successful surgery for quite some time. We frequently will tell patients that 90 to 95 percent of people will get back to complete activity with no problems from where they were pre-operatively. But what we’re finding now from the long-term literature is that with procedures from 10 to 20 years ago, maybe only 50 percent of people truly got back to that elite level of activity. But techniques are constantly changing, it’s been a very successful surgery for quite some time. I would even venture to say that when we look back 15 years from now, we’ll have even better results than what we had 10 years ago.

http://spectrumhealthblogs.org/you-me-and-pt/2014/02/13/dreaded-injury-olympic-athlete/
Lindsey’s re-injury to her reconstructed knee after many months of grueling rehabilitation is a perfect example of how devastating these injuries can be. It has been found that the risk of a second injury to the ACLR within the first 12 months is 15 times greater that an uninjured athlete. According to the research presented at the 2013 annual meeting of the American Orthopaedic Society for Sports Medicine, the risk of ACL injury is six times greater in the same or opposite knee for those who have already suffered an ACL reconstruction. In addition to this, a systematic review from 2011 reported that following ACLR the rate of tearing the opposite side ACL (11.8% injury rate) is double the risk of re-tearing the ACL graft (5.8% re-injury rate). That means that some studies suggest one in ten athletes are at risk of tearing the opposite side ACL following surgery – this is so eye opening!


ACL re-injury is affected by so many factors including surgeon experience, graft placement, graft type, gravest(?) harvest site, age, physiological factors, rehabilitation and fear avoidance. I believe that more research also needs to be dedicated to look at ACL prevention programs. If we can lower the rate of injury, we will lower the rate of re-injury. Stay tuned over the next couple months for advice on joint protection and ACL prevention exercise.

All great points, check out what I believe are some very key points...and like many situations, so many variables determine re-injury. The keys for me are the individual...That pertains to his efforts in rehabilitation...Not sure who are the people that suffer re-injury, perhaps we need to be specific to professional football players, that have suffered acl tears and had reconstructive surgery. I have heard that most have re-habbed so intensively, that their body's, especially around the injured limb, are stronger than they have ever been. I'd include basketball, hockey players in this study too, since their sports require a bunch of cutting & stopping and some contact.And, in my opinion, the thing that seperates PRO athletes is their drive, which shows up when they rehab, tougher, longer and more consistent than the avg. Joe that tears a ACL
Assuming his satisfaction with his already substantial wealth isn't hindering his drive to work out and return to achieve the greatness we all believe he can accomplish, Sam can return better than before with all the new therapies. Also, I personally don't believe Sammy's injuries are a result of contact, more likely the stress or pressure on the knee in awkward positions...causing some shearing type forces on the ligament itself. I wish I could look inside like the video, and compare the first tear to the second....With vigorous rehab (like the pro athlete he is..), significant resistant training ( I wanna see some bulging quads & calves & hammy's & glutes Sammy) with some type of yoga or something for flexibility(esp in his ankles & hips), I personally don't think a guy that really rehabs his injury is at a greater risk in the same area, and maybe less than say the opposite side which is usually neglected. That is to say, I have heard of guys injuring an ACL in the left knee, then having problems with stuff on the right side....More than the left ACL blew out again. JMO
oh, I worked on an ortho unit, so I've spoken to a phys. therapist, a MD or 4, and a bunch of patients with all kinds of joint injuries with torn ligaments.....

 

[Alan]

