By: Eric Schuettenberg
Year after year, NFL players are decimated with injuries. An injury that seems to continuously grow each year is the torn ACL (Anterior Cruciate Ligament). The ACL provides stability in the knee by resisting anterior translation or forward movement and medial rotation or rotation towards the inside of the knee.
The structures of the right knee are shown above. Photo from Wikimedia Commons.
This is injury may occur with or without contact. Once an athlete suffers a full ACL tear, the ability to plant or turn while running becomes impossible as the athlete will lose stability in the knee. The video below displays an example of the instability in the knee once the ACL is torn.
This is what a torn ACL looks like. Essentially the Lachman's Test with no hands. pic.twitter.com/ud8yqC7BsU
— ACL Recovery Club (@ACLrecoveryCLUB) August 24, 2015
Following this ACL tear, an athlete requires surgery to repair the tear and return stability to the knee. This can be completed with the use of a few different tissues. The gold standard is to utilize the middle one-third of the athletes own patellar tendon but the athletes hamstring tendon or a cadaver tendon can be used as well. This is often dependent on the surgeon, how strong the potential graft sites might be and if the athlete has had previous ACL surgeries.
Once surgery is complete the athlete will return home in a brace for a few days to begin Physical Therapy. During the first two post-operative weeks, the athlete will focus on restoring range of motion without in knee for bending and straightening as well as begin to reeducate the quadricep muscle. The athlete will begin to return to walking without a limp and progress exercises to include hip and knee strengthening utilizing body weight and machines in the gym. The athlete will continue to normalize range of motion in the knee, utilize challenging balance activities and improve strength in their core, hips and knees while also working on functional activities such as lunges.
At around the three month mark following surgery, the athlete will begin jogging activities. This means the athlete has gained back approximately 80% of his pre-injury strength. Athletes using the patellar tendon graft can typically return to jogging and agility a few weeks before athletes who used hamstring tendon or cadaver grafts which can be important depending on the timing of the injury with regard to the athletes return to football. During the next few months, the athlete will continue to work on strength and return to activities with the use of sport specific drills such as agility ladder, cutting, jumping, conditioning and plyometrics.
The final timeframe for an NFL player to return to full participation in typically 6-9 months. We all know the Adrian Peterson story, torn ACL and MCL during the last week of December in 2011 and return to not only start week 1, but to take his first carry 78 yards to the house only 8 months after his surgery. He went on to finish the season just nine yards short of breaking the single season record for the most rushing yards. This was an incredible feat and is not the norm with regard to timeframe. For a more realistic reference, Todd Gurley suffered his torn ACL in early November of 2014 while at Georgia and made his NFL debut on September 27, 2015 with limited touches which means it was approximately 10 months before he was back. Gurley finished last year with over 1,200 scrimmage yards and 10 TDs and most are expecting that to improve this coming season.
For full-disclosure, there can often be additional injuries coupled with a torn ACL. Depending on the mechanism of injury sustained the athlete may also injury the meniscus, MCL, PCL, LCL, or suffer a micro fracture. There are specific guidelines that would alter rehab with each of these additional injuries.