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The New Norm for ACL Tears: GSP Rebounded, Expect Same from Cruz

Frank Curreri examines ACL tears and the new science that is allowing athletes to return to previous form after surgery.

UFC bantamweight champion Dominick Cruz(Insert name of pro athlete ) Tears ACL, Out For Season.

How many times a year do you come across that headline? It seems to be one of the most common headlines in sports, year after year.

We immediately empathize with the limping wounded, of course. The uncertainty that races through their mind jumps to ours as well. You ask - we all instinctively ask - the most obvious question: Will he ever be the same again?

We wondered that when UFC welterweight champ Georges St-Pierre blew out his knee last year. We speculated again when bantamweight kingpin Dominick Cruz ruptured an ACL during a training session in May. And we’ve thought about former light heavyweight champ Mauricio “Shogun” Rua, who has endured and defiantly bounced back from three ACL tears, and battles Sweden’s Alexander Gustafsson = in the co-main event on Saturday’s UFC on FOX 5 card.

In the case of Cruz, most unfortunately, his return to championship form was recently interrupted after another gut-wrenching setback. The 27-year-old San Diegan had hoped to battle interim champ Renan Barao early next year. Last Thursday, however, Cruz underwent his second ACL surgery in 8 months (on the same knee). A rough timetable for his recovery has been set at six to nine months, standard within the industry.

“He’s over the shock part,” Cruz’s head trainer, Eric DelFierro, said Tuesday. “He had an MRI recently and it revealed the ligament was basically detached. His body rejected the cadaver. It just didn’t take the way it should. From what the doctor said, the cadaver has a 20 percent failure rate in an athlete. Better to get it done now and just get over with.”

Cruz said on UFC Tonight (FUEL TV) Tuesday night that he reinjured the knee during light shadow boxing sessions with a teammate. He pivoted, mildly he thought, and heard a pop.

Far worse than the physical pain has been the emotional toll.

“It is like you get dumped by a girl that you love very much or you lost a family member,” Cruz said on the show.

Cruz choked up during the broadcast while recalling the outpouring of support from fans on his Twitter account @TheDomin8r.

“If the fans out there could know how much that helps me,” Cruz said. “Thank you guys so much.”

It will come as no comfort to Cruz, one of the sport’s most mentally stout and sincere figures, that his extended misery is not the norm. When the three most dreaded letters in sports strike again – sidelining an astonishing 100,000 or more American athletes each year – the popular knee-jerk reaction of “Will he ever be the same again?” assumes that full recovery boils down to a coin toss of sorts. But where ACLs are concerned, it is well past the time for popular perception to catch up with reality. And the present reality is this: An ACL reconstruction today is usually not career-threatening or career-altering to a pro athlete. In fact, over the past seven years or so the odds of a full recovery have heavily shifted in the athletes’ favor.

World renowned orthopedic surgeon Dr. Tarek Souryal, head team physician for the NBA’s Dallas Mavericks, spelled out that overwhelmingly positive trend during an interview with ESPN’s “Training Room.”

“It used to end athletic participation both on the professional and recreational level,” Souryal said of ACL tears. “Now with arthroscopic surgery and proper strengthening and rehabilitation techniques, the future is much brighter. National results show a 96 to 98 percent return to sport.”

Yet the doomsday stereotype among fans, largely unjustified by present-day statistics, continues to cast a large shadow because the sports landscape HAD BEEN littered with some very high-profile ACL horror stories dating to more than a decade ago. Men of a certain age remember a time when a violent buckling of the ACL derailed the career of Terrell Davis, culminating in his retirement at just 29 years old (yeah, the military-saluting Terrell Davis who was once voted MVP of the NFL, rushed for 2,000 yards in a season and led the Denver Broncos to two Super Bowl titles). We remember when Jamal Anderson of the Atlanta Falcons was never quite the same after ACL surgery. We remember when Ki-Jana Carter of Penn State University was drafted No. 1 in the NFL, tore his ACL in a preseason game and totaled less than 1,200 yards rushing over a seven-year career.

A prominent study by Dr. James Carey and University of Pennsylvania (Department of Orthopedic Surgery) studied NFL players who tore their ACLs from 1998 to 2002; one out of five of those players never returned to the NFL, the study found, and a sizable number of players who returned to the field saw a decline in production.

A decade later, a pro like Dominick Cruz, still grinding away in rehabilitation and deprived of what he most enjoys, will nevertheless be inspired by the large number of professional peers who have returned to their domains and dominated.