LACHAMP46 needing more clarification and providing some of his own:
All great points, check out what I believe are some very key points...and like many situations, so many variables determine re-injury. The keys for me are the individual...That pertains to his efforts in rehabilitation...Not sure who are the people that suffer re-injury, perhaps we need to be specific to professional football players, that have suffered acl tears and had reconstructive surgery. I have heard that most have re-habbed so intensively, that their body's, especially around the injured limb, are stronger than they have ever been. I'd include basketball, hockey players in this study too, since their sports require a bunch of cutting & stopping and some contact.And, in my opinion, the thing that seperates PRO athletes is their drive, which shows up when they rehab, tougher, longer and more consistent than the avg. Joe that tears a ACL
Assuming his satisfaction with his already substantial wealth isn't hindering his drive to work out and return to achieve the greatness we all believe he can accomplish, Sam can return better than before with all the new therapies. Also, I personally don't believe Sammy's injuries are a result of contact, more likely the stress or pressure on the knee in awkward positions...causing some shearing type forces on the ligament itself. I wish I could look inside like the video, and compare the first tear to the second....With vigorous rehab (like the pro athlete he is..), significant resistant training ( I wanna see some bulging quads & calves & hammy's & glutes Sammy) with some type of yoga or something for flexibility(esp in his ankles & hips), I personally don't think a guy that really rehabs his injury is at a greater risk in the same area, and maybe less than say the opposite side which is usually neglected. That is to say, I have heard of guys injuring an ACL in the left knee, then having problems with stuff on the right side....More than the left ACL blew out again. JMO
oh, I worked on an ortho unit, so I've spoken to a phys. therapist, a MD or 4, and a bunch of patients with all kinds of joint injuries with torn ligaments.....

So I'll try and address each of your points after I make some general comments.

Picking and choosing between types of patients is a double edged sword. While professional athletes probably undergo a much more rigorous rehabilitation and receive much, much more hands on supervision, they also require a much higher level of recovery and the patients themselves will probably put that recovery to the test under conditions that non-athletes would not usually be subject too.

The second article specifically deals with sports injuries and I know this because of their name American Orthopaedic Society for Sports Medicine. Your contention that athletes "really rehab" and non-athletes don't is canceled out when everyone in the study is an athlete.

On to your points:
"perhaps we need to be specific to professional football players"
The second link deals with Olympic skier Lindsey Vaughn's injury. I doubt her recovery regimen was any less strenuous than that of a football player. If anything, the complete recovery of a knee is even more important to a skier than it is to a football player. I also don't believe that her "drive" is any less than that of a football player. If anything it's probably more intense.

"I personally don't think a guy that really rehabs his injury is at a greater risk in the same area"
Scar tissue is stronger than regular tissue (although less flexible) and a bone never breaks at exactly the same place as it did the first time are all things I believe too. I understand that you might think that a greater chance of re-injury of the ACL/MCL doesn't pass the smell test but the data is irrefutable. "the risk of ACL injury is six times greater in the same or opposite knee for those who have already suffered an ACL reconstruction", "In addition to this, a systematic review from 2011 reported that following ACLR the rate of tearing the opposite side ACL (11.8% injury rate) is double the risk of re-tearing the ACL graft (5.8% re-injury rate). That means that some studies suggest one in ten athletes are at risk of tearing the opposite side ACL following surgery".

So those are the facts and whatever you're basing your "really rehabs" assertion on, it doesn't seem to apply in real life unless you think that all those athletes (and they are all athletes) didn't really try in their rehab efforts. I'm not buying that because all athletes have a strong desire to get back to their top form. Not only that, those athletes who you think do really try (football, basketball and hockey players) are included in the data. Not to mention that the NFL, using their own data, agrees with that assertion.

Lastly, good thing I didn't try and answer this later tonight.

 

[LACHAMP46]

Lastly, good thing I didn't try and answer this later tonight.

I'm really starting to love you Alan.....great response....my points are based on the graft is stronger...broken bone doesn't break in the same place analogy....plus various conversations...I can hardly wait for the research to flood out in this continuously emerging field....and I'll leave it at that. I agree with your assessment at this time....well done.

 

[Alan]

LACHAMP46 happy he learned some stuff:
Stuff.

Thanks but you know I didn't know all of that stuff before I had to respond to you. I knew you were wrong but I had nothing to back that up. Forced me to research it and I learned almost as much as you when doing it. That's why I like debating something. It forces you to think and that's what is important to me. Learning stuff and becoming more knowledgeable about what you love is where it's at.

So thanks for the conversation.