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Thread: Lloyd Perris to miss the rest of the season

  1. #25
    Quote Originally Posted by Ludwig View Post
    Thanks goswannies for the medical clarification. I hope you don't mind a few more questions.
    You're welcome & no worries

    Quote Originally Posted by Ludwig View Post
    When the term 'rupture' is used, does that mean a total severing of the ligament or can it encompass partial tears as well?
    Rupture usually means completely torn. Partial tear is when some fibers are torn. Some are intact. The ACL has a poor blood supply and consequently a poor capacity to heal. A partial tear that doesn't compromise the ligament vascularity may heal, although some of this will be scar tissue which is less elastic (and consequently less effective that natural ACL tissue


    Quote Originally Posted by Ludwig View Post
    In hybrid grafts, like the one used for AJ, do they combine autologous tissue with synthetic material?
    By hybrid do you mean synthetic? The old carbon fibre ones, no. In fact they tended to degrade, leaving carbon particles that caused inflammation. The developers of the LARS suggest it is biocompatible allowing natural tissue to infiltrate the graft scaffold, increasing the strength. Not every surgeon subscribed to this, however.

    Quote Originally Posted by Ludwig View Post
    I though I heard that several teenage footy players got LARS grafts. Maybe I'm thinking of the Menzel brothers.
    Yes, they did, but there was a short period where the rapid recovery was fashionable ... until guys like Malceski & David Rodan re-ruptured. This caused many medicos to re-consider. Doc Larkins also gave it some negative press. The advantage for a young player, pre-draft, of having a LARS is that an ACL injury might not keep them out for as long (3 months vs 9-12 months) which might make them a more appealing draft prospect.

  2. #26
    Go Swannies! Site Admin Meg's Avatar
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    In a recent AFL.com.au article on Daniel Menzel it said the second of his three left knee reconstructions was a LARS procedure but that the LARS graft snapped when he was attempting to make a comeback through the VFL. So he hasn't had much luck with either form of reconstruction.

  3. #27
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    Quote Originally Posted by goswannies View Post
    You're welcome & no worries


    Rupture usually means completely torn. Partial tear is when some fibers are torn. Some are intact. The ACL has a poor blood supply and consequently a poor capacity to heal. A partial tear that doesn't compromise the ligament vascularity may heal, although some of this will be scar tissue which is less elastic (and consequently less effective that natural ACL tissue



    By hybrid do you mean synthetic? The old carbon fibre ones, no. In fact they tended to degrade, leaving carbon particles that caused inflammation. The developers of the LARS suggest it is biocompatible allowing natural tissue to infiltrate the graft scaffold, increasing the strength. Not every surgeon subscribed to this, however.


    Yes, they did, but there was a short period where the rapid recovery was fashionable ... until guys like Malceski & David Rodan re-ruptured. This caused many medicos to re-consider. Doc Larkins also gave it some negative press. The advantage for a young player, pre-draft, of having a LARS is that an ACL injury might not keep them out for as long (3 months vs 9-12 months) which might make them a more appealing draft prospect.
    Where is your orthopaedic practice ? That could only have been the answer of an orthopaedic surgeon. I know too many

  4. #28
    Quote Originally Posted by aguy View Post
    Where is your orthopaedic practice? That could only have been the answer of an orthopaedic surgeon. I know too many
    Haha, I wish! Just a physio working in orthopedics, but I spent a bit of time doing some research & my theses & publications investigated ACL outcomes.

  5. #29
    On the Rookie List Conor_Dillon's Avatar
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    Surely if he has experienced an ACL previously he'd know straight away when he's done it again, and therefore wouldn't return to the field? And the medicos present would have to have known his inury history and therefore erred on the side of caution? Could someone with medical insight tell us whether returning to the field could have turned a potential ACL tweak into a full rupturing of the ACL?

  6. #30
    Quote Originally Posted by Conor_Dillon View Post
    Surely if he has experienced an ACL previously he'd know straight away when he's done it again, and therefore wouldn't return to the field?
    Not necessarily. Muscles can compensate to a degree (perhaps more so when they have been specifically trained for this role from the first recon. So the quick agility tests done on the sidelines to see if he's ok to return might looked ok. Also the pivot shift test is quite an uncomfortable test. It requires the player to be as totally relaxed as possible to detect the laxity. If you've had this done before and you are anticipating the resultant "clunk" there is a natural tendency to tense & this can yield a false negative result (ie the test might indicate the ACL is ok, when the feeling of stability is actually given by hamstring contraction that prevents the anterior tibial translation rather than a seemingly intact ACL. My second ACL rupture (in the same knee as the initial ACL recon) was initially diagnosed as a sprain in an emergency department Dr. The knee felt ok at the time of injury and it wasn't until 2 weeks later that my physio did the test when I was more relaxed that I was found to have re-ruptured.

    Quote Originally Posted by Conor_Dillon View Post
    And the medicos present would have to have known his inury history and therefore erred on the side of caution?
    Ideally yes. But that is a judgement call.

    Quote Originally Posted by Conor_Dillon View Post
    whether returning to the field could have turned a potential ACL tweak into a full rupturing of the ACL?
    Definitely yes. An analogy would be taking a rope. Apply tension & it holds nicely. Cut several strands of the rope and it's still ok without tension but apply tension ... fair chance the weakened rope will fail.

  7. #31
    pr. dim-melb; m not f
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    Great work guys. Leaves Wikipedia for dead!
    He reminds him of the guys, close-set, slow, and never rattled, who were play-makers on the team. (John Updike, seeing Josh Kennedy in a crystal ball)

  8. #32
    Human CJK's Avatar
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    That goswannies expertise....
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  9. #33
    On the Rookie List Reggi's Avatar
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    Best of luck to Lloyd he seems kike a mentally tough kid

  10. #34
    On the Rookie List Conor_Dillon's Avatar
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    Thanks heaps goswannies, much appreciated! Definitely cleared things up

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