Dr. Selene Parekh
Derrick Rose, Guard of the Chicago Bulls, Out for Season and Olympics
Guard, Derrick Rose of the Chicago Bulls injured his right knee. He was diagnosed with an ACL tear.
Will he be able to return next year?
ANATOMY
The knee is a complex joint, with four main ligaments that stabilize the joint: the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the lateral collateral ligament (LCL) tear, and the medial collateral ligament (MCL). Together, these four ligaments help to stabilize the knee in all planes of motion.
The ACL stabilizes the knee and prevents it from “giving out,” particularly when twisting or bending on the knee.
CAUSES
An ACL tear is usually seen in the athlete during sporting activities, but it can happen with other mechanisms, such as motor vehicle accidents and falls. Usually these injuries are “non-contact” injuries, occurring when the athlete lands on the knee after jumping. The pivoting or twisting of the knee stresses the ACL and causes it to tear.
Female athletes are at a higher risk of developing an ACL tear. It is not enirely clear why this is the case. However there are thoughts that the anatomical differences in a woman, hormones, or even biomachanical differences in a female versus a male may account for this higher risk.
WHEN TO SEEK MEDICAL CARE
If you believe you have an ACL tear, you should seek medical attention immediately.
SIGNS
When one tears the ACL, there is usually a pop that is heard with sudden pain in the knee. There may be swelling of the knee (effusion), black and blue discoloration, knee stiffness, or the feeling of instability. The individual may have difficulty walking on the knee. An MRI can diagnose the ACL tear and any other injuries of the knee.
TREATMENT
Not all individuals with ACL tears require surgery. If there are symptoms of instability of the knee or if one is a high level athlete, then the surgery would be preferred. If you do not fall into any of these categories, then a knee brace, followed by extensive physical therapy can be used to treat these injuries.
Surgical reconstruction of the ACL can be performed in a variety of different ways. The ACL can be reconstructed with the patients own tisssues (autograft) or tissues from a person who has died (allograft). Autograft reconsturction may require harvesting the “new” tendon from either the patellar tendon or the semitendinosus tendon (one of the hamstring tendons). Different techniques can also be used to reconstruct the tendon, such as single bundle or double bundle techniques. These discussions are beyond the scope of this blog.
Rehabilitation is critical to the success of surgical or non-surgical treatments for ACL tears.
OUTCOMES
In 2005, we presented data on NFL athletes with ACL injuries. Of the 31 running backs and wide receivers with 33 anterior cruciate ligament injuries, more than one fifth of players never returned to a National Football League game. Returning players first competed in a game 55.8 ± 5.4 weeks (mean ± standard error) after injury. For the 24 anterior cruciate ligament–injured players with a minimum total power rating (sum of all 7 seasons) of 200 points, power rating per game played decreased from 9.9 ± 1.1 preinjury to 6.5 ± 0.9 postinjury. This decline in power rating per game played was statistically significant (P = .002) when compared with the change for the 146 control players. http://ajs.sagepub.com/content/34/12/1911.abstract
RETURN TO ACTIVITIES
If we use the above study as a guideline for the return to professional sports, it is likely that Rose will be back on the court somewhere between six and nine months. He will need a lot of work and rehabilitation in order to return to his pre-injury level.
VIDEO/ANIMATIONS
Dr. P
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