Anterior cruciate ligament (ACL) injuries profoundly affected both the collegiate and professional basketball world recently. The Wizards' star Josh Howard and Purdue's forward Robbie Hummel tore their ACLs a few weeks ago on the court, ending their season and potentially changing the fate of their teams' title hopes.
The anterior cruciate ligament (ACL) helps to hold the bones of the knee in proper alignment and guide the way the knee moves. The ACL provides stability to the knee and prevents excessive forward movement of the lower leg bone (tibia) in relation to the thigh bone (femur). Athletes usually suffer an ACL injury during a pivoting event of the knee, most commonly during cutting or twisting maneuvers during sport. An athlete who suffers an ACL injury often report hearing an audible pop followed by significant swelling. Afterwards, they may complain of instability of the knee during sporting activity and an inability to "trust the knee." Continued athletic activity with a torn ACL can have devastating consequences, as repeated pivoting of the knee can result in irreversible damage to the meniscus ("shock absorbers") and cartilage in the knee joint.
Athletes who desire to return to competitive play typically require reconstruction of the ACL. Modern techniques have allowed this surgery to be largely performed in a minimally invasive fashion with the assistance of the arthroscope. The ligament can be reconstructed with tendon from the athlete ("autograft") or from a donor ("cadaver" graft), and each option is associated with certain risks and benefits. The most common choices for elite athletes are their own hamstrings or patellar tendons. While meticulous surgical technique and graft placement are important to a successful outcome, a controlled but rigorous rehabilitation program is of tantamount importance. Return to play is allowed on an individual basis, and is a function of athletic demands, graft healing, and demands of the sport.
We wish Robbie and Josh an expeditious recovery to the basketball court. However, it is important to recognize that ACL surgery is just one element of a several month process that allows a safe and successful return to competitive sports.