From 48minutesofHell - Playing Without an ACL [Archive]

spurtilldeath

06-26-2009, 06:33 PM

Dan Feldman of PistonPowered (http://www.pistonpowered.com/2009/06/a-doctor-weighs-in-on-dejuan-blair-and-austin-dayes-medical-histories/) spoke with Dr. Ben Wedro of MD Direct (http://www.mddirect.org/index.html) about professional athletes playing without an ACL.

Some background from Kevin Arnovitz of TrueHoop (http://myespn.go.com/blogs/truehoop/0-41-151/The-Upside-of-Falling-Down.html):
In high school, Blair tore both of his ACLs and had them surgically repaired. Blair’s scar tissue essentially got re-absorbed by his body and the result left Blair with essentially no ACLs.
Although he’s suffered no adverse effects ever since, Blair’s is an unprecedented injury and one that scared off a slew of NBA executives. Though Blair literally has no ACL to tear, some team physicians feel that Blair could eventually develop a nagging issue that could wear him down a few years down the road.
Here’s Dr. Wedro’s assessment:
The ACL’s job is to be one of the knee stabilizers in the anterior-posterior direction, that is preventing the tibia or shin bone from sliding frontwards or backwards in relation to the femur or thigh bone. This is especially important in quick stops and starts. If there is no ACL, then the quadriceps and hamstring muscles need to take over the stabilization role. Good knee stability should be able to be maintained as long as the quads and hams remain strong and in balance.
There are examples of pro athletes who have played with absent ACLs including Philip Rivers in a playoff game for the Chargers. Marty Barrett played with the Red Sox without an ACL and I presume that there are many athletes who did not know of the injury or chose not to disclose it for fear of cutting their career short.
I appreciate Feldman’s work in this area, but a I can’t help but wonder why nearly thirty medical staffs advised their employers to pass on Blair?
Still, I’d be fine with DeJuan Blair had the Spurs moved to 15 and selected him there, guaranteed salary and all. In fact, I’d still wear the same grin from ear to ear. The Spurs’ window is 33 years old and time has come to go all-in. Moving up would have made Blair a high risk/high reward selection. But getting him at 37? What are you risking? $880,000? That’s a drop in the bucket. I’m convinced that no fewer than 6 teams erred by siding with caution on draft night. What does Bill Simmons say N.B.A. stands for?

Tully365

06-26-2009, 06:59 PM

Blair’s scar tissue essentially got re-absorbed by his body and the result left Blair with essentially no ACLs.

:lol I'm no doctor, but this sounds like a very poorly understood translation of whatever it was the Doctor actually said.

GSH

06-26-2009, 08:07 PM

I called a friend earlier and asked about the "no ACL" description of Blair. His first response was, "I doubt it." He said that the anatomy of each person's knee is different, and some do better than others with the ACL removed (rather than surgically repaired). They can do well in day-to-day activities, so long as they work on strengthening their quads and hamstrings. But athletes who do not have the reconstructive surgery have to come to terms with the fact that they are not the same as they used to be.

He also said that people with an ACL removed, even the successful ones, have a tendency to have the leg buckle when doing things like going down stairs or ladders... or sometimes even curbs. They will be doing fine, but randomly "wobble" on the leg.

But the main thing he said was that if someone with no ACL continued to play sports at a competitive level, he WILL tear the meniscus in his knee(s). Playing professional basketball with neither ACL - he said he would be surprised if someone went more than a couple of months without a meniscus tear.

He also questioned the statement about the scar tissue being absorbed, leaving him with "no ACL". He said it sounds like somebody got the story screwed up. His only guess was that he had reconstructive surgery which failed, which would leave you with no functional ACL. And that would leave free-floating tissue inside the knee which would probably have to be removed. But he said that neither the original ligament, nor the transplanted tissue used for reconstruction, would be absorbed by anyone's body.

Tully365

06-26-2009, 08:13 PM

If someone with medical knowledge associated with the Spurs were to come out this week and say that Blair's ACLs are weaker than normal in a guy his size, or underdeveloped, or had somehow atrophied due to surgery, I would believe it. The explanation that his scar tissue was "absorbed" into his body and that his ACLs just magically disappeared sounds extremely unlikely.

Spur