Doctoring the Facts: Are ACL Injuries Becoming the New Ankle Sprain?

We see them all the time, these knee ligament injuries. Given my education as a physical therapist, it has now gotten to the point that I can make an educated guess about which ligaments were damaged in that athlete limping off to the training room simply by watching the replay of how they were impacted.

After learning that Long Island-Brooklyn's stud forward Julian Boyd re-tore his ACL earlier this summer - the same one he injured back in December - I had my interest piqued and wanted to look into things further and share what I uncovered. I'm not so sure I can be positive about what I found.

In the past decade or so, the repair of the anterior cruciate ligament (ACL) has become more routine to the point that it is done arthroscopically (with a camera and very tiny incisions) on an outpatient basis, which means it doesn't even require an overnight hospital stay if there are no complications.

As anyone with medical knowledge of the human body will tell you, that injury and surgery, while allowing you to return to your prior level of function, still leaves a structure that is no better than 99% of it's original strength and stability. That said, there are thousands of athletes who injure ligaments, get them repaired, and are then injury- and symptom-free at least for the remainder of their playing careers.

Even if the speed of surgery has improved, the recovery still takes time - anywhere from four to six months depending on the individual. Boyd's case is so unusual because of the time frame - the first ACL tear came on December 12, 2012, in a game against Rice. His second injury is recently in the news, but actually happened back in July. Simple math tells you that makes two tears of the same ACL within only seven months.

This got me curious about the whole concept of return to sport after ACL tears and reinjury. The current available research shows that the process of getting a player back to playing the sport they love after an ACL injury is... let's just say "subjective" would be a generous term.

It is considered best practice as a therapist to have some objective data to use in order to compare the athlete's ability before surgery, immediately after, and sequentially during their recovery. One research review showed that no objective measures are used regularly outside of muscle strength, range of motion and degree of swelling. Another (much larger) review showed that nearly 90% of the time, no criteria are used other than how far past the surgery the athlete is and their own subjective report of symptoms - if any criteria are used at all.

To the credit of those handling Boyd's situation, it was reported by LIU's assistant AD that Boyd "was on track to make a full recovery from the first ACL tear before re-injurying the knee this summer." That tells us that the injury happened in the rehabilitation process, not because he necessarily rushed back to full action.

That being said, given the current nature of how these injuries are treated, I'm surprised there aren't more stories like this. Any fool can tell that a sport where you spend a lot of time jumping and cutting - a lot of it on one leg at a time - will lead to things like knee ligament injuries. Factor in things like the forces your legs experience when the mechanics of your landing even a little asymmetrical, let alone on a surgically repaired knee, and it makes sense to proceed with caution.

As it stands now, who knows if Boyd will ever play again, let alone returning in January as some have suggested. Given that his knee is now doubled down on the surgery, it's impossible to tell whether the knee will truly be structurally strong enough to handle even another half-season of competitive basketball let alone a career beyond that. It's also impossible to tell whether Boyd will able to trust that knee enough to return to the court at all or approach the skill level he was at prior to these injuries.

I mean no ill will towards those who tended to Boyd's care, but it would seem that across the board there needs to be a greater focus on gradually recuperating these athletes and making sure that they are truly ready to return to competition when they step on that court. That way someone like Boyd - who has already had his playing career derailed and sidetracked by his own physiology more than once - can feel safe focusing on nothing but the game once he's back in it.