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The evolution of ACL injuries

Not long ago, ACL tears were the greatest fear of an athlete. In 2012, Adrian Peterson of the Minnesota Vikings nearly broke the NFL rushing record less than one year after the injury. How has surgery and rehabilitation come so far?

We all have heard someone talk about their 'trick knee' they hurt in high school football, or the stories of players losing their college scholarship due to a knee injury. So how does Adrian Peterson return in less than a year and just miss the NFL rushing record?  Let's look back and see how we've gotten from there to here—from career-ending setbacks to near-record setting comebacks.

An online search reveals little specifics when looking for career ending knee injuries. This may be because the injury kept players from ever having a recognizable career. Joe Namath was one of a few players to have a successful career in early days of ACL injuries. Namath had a brace made especially for him that allowed him to continue to play without surgery. Back then, surgery was almost always career ending due to the procedure itself and the poor rehabilitation afterwards.

It wasn't until the 1970s when Temple physician Dr. Joe Torg first discussed the Lachman's test for assessing an ACL injury. In the 1980s the MRI helped us to diagnose an ACL tear. Around this same time, arthroscopy was first used for knee injuries. Since then there has been an evolution in both the surgery itself and the subsequent rehabilitation.

Surgery has gone from using a button outside the skin as an anchor for the ACL graft to bioabsorbable screws for anatomical reconstruction. Rehabilitation has also progressed from being casted for 6 weeks to riding a stationary bike the next day following surgery. These advances in surgery and rehab are what allow exceptional athletes the opportunity to return to same level of play in such a short period of time.

But players like Adrian Peterson are the exception and not the norm. In reality it takes a year or more to fully recover from ACL surgery. And even Peterson has not fully recovered as evidenced by some physical measurements and teammates' reports. Now when players suffer career ending injuries it is not solely due to the ACL, but multiple ligament injuries or articular cartilage damage.

New surgical and rehabilitation techniques are allowing players to return to pre-injury levels of competition—but only through months of hard work. In the past, surgery ended careers. Now it allows extraordinary athletes to return in such short periods of time, and average athletes to eventually return to the sports they love.

Justin Shaginaw, MPT, ATC is an assistant athletic trainer for the U.S. Men's National Soccer Team. Arthur Bartolozzi, MD, is Director of Sport Medicine at Aria 3B Orthopaefic Institute.

Read more Sports Doc for Sports Medicine and Fitness.