Evidence of this encouraging trend:

Exhibit A – The Beast who is turning everyone’s head and blowing everyone’s mind and whose sheer awesomeness is having the greatest universal impact to make everybody rethink ACL tears, Mr. Adrian Peterson of the Minnesota Vikings. Before wrecking his knee near the end of 2011, Peterson was widely regarded as the NFL’s best running back. A mere eight months after rising off the surgical table, the human freight train returned to the gridiron and has averaged a whopping 5.8 yards per game to lead the league in rushing. To which I declare, “Are you kidding me!!!??” Best believe that thousands of Fantasy Football players out there deeply regret passing on Adrian Peterson early in round one of their league drafts. I should know; I’m one of ‘em.

Exhibit B – Georges St-Pierre, UFC welterweight champion. What I witnessed Nov. 17 was truly eye-opening and the absolute motivation for this column. Think about it: If GSP had lost to No. 1 contender Carlos Condit, what would the storylines have been? GSP’s knee! His knee! His knee! Without a doubt, that’s all we would have heard about, not how dangerous and talented Condit is. The backup alibi would have been “ring rust!” … ring rust! … ring rust … referencing, of course, the Canadian superstar’s 19 months away from the octagon.

In the interest of full disclosure, I didn’t expect to see such a rejuvenated, well-conditioned and supremely confident GSP at UFC 154. Only 10 months removed from major surgery, I expected there to be some psychological compromise, some doubt in the recesses of GSP’s mind as to how his knee would hold up in a live fight. Some hesitation and huffing and puffing in round five seemed natural for the 31-year-old. After all, potentially career-threatening, right?  

Let me tell you what – that might have been the best GSP I’ve seen yet. It certainly shed the most light on the strength of his character. Considering how deep GSP had to dig within himself, how he needed to pick himself off the canvas in the third round; it was definitely his finest performance, and it came when he needed it most and against the most dangerous opponent he’s ever faced. Whatever GSP may have lacked in timing while in the Octagon a few weeks ago, he compensated for with the most palpable fire to win we’ve ever seen from him. Prior to that night, even some of the champ’s most loyal supporters were left with the feeling that he was holding a lot back inside the cage and had much more to give. Certain comments seemed to shadow GSP even as he racked up wins. Rather than fighting to win, he seemed to be fighting not to lose. Fans still adored and admired the welterweight prince, but many couldn’t resist thinking, “His fights are boring …. He fights too conservative … But he doesn’t finish fights … But he doesn’t like to get hit.”

A blood-soaked, 25-minute scrap against Condit quashed all of those criticisms. We saw GSP in a dogfight, his face as marked up as we’ve ever seen afterward, and saw how badly he wanted to win. Unlike other recent title bouts, GSP laid everything on the line against Condit and made good on his pre-fight promise: “All those who doubted me will have a reality check, because I’m better than ever.”

Exhibit C: Jamaal Charles, Kansas City Chiefs. One of the NFL’s premier speedsters, Charles tore his ACL last September. Thus far in 2012, the University of Texas alum ranks eighth in rushing and is on pace for a very commendable 1,350 yards.

Exhibit D: New England Patriots QB Tom Brady. In the 2008 season-opener, the NFL’s then-reigning MVP went down with ACL and MCL tears. A year later, the game’s most famed sixth-round-pick-turned-superstar posted his second-best season as a pro up until that point and again made the Pro Bowl. Good as new. Like nothing ever happened.

Exhibit E: Tiger Woods. The greatest golfer of my generation underwent ACL reconstruction in mid-2008. The Stanford grad rebounded nicely and was ranked No.1 in the world through late 2010. Despite some other well-publicized hurdles, Tiger remains one of the top three golfers in the world.

An interesting aside: Dr. Neal ElAttrache, the Los Angeles-based orthopedic surgeon who performed surgery on Brady, also repaired GSP’s ACL.

More outstanding recoveries that signal the “New Norm” for ACL outcomes:

•    The case of New England Patriots wide receiver Wes Welker. Tore his ACL in Jan. 2010. Eight months later started first game of the season and scored two touchdowns. The reception machine made the Pro Bowl that season and again in 2011.

•    The resurgences of NFL running backs such as Frank Gore, Jamal Lewis, Willis McGahee and Edgerrin James, who each became very successful NFL running backs despite ACL tears in the early 2000s. These guys were actually pioneers who started to change perceptions, enlightening doctors and ACL-injured athletes about the possibilities for recovery.

Yet, for the most part, UFC fighters have rebounded well from ACL surgery and registered some of their best performances after having that all-important ligament stabilizer reconstructed. Some prominent cases stand out, including:

•    “Shogun” Rua was out 16 months after back-to-back ACL tears in 2007. Though three major knee surgeries have limited the Brazilian dynamo to just nine fights in the past five years, Rua has knocked out Lyoto Machida (to win the UFC belt), Chuck Liddell, Forrest Griffin and Brandon Vera in recent years. And Rua’s dramatic five-round clash with Dan Henderson at UFC 139 is widely considered one of the most exciting contests in UFC history.

•    Joe Lauzon, who tore his ACL against Jeremy Stephens during a February 2009 bout, returned 11 months later. The aggressive Bostonian has since fashioned a 4-2 record with signature wins over Melvin Guillard and former World Extreme Cagefighting champ Jamie Varner.

•    Former WEC champ and UFC fighter Miguel Torres shredded his knee in mid-2002. The mullet-haired bantamweight returned over a year later, winning 17 of his next 18 fights to earn mention as one of the sport’s top pound-for-pound fighters.

•    Like Rua, UFC vet Javier Vazquez suffered multiple ACL tears (famously rupturing his ACL while throwing a punch in the early seconds of a 2003 fight against Alberto Crane and amazingly fighting until the end to lose via decision). After a few years away from the cage, the Gracie Jiu-Jitsu black belt returned and scoring memorable victories over Jens Pulver and Joe “Daddy” Stevenson.

•    Kurt Pellegrino, now retired, is another ACL success story. The scrappy New Jerseyian tore his ACL in the first round of a July 2010 match against George Sotiropolous, yet showed great determination to still finish the bout (losing a unanimous decision to the Aussie). Pellegrino returned to the Octagon just eight and a half months later, giving the immovable object known as Gleison Tibau all he could handle but still losing a split decision.

•    UFC veteran Alessio Sakara, who fought in Montreal last month, tore his ACL in late July 2011 and returned to the cage eight and a half months later.

•    Welterweight Duane Ludwig is presently recovering from a torn ACL he suffered in an October fight with Che Mills.

Other Noteworthy Points of Emphasis About ACL Tears

•    Roughly 70 percent of all ACL tears are non-contact injuries that occur when an athlete pivots, cuts or plants sharply, or lands awkwardly on their knee

•    Females are two to four times more likely than males to tear an ACL. This is due to many of them having a narrow channel where their ACL resides, and possibly hormone changes that can increase chance for a rupture during certain parts of their menstruation cycle (Source: Dr. J. Martin Leland, assistant professor of surgery at University of Chicago Medicine, quoted in “Science Life” interview for University of Chicago Medicine and Biological Sciences)

•    Fascinating: There are two common ways for orthopedic surgeons to repair an ACL – via an autograft (using part of a patellar, hamstring or Achilles tendon from the injured patient’s own body) or an allograft (donated, frozen tendons from someone else’s body). Several studies have found that ACL surgeries using the allograft or “cadaver” grafts – the same method used to repair Cruz’s ACL the first time -- carries a much higher risk for athletes 40 years old and under.

“The allograft is still a good option for many people and probably works fine for people who have moderate activity and are really not stressing their knee, particularly in the first year or two after surgery, but physicians should be aware that it has a very high failure rate for young patients,” Dr. James C. Tucker told the Arkansas Medical News during a 2008 interview.

The Arkansas Medical News article referenced two studies, one from researchers at the University of Kentucky in 2007 and another Mississippi Sports Medicine and Orthopaedic Center study (2008). The Kentucky study found that with cadaver ACL reconstructions “37.7 percent (of patients) required repeat surgery (and) the failure and repeat surgery rate for patients under 25 was 55 percent.”

The Mississippi study chronicled 64 patients and found that 23.4 percent experienced failed cadaver graft surgery.  Their findings were presented to the American Orthopaedic Society of Sports Medicine.

“The allograft (cadaver) failure rate in this young active population is exceedingly high when compared to the 2.6 percent failure rate in our previous study of patients older than 40 years old,” said Dr. Gene R. Barrett, a senior author of the study, told the American Academy of Orthopaedic Surgeons (AAOS) Now website.

“From what the doctor told us, the cadaver has a 20 percent failure rate in an athlete,” Del Fierro said.

Cruz’s second surgery was not from a cadaver. Rather, it involved “a patellar tendon from Dominick,” DelFierro said. GSP’s ACL reconstruction was also repaired using a patellar tendon from his own body.

“I wouldn’t wish this on my worst enemy,” Cruz said a few weeks ago of the ACL recovery process.

Cruz is one of the most determined athletes in the world’s hardest sport. It would unwise to bet against such a driven workaholic who has already defied almost everyone’s expectations by becoming world champ in the first place (almost no one saw that coming five years ago). Most pro athletes recover well from ACL tears. You have to expect that Dominick Cruz, when it’s all said and done, will come back better than ever. Just as GSP did.

“Just want to say thanx to all my supporters through this humbling time,” Cruz posted on Twitter Tuesday evening: “I WILL b back 100% this will only be a stepping stone in my life after I push through.”

For further, interesting reading on the subject of ACL’s try these links: