Packers fans everywhere are still reeling from the news that Aaron Rodgers’ greatest deep threat Jordy Nelson will be lost for the season, yet another victim of the dreaded anterior cruciate ligament (ACL) tear. Of course there is the initial shock when the All Pro wide receiver went down in a non-contact injury. While it was a shocking surprise to everyone else, perhaps the most shocked was Nelson himself. As he said yesterday, he did not think much was off with his right knee. After all, it was something he’d done countless times: jump, land, pivot and wait for a Rodgers’ rocket.
In fact, there was little pain, so when his knee collapsed he wrote it off as a fluke that could be ironed out on the sidelines. Nelson said, “I thought it would be honestly more painful than what it was. So the shock of when the doctor told me was a little overwhelming. I was shocked and obviously disappointed.”
But that’s the tricky nature of an isolated ACL tear. We–Jordy included–typically think of the football-related injury as something that occurs when a player is hit or tackled and collapses to the ground in ways the knee did not intend. Yet the overwhelming majority of ACL tears are from non-contact injuries. Yet regardless of the mechanism, the backstory leading up to the tear is almost uniformly the same:
Plant, pivot and tear.
It happens in football all the time, and is what felled teammate Jared Abbrederis last year. It’s how the reigning MVP Aaron Rodgers blew out his knee when he was a teenager playing a pickup game of basketball back in 2000. The foot plants and the lower leg goes one way while the pivot turns the upper leg in another direction. In fact, in a letter to his 17 year-old self, Rodgers described the classic mechanism to a tee, “You’ll turn and plant and try to pass back toward the rim. That’s when your knee gives out.”
Pain can be a symptom of an ACL tear. And if you ask my husband, it was a white-hot blinding pain to end all pain when he tore his ACL rock climbing in college. Yet for others, the pain can be minimal to non-existent, which was the case when Abbrederis injured his knee last year. He likely continued to practice with a torn ACL for a full day before realizing something wasn’t quite right. “”I thought I was fine. Practiced Thursday and after Thursday I went in, got it looked at, and that’s when they found that.”
The ACL is one of four ligaments that hold the knee together. With the posterior cruciate ligament, they anchor the femur (thigh bone) to the tibia (shin bone) on the inside of the knee joint while the medial and lateral collateral ligaments strap the knee together on the sides. The ACL and PCL crisscross each other and form an X (cruciate = cross.) They keep the lower leg from moving out of line with femur. If the femur is a boat and the tibia is the bottom of the lake, the ACL and PCL are the ropes holding the boat to the anchor.
When one tears the ACL, there is often an audible pop as the ligament gives way (quickly snap a piece of Silly Putty apart, and you get the picture), because in most cases it’s a complete tear. Yes, like all ligaments, there are three grades of injury. Grade 1 is a stretching and minimal tearing occurs. This isn’t what happened to Nelson. A Grade 2 tear rarely if ever happens with adults because much of the elasticity in the ligament is gone in adulthood. A Grade 2 is a partial tear. While this can occur in teens, it is almost never seen in adults. Grade 3, it goes without saying is a complete tear like the illustration to the left.
While pain can occur with an ACL tear, the biggest issue is stability. That proverbial rope tethering the boat down is severed and knee joint slips and slides in unsettling directions. It’s why athletes crumple to the ground. It’s not because of the pain (while that is still a factor), it’s because joint stability is lost. Those who have sustained an ACL invariably complain that their knee keeps giving out. It’s why many wear the hinged brace following such an injury. It’s not to splint bones or joints together so the injury can heal properly. It’s to keep the knee from slipping and sliding, because no one likes it when their knee gives out.
The other problem is swelling. It’s the biggest reason surgery is often delayed weeks following the tear. Technically one can live without an ACL. Many who are less active chose not to have the ligament reconstructed and either learn to deal with the instability or wear a brace to provide extra support. But in the immediate period following an ACL tear, the knee blows up like a balloon because the blood vessels feeding the ligament are also torn, and that blood escapes into the knee joint. There’s no rush to repair an ACL, so it is typically the orthopedist will wait until the swelling goes down and some of the fluid is reabsorbed.
When Nelson eventually heads to the OR this fall, he will likely have an ACL reconstruction using either his patella (kneecap) tendon or hamstring swung into place and tacked down to form a reasonable facsimile of his ACL. Cadaver grafts are used too, but not as frequently. As he recovers, it is important to know that the typical healing time for an ACL reconstruction is 9-12 months, not the 7 months that Robert Griffin III seemed to miraculous bounce back. Grafts need to heal and take. And then there’s the rehabilitation that needs to occur. Return from such an injury is one part successful surgery, one part successful healing and one part successful physical therapy and rehabilitation.
Don’t expect to see Jordy back come the post-season. While he will likely be working daily with the therapists and trainers, he won’t be suited up until next summer. And if RGIII’s hasty return is the cautionary tale of hurrying back, then Jordy isn’t in any hurry to rush the process.
**Disclaimer: right as I was about to hit send, my ever fabulous brother Jay Hodgson posted something similar to Cheesehead TV five minutes before. This isn’t the first time it has happened. And we both wrote these without knowledge of the other doing so. Relax, we didn’t lift something from each other. What can I say? We aren’t twins (I’m five years older) but we tend to share a brain. A lot. Actually, more often than I’d like to admit. We have the same sense of humor and the same love of science nerdery which brings us to the same concept about the mechanism of an injury. But I highly recommend you check out Jay’s article because he has neato-videos and I just talked about boats and anchors.**--------------