Advances in the understanding and treatment of knee injuries make it possible for injured athletes such as Vikings quarterback Teddy Bridgewater to return to peak performance, according to physicians interviewed Wednesday, but research shows that they nonetheless face a long and uncertain road to recovery.
Researchers at Northwestern University analyzed orthopedic injuries suffered by 559 NFL athletes, and found the ACL tear to be one of the most damaging to the course of pro football players' careers. Those with ACL injuries needed more than a year to recover, on average, and their careers following their injuries were shorter than those of players recovering from other orthopedic injuries, according to results being printed Thursday in the American Journal of Sports Medicine.
While ACL injuries might be more familiar to sports fans, given their frequency, doctors said the knee dislocation that Bridgewater suffered on Tuesday is more troublesome, because a knee bone moving out of joint can cause severe damage to the surrounding nerves and blood vessels. Reports that Bridgewater did not suffer this additional damage suggested optimism for his return to play.
"That's the scary thing _ that's usually the emergent thing we need to manage," said Dr. David Jewison, an orthopedic specialist and team physician for the University of Minnesota football and hockey programs. "It appears that didn't happen with him, which is great news, because that will definitely change the picture."
Bridgewater was reportedly dropping back to make a pass in practice Tuesday and wasn't tackled or hit when he suffered the injury involving his ACL, or anterior cruciate ligament.
The ligament crisscrosses in the knee with the posterior cruciate ligament to form the joint of the knee, and stabilizes it and prevents its bones and cartilage from grinding against one another.
Minnesota orthopedic and sports medicine experts said they weren't surprised that a dislocation would cause an ACL tear, an injury that afflicts 100,000 Americans per year and can occur despite little trauma and pressure on the knee.
The ACL commonly tears when athletes hyperextend their knees _ which means they bend them too far backward _ or twist the joints. But the risk is greater when these motions happen in combination, which is a common sequence for a quarterback who would drop back and then move side to side to survey the field and look for open receivers.
But a knee dislocation from a noncontact injury is rare in a healthy athlete, they said. Such an injury requires extreme force directed at the knee, usually when someone plants his foot and rotates his body while keeping his foot in place.
"Usually it happens in obese people," said Timothy Hewett, who directs the Mayo Clinic Sports Medicine Research Center and has expertise in knee injuries. "In a young athlete like Teddy, it's quite unusual in a noncontact situation. Usually, it would take a major blow directly to the knee."
Bridgewater was taken by ambulance to a nearby hospital following the injury. The response of medical staff at the Vikings facility could have made a difference, doctors said. First-responders often try to put patients' dislocated knees back in place, because that reduces the pain and the chance that it will damage surrounding nerves and blood vessels.
NFL running back Willis McGahee and quarterback Carson Palmer are recent NFL stars who recovered from knee dislocations. Former Vikings quarterback Daunte Culpepper suffered a grisly knee dislocation along with multiple ligament tears that shortened his career.
Hewett said there has been an uptick in ACL injuries; he counted 13 in the NFL preseason already. Usually, there are about 35 total in an average NFL season.
Some medical experts have hypothesized that the players are more at risk these days due to changes in NFL contracts that take them away from their team doctors and medical staffs who can help them prevent or reduce their risks. Hewitt and Mayo colleagues published a study recently noting that the NFL posted the most ACL injuries for a season after the 2011 lockout, when preseason training was shortened.
"Our speculation was that the disconnect between the players and the medical staff ... after the lockout, and then a very shortened preparation for the season, led to that rash," he said.
