Nearly a year to the day he tore his ACL Notre Dame starting quarterback Dayne Crist went down for the season with a patellar ligament injury to the knee.
The simple action of straightening one’s leg, let alone the explosion that takes place in any athletic move, comes from an intricate system and chain reaction from quadriceps contraction through the quadriceps tendon and patella itself through the patellar ligament (sometime referred to as the patellar tendon), its anchor point.
The patellar ligament (tendon) stretches from the bottom of the patella or knee cap and anchors on the front of the shin.
The structure is instrumental in allowing a person to straighten his or her leg.
When the quads fire and contract, the force is transmitted through the quadriceps tendon, and the patellar ligament uses the patella as a fulcrum to generate more strength as the individual straightens his leg.
There are many documented cases in the NFL of this, one of the most notable is the Denver Broncos' running back Correll Buckhalter. He returned from this injury twice to be a productive NFL running back.
It will be in the best interest of Crist to have surgery this week as it will allow for less complicated repair, as scar tissue will have little time to develop and settle in.
Most surgeons will attempt to make the repair primarily, meaning using the tissue in place, if the injury is too severe a surgeon may harvest tissue from a donor or another site of the body.
Post-operatively, the client will be partial weight bearing period for five to six weeks, rehab protocol will be determined by the surgeon but will be modified if need be by working with the board certified physical therapist in charge of the rehabilitation.
Typically the client starts bending the knee himself one to two weeks after surgery, straightening it is typically only performed passively with assistance.
It is important to start ranging the knee in rehab as soon as possible as the two complications associated with this surgery are quadriceps weakness and lack of range of motion.
Of course those are actually dependent on each other as limitations in strength can limit range of motion, and limited range of motion can over time lead to limitations in strength and stability.
Some clients can return to athletic activities in as short of a time as six months, however, returning to the high level of playing competitive college football could take eight to nine months.
Many factors go into the length of recover period, the surgery itself and the client's physical initial response have a great deal to do with the recovery time, as does the physical therapy afterward.
The real work will be done in physical therapy as the client will be spending at least four to six hours a week, conservatively speaking, in rehab.
The goal will be to decrease the onset of scarring, contracture or range of motion limitations. This will mostly likely be done with and great deal of manual ranging and the use of a constant passive motion (CPM) machine.
Additionally, the goals will be to encourage tissue regeneration, and decrease swelling and edema. Traditionally the use of ultrasound and electric stimulation is used in this situation.
With more recent advancements in technology, those modalities have been less utilized especially in the cases of higher end athletes.
In case with Kellen Winslow Jr after his motorcycle accident in 2005, and with the bone bruise to Lindsay Vonn at the Vancouver Olympics, the use of FDA approved cold laser therapy has been utilized to assist in speeding up the recovery process with biochemical stimulation versus just temporarily decreasing the pain as is the case with ultrasound and electric stimulation.
Not only do the clients report decreased pain, they report more mobility and stability in a shorter time period.
Finally, the goal will be into introduce athletic activities, first going forward, then forward and backward. Overtime side to side activities will be introduced at 25, 50 and 75 percent speed. Crist will eventually be allowed to perform compound athletic movements again at 25, 50 and 75 percent before returning to non-contact practice activity.
Once Crist returns to full football activities, the use of a brace may be warranted.
However, it would be more for comfort then anything else as the traditional braces you see most football players wear provide lateral stability primarily protecting the ACL and collateral ligaments.
Christopher Stulginsky, PT is the managing partner of Ayrsley Town Rehabilitation, in Charlotte, NC. He is a Prehab Network Specialist, an 830 Cold Laser Certified Premier Provider and certified by the prestigious Titleist Performance Institute. Christopher has provided injury coverage to numerous websites most notably Deadspin, Redskins.com and NFLSportchannel.