ACL surgeries: A blessing or a curse?

2014-11-28 12:04:19 by Dr. Joe Congeni - Director of Sports Medicine, as posted on the blog.

St. Louis Rams quarterback Sam Bradford tore the ACL in his left knee and will miss the entire 2014 season. St. Louis Rams quarterback Sam Bradford tore the ACL in his left knee and will miss the entire 2014 season. Bradford has had revision surgery, which has a lower success rate.

ACL surgery isn't what it used to be. We've come a long way, improving the procedure and getting players back on the field faster. In fact, it's one of the biggest advancements in sports medicine and orthopedics.

But I believe we're pushing the envelope too far and many players are facing revision surgery -- with a success rate significantly lower than the initial surgery.

Today, I had the chance to speak with WAKR morning show host Ray Horner about this topic. We discussed several athletes, including Sam Bradford, Derrick Rose and our own Brian Hoyer, who are struggling back on the field, most likely due to premature returns.

Below is an audio file and transcript of our discussion. Originally aired on 1590 WAKR-AM on Aug. 27, 2014.

HORNER: Boy, ACL injuries, now you go back 25 years ago, you were down 12, 15 months. A little bit different now, but there are higher expectations now. Guys are having a tough time recovering from these.

Dr. Joe Congeni with us right now, and, Joe, isn't that right? Years ago, this was a year and a half or so? Certainly the time frame has been sped up, but we're expecting more, too, aren't we?

DR. CONGENI: Yeah, we are. And, you know, Ray ... the lead-in was really good. One of the great advances of the time in orthopedics, sports orthopedics, and surgery and sports medicine was the ACL surgery and how much it improved, and how much we've gotten people back to play quicker.

But, it's also one of those, you know, that I wonder about and we've talked about, you know, do we push the envelope of how quickly your body can get ready to play high-demand sports with a new ligament, with a reconstructed ligament.

Dr. Joe Congeni Dr. Joe Congeni

And, I think, as a lot of these things trickle down into the high school and college setting, it becomes a difficult problem for us, too.

The biggest question everybody's asking is, "What's wrong with the ACL surgery? You say it's a 90 percent-plus success rate in the last decade or so, but all of a sudden as we're watching these athletes at the highest level in the highest-demand sports, ."

Sam Bradford (of the St. Louis Rams) ... re-tears his ACL. RG3 (of the Washington Redskins) after revision surgery he's just not getting back to where he was previously. Derrick Rose (of the Chicago Bulls) again running into problems after missing a couple seasons in a row.

Right in town here, Brian Hoyer (of the Cleveland Browns) may be rushed to play a little soon. He was at some of the mini camps in March or April, I think, after having his ACL (surgery) in October.

A lot of people are asking why are we getting some of these ACL failures? Uh, you know, we know that if it fails once, you need to have a revision surgery the second time and the success rate of a revision surgery -- which Sam Bradford's facing -- is not nearly as high as an initial surgery.

I really do believe it's what you said in your lead-in is that we've pushed the envelope so far, I think it's really mostly related to premature return.

HORNER: Yeah, and you know, that could be part of the problem with Brian Hoyer right now, correct?

DR. CONGENI: You know, I think it could be. I mean ... I was hoping that some of it is just he hasn't taken enough reps, he hasn't been with the first team and everything else, but the real question is as far as his movement pattern, as far as his performance testing, is he moving the way he was before or was this a mirage, this 2 1/2 games we saw last season?

He doesn't look like the same guy and I think part of it may be related to that knee may not be ready.

And so in these high-demand sports, I literally have high school kids who ask me could I be back in the same season? They're thinking that they could be back in, you know, 4 months, 6 months because they're looking up to what a lot of the people are doing at other levels.

This is a surgery we used to say, gosh, it's a year before you're back playing well, and there's a lot of other variation, too, depending on did you tear cartilage with it? Did they have to repair other structures?

So, I think that everybody has focused so much on how quickly you're gonna get back, we've done ourself a disservice. And, I think it's kinda starting to bear itself out in some of these revision surgeries that are needing to be done.

HORNER: Alright, Joe, good stuff. Thanks for the insight, my friend.

DR. CONGENI: Okay, Ray, looking forward to seeing you out there. It's our time of year now. It's gonna be fun.

HORNER: It is. Dr. Joe Congeni, Sports Medicine Center at Akron Children's Hospital, with us.

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