Another graft bites the dust: Which tendon will this unlucky bird use to repair his ACL injury?

Thirteen games have come and gone. How will this week compare to the 43 injuries that occurred in week 9? Week 10 by the numbers:

40 = Number of players who missed game time due to injury.

4 = Number of players placed on season-ending IR.

8 = Number of reported knee injuries.

12 = Number of reported ankle injuries.

Lower body injuries are an unfortunate trend in the NFL. Guys, when will you learn that knee and ankle injuries are not the new black?! One of the eight knee injuries sustained this week was courtesy of Keenan Lewis. This New Orleans Saints cornerback hurt his knee in the first half, hobbled off to the sidelines, and then was carted away. Saints fans sighed when it was announced that Lewis would not return to the game. But in a shocking turn of events after halftime, Lewis was spotted on the Saints sidelines in full gear and limping around. And not too shortly after, he was back on the field making plays! Although the Saints lost the game anyway, the average sScreen Shot 2014-11-11 at 12.15.24 PMports fan likely gained some respect for the toughness of these athletes. Why do I say that? Well, why don’t you take a look at the Instagram of Lewis’ knee posted after the game. Ladies and gentlemen, your knee should not – I repeat, should not – look like this. If you just aloud, “Holy crap, that is one ridiculously swollen knee!” then jinx! Because I just said that too… At first glance, it appears that Lewis has a case of traumatic bursitis. It shouldn’t keep him out of the game for a long time but it would have been incredibly painful to play through. Keenan Lewis, you deserve a pat on the back. And maybe a beer too…

Let’s keep this knee discussion going! I want to tell you a story about a man named Palmer, Carson Palmer. Born and raised in California, Palmer was destined to be a football quarterback from his school days. He won the Heisman Trophy (college football MVP) and was drafted first overall in 2003 to the Cincinnati Bengals. After a couple seasons, Palmer led the palmer first aclBengals to their first playoff appearance in 15 years. At the end of the regular season and ten days before the start of the playoffs, the Bengals decided to lock up their franchise QB with a $119 million contract extension over nine years. Life was peachy…

But then Palmer’s streak of good fortune came to a blazing halt. With his first pass in the playoff game against the Pittsburgh Steelers, Palmer was hit awkwardly in the left leg by a defensive lineman. This blow to his knee resulted in a significant injury. He had torn his ACL, MCL, and meniscus and dislocated his patella (knee cap). Ouch. Not only did the Bengals lose their starting quarterback, but they also lost the game.

Here’s where this week’s lesson kicks in! There are generally three structures used to replace a ruptured ACL.

  1. Hamstring tendon graft.anterior-cruciate-ligament-acl-reconstruction-graft-selection-osuv6n2-3-2coljpg
  2. Patellar tendon graft.
  3. Allograft.

Hamstring and patellar tendon grafts are known as autografts. Autograft implies that the tissue used to replace the ACL is harvested from the patient’s own body. On the other hand, allografts use tissue from a cadaver to replace the ligament. Typically, autografts are preferred over allografts as the likelihood of the body rejecting the new ACL is significantly lower.

In January 2006, Palmer underwent surgery to repair his knee. Because he had such extensive damage in his knee, his surgeon was required to use an allograft of an Achilles tendon to replace his  ACL. The next 8 months of Palmer’s life were spent in rehab and at the gym trying to reestablish the strength and stability in his knee. I might be biased but I’m sure if you asked him, he would say that was the best time of his life. Physio is so fun!

By September 2006, Palmer made a quick recovery and was ready to start in the Bengals’ season opener. Keep in mind that this injury occurred 8 months ago! Surgery and rehab protocols have evolved a lot since then. For Palmer to return to football after only 8 months was nothing short of miraculous. Even Palmer himself said that he was not fully comfortable with his “new” knee until halfway through the 2006-07 season.

Skip ahead a few years! Palmer eventually left the Bengals and had a brief stint with the Oakland Raiders before being traded to the Arizona Cardinals in 2013. Even though he was now playing with birds and not tigers Palmer(please refer to the image on the right), he still enjoyed success with the Cardinals in his first season. Palmer endured some nerve issues in his neck, missing 4 games, at the beginning of this year but returned in great form in week 6. Quarterbacking the Cardinals to a league-best 8-1 record, Palmer signed a 3-year contract extension worth $50 million on November 7th. Two days later, the Cardinals faced off against division rivals, the St. Louis Rams. In the second half of a tight game, Palmer stepped up in the pocket to avoid pressure when his left leg (yes, the same one he previously injured) buckled underneath him. That’s right folks, no one tackled him this time. Here’s your classic ACL non-contact injury! Sound familiar? That’s because we’ve highlighted this type of non-contact injury twice this season already (here and here) in slightly more embarrassing fashion. Okay, I’m probably sounding too excited about this. Ignore me and continue with the story. Palmer was able to walk off the field on his own before his knee gave away again when he was on the sidelines. The dreaded cart was then brought out to carry a very sad Carson Palmer to the locker room.Ui4mbrYTo hamstring tendon graft or patellar tendon graft: that is the question. The good news for Palmer is that autografts tend to have lower failure rate than allografts. The great news for Palmer is that (like I mentioned before), arthroscopic knee surgery and physiotherapy protocols have vastly improved over the last 10 years. The best news for Palmer is that… He was featured in this awesome blog!Screen Shot 2014-11-11 at 11.16.15 PMSurgeons train all over the world and their mentors will influence whether they are more comfortable with ACL reconstruction using a hamstring tendon or patellar tendon. In either situation, the tendon is harvested from the patient’s own body and is used to create a new ACL. The tendon acts as a scaffold for the patient’s tissues to grow into and reinforce over time. Both types of tendon will heal normally and the strength lost the respective muscle will be minimal… Miniscule… Microscopic!

Check out this animated video on ACL reconstruction with the hamstring tendon. Feel free to skip to the 1:30 mark to get straight to the surgical procedure.

I hope you learned a bit about ACL reconstruction today! I’m lucky enough to know a surgeon in the city who has let me follow her genius brain around. No wonder ACL injuries are one of my favourite problems to fix! I have learned from the best!

As for you, Carson Palmer, I hope you learned to never sign a contract extension ever again… Or at least knock on wood while you’re doing it! Fingers crossed this story ends with a happily ever after!

– Chris (3-7)

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