Lloyd Perris to miss the rest of the season

[liz]

The multiple ACL club is pretty large at the Swans: Perris, AJ, Mal and Shaw. Have I left anyone out?

Campbell Heath too, albeit no longer a Swan. I suspect it is not atypical of the competition wide experience. I read somewhere that the single biggest predictor for a player doing an ACL is the fact they've already done one. It can't just be put down to a rupturing of the replacement ligament because it predicts them rupturing their other knee too. Suggests some people are particularly prone, maybe due to structural issues in their knees, running style, or something else of this ilk.

[Matt80]

I was speaking to a female athlete who had experienced multiple ACLs and she said that ACLs can be traced to hereditary factors. Her father had also experienced multiple ACLs. I'm not sure of the total truth of this but I'm sure there will come a time when the parents of young AFL talent will also face medicals to predict the potential risk of injury to AFL players.

[aguy]

Campbell Heath too, albeit no longer a Swan. I suspect it is not atypical of the competition wide experience. I read somewhere that the single biggest predictor for a player doing an ACL is the fact they've already done one. It can't just be put down to a rupturing of the replacement ligament because it predicts them rupturing their other knee too. Suggests some people are particularly prone, maybe due to structural issues in their knees, running style, or something else of this ilk.

You're right. They is definitely a big genetic predisposition to rupturing acl. And once you have ruptured once you are much more likely to rerupture the same side OR rupture the other side than the general population average

[ugg]

At the beginning of the last quarter of the ressies game he started on the bench which was weird because there were plenty of topups playing and they usually start on the bench

But he eventually came on and even kicked a goal in that quarter

[Ampersand]

Poor guy. Is he a candidate for LARS or is he too young? I wonder if AJ's experience might affect his thinking.

[Nico]

At the beginning of the last quarter of the ressies game he started on the bench which was weird because there were plenty of topups playing and they usually start on the bench

But he eventually came on and even kicked a goal in that quarter

IIRC Lenny Hayes went back on or even played the next week and did his ACL well and truly after a "twinge".

[Auntie.Gerald]

Stanley brothers in rugby league have had 7 knee recons between them not sure if ACL and or Medial etc

[Ludwig]

Hopefully the fact that he was able to come back on indicates that it's only a partial tear and will be easier to heal, and perhaps a good candidate for LARS.

[giant]

That's his second ACL. He did one (same knee or other knee?) in the year before his final U18 year.

Ouch, really? Poor bastard, it really leaves a sour taste in your mouth no matter who gets one.

[Meg]

Unfortunately some people do seem to be susceptible to repeated knee problems. Daniel Menzel is only 22 y.o. and he has had four knee reconstructions, one on the right and three on the left. He hasn't played since September 2011 and is now out till next season.

[goswannies]

Hopefully the fact that he was able to come back on indicates that it's only a partial tear and will be easier to heal, and perhaps a good candidate for LARS.

'Fraid not. It can indicate a number of things. If his hamstrings were very active when they did the anterior draw or pivot shift tests to assess the ACL, it can easily yield a false negative (ie the ACL appears bot to be torn when it is). In some instances, if there isn't a lot of swelling, it can mask a more sinister injury, with medicos unaware of the severity and they allow the player to continue. Elite athletes generally have good quad/hammy muscle control which provides considerable dynamic muscle control that can compensate for lack of stability usually provided by the ACL. The dynamic stability can be adequate for controlled agility quick tests that might b preformed on the sidelines to assess of a player can return, but without an intact ACL the muscles cannot provide adequate support for uncontrolled or high impact forces.
Any of those circumstances might have allowed him to return.

The LARS graft is commonly suitable for a primary ACL repair (as opposed to a reconstruction using autologous tissues like patella tendon or hamstring), it's ok for players at the twilight of their careers as the shortened rehab time allows a rapid return (less deconditioning), players who have a small window of opportunity (approaching finals, or, say Olympics where they only get a chance every 4 years), also often used in work people who won't exert high impact forces but need to get back to work quickly, or people who have run out of autologous tissue.
Younger athletes are often directed away from LARS grafts as their is a school of thought that autologous tissue (athlete's own tissue) provides a stronger fixation in the long term, less chance of natural degradation, lower infection/rejection risk - and as a younger athlete has more years ahead of them to recover and rehab before Father Time naturally ends their career, it will potentially result in a more favourable outcome.

As for the chance of re-injuring, a recent study found nearly 30% of athletes sustained a 2nd ACL injury within 2 years of returning to activity, with 20% sustaining an opposite leg injury and 9% incurring a graft re-tear injury on the same leg. Females had twice the incidence of injury to the opposite leg than males.

While athletes often return to sport by 1 year postop, there is evidence that there is continued remodeling (and consequent strengthening of the graft for at least a year beyond that - possibly contributing to the re-injury incidence during that initial two years postop).

Females also have a predisposition to ACL injuries as the female hormones tend to result in slightly greater laxity in soft tissues, rendering them statistically more prone to injury.

[Ludwig]

Thanks goswannies for the medical clarification. I hope you don't mind a few more questions.

When the term 'rupture' is used, does that mean a total severing of the ligament or can it encompass partial tears as well?

In hybrid grafts, like the one used for AJ, do they combine autologous tissue with synthetic material?

I though I heard that several teenage footy players got LARS grafts. Maybe I'm thinking of the Menzel brothers.