Originally Posted by dc_txtech
Thanks doc. Could you explain what "went well" might mean? What complications might arise or why one successful surgery might be better than another successful surgery.
Cushing’s surgery having gone “very well” is standard for we didn’t come up against problems during the surgery that we didn’t expect or were able to handle them if encountered. It does not speak for prognosis per se.
A 2006 American Journal of Sports Medicine study looked specifically at ACL injuries in NFL players (running backs and wide receivers) found those who suffer one of these injuries will likely never be the same player again. Essentially, total yards and touchdowns were markedly diminished (~30%) when they returned after surgery.
The lead author concluded that these players were only playing at approximately 2/3rds of the level they were playing at before the injury. This study was the first time anyone used player performance and their statistics to look at the outcomes of a surgical procedure.
Probably the most concerning stat was that 21% (1/5) of these injured players never played another NFL game. The predominant thinking when 31 head NFL team physicians were interviewed, was that 90 to 100 percent of players, presuming not borderline talent, return to the NFL. Of those who did return, it took 9 to 12 months to get back on the field.
The chief author of this study stated that it gave all of his co-authors pause. He said that even in the best case scenarios these were players who were going to work in the extreme doing rehab 8 hours a day to get back to playing and even then a fifth of them weren’t getting back to playing. Interestingly, those who sustained ACL injuries are more likely to be high-performance players, essentially those players who perform frequent accelerations, decelerations, twisting, cutting maneuvers, that puts them at the highest risk. They were also more likely to be injured because they compete in more plays per game, carry the ball longer on each play, and attract more defensive attention.
The biggest problem with an ACL injury is that once it's torn there is no way that it's going to heal or be repaired, except with surgery. But those elite players ended up less great after that surgery. It's believed players don't get back to where they were because of one or more factors, including knee pain, stiffness, loss of strength, deconditioning and reduced proprioception, which is the sense of knowing where your leg is. A summary message was left that ACL reconstruction does not perfectly recreate the complex anatomy and composition of a player's ACL before injury.
Now, some could say that this is an older study and that both surgical and rehab techniques have improved since then. So then we are handed additional information from a newer study published in July 2010 in the same Journal that concluded that 63% of NFL athletes returned to NFL game play at an average of 10.8 months after surgery. Age at time of surgery, position, and the type and number of procedures were not significantly different between those who did and did not return to play. They found that the return to play rates after ACL reconstruction in NFL football players are lower than previously perceived. More experienced and established athletes (4 years or more) are 5 times more likely to return to competition at the same level after this procedure than those with less professional experience. Being selected in the first 4 rounds of the NFL draft was highly predictive of return to play.
Keep in mind that not all ACL injuries reflect the same level of trauma. Approximately only 1/3rd are solitary injuries, where as 2/3rd are accompanied by a combination of tears to the medial or lateral collateral ligaments, and/or medial or lateral menisci. If you ever talk to a professional football player who has undergone the reconstruction.....even the elite who return to commendable performance....if they are totally honest with you, they will tell you that their knee still doesn’t feel entirely “right.”
I’ve posted the above more for those interested in reviewing some of the “available” information on the subject in NFL players. It does not include the recent attempted use of combined platelet or stem cell therapy, which at this time are still in infancy and not of proven value. As for Cushing, the “gym rat” in him gives him the best shot for returning “in tact” to kick butt.