This type of injury is serious. The reconstruction of the ligament and subsequent rehabilitation is a long and arduous ordeal. Most ACL injuries occur in high-risk sports like basketball, skiing, football and soccer. It occurs less in ice hockey because of the gliding motion of the players. In any event, Palmer is just the latest in a long list of famous athletes who have been devastated this season-ending injury.
The ACL - or anterior cruciate ligament - is a ligament that connects the thighbone to the shinbone (fig. 1). Other knee ligaments such as the MCL (medial collateral), LCL (lateral collateral) and PCL (posterior cruciate) ligaments usually heal on their own with extensive physiotherapy and rest but the same privileges are not accorded with the ACL. ACL tears require surgery to repair. The ACL is the ligament (ligaments are tough non-flexible fibbers that keep your bones in place) that crisscrosses and stabilizes your knee. In doing so, it permits lateral movements.
The ACL tears with sudden rapid moves or high impact collisions on the side of the knee like Palmer suffered. Interestingly, 30% of all ACL incidences are a result of impact. 70% of ACL tears happen without impact. While a person can go on without repairing the ACL since it will not bother you while walking, swimming or cycling it will buckle (with pain I might add) if you decide to play sports that demand pivotal and directional moves.
In my case, one injury was without impact and the other was. The injury sustained without the impact was during a ball hockey game. Moving up the rink I made a sudden lateral move to avoid a defender. I still remember the popping sound. The pain was unbearable. In this light, I knew exactly what Palmer was going through.
My second injury was during a soccer match. This time I cut across the filed at top speed only to have a defender step into me. I was heading in an east-west direction and he slammed into me knee on knee from the north south angle. This injury was very similar to Palmer's. The pain, again, was incredible.
I knew right away it was an ACL. Oddly, the physiotherapist on the field and the sports doctor the next day both felt it was an MCL. I disagreed. I went to my orthopedist (who is part of a sports clinic who handle pro-athletes) and a subsequent MRI proved me right. He too, by the way, initially thought it was an MCL.
The first time I tore the ligament I was 16 and was expected to attend the under-16 Team Canada soccer try-outs. I never got the chance. It was all-downhill from there. I could never overcome the psychological trauma of the injury. A pro athlete can do so because it is his job, for a teenager it proved too much. Since I was 17 I have played sports at maybe 75% throttle. It's tough to play a sport when you are always thinking about that 'pop' sound. It's even tougher if you are competitive as I am. Of course, I could not expect others to ever understand this which made playing 'for the team' hard.
After tearing the ligament, it took me another year before I decided to have surgery. I popped my knee maybe another 8 times thus shredding not only the ligaments but damaging the meniscus cartilage.
The decision to have the surgery was simple for me and can be just as straightforward for others. If you are active and want to play sports or have a job that is physically demanding have the surgery. You will never be 100% but it's pretty close. Ironically, the knee will probably be stronger. Conditioning will help to strengthen and stabilize the knee - this is crucial to the success of the surgery. However, your range of motion and quickness are reduced. Speed comes from your hamstrings and quads but your ACL's have a lot to say in the matter and I have noticed I lost a slight step. It's much different for a well-conditioned athlete of today. They have so many advantages and as such a full recovery is usually successful.
Once a career ending injury, modern medicine has developed techniques to repair the ACL. It usually takes three to six months to repair and heal. It takes an additional three to six months before one gets cleared to play again. When all is said and done, it can take up to one-year before getting clearance.
The ACL does not discriminate and watching Palmer go down right after his first career playoff completion in the second play of the game was proof that life isn't fair. The Cincinnati Bengals were not able to recover after that. They'll have to wait a while before Palmer does so too. Each time I watch an athlete go down with a knee injury, this one time I know exactly what is going through their mind.
Sources: American Academy of Orthopaedic Surgeons. Canadian Sports Medicine.
NOTE: Since I wrote this piece, it has been reported that Palmer's injury is far more extensive than an ACL. It turns out he shredded other ligaments and suffered a dislocated knee cap. Bengal fans are holding their breaths I am sure.
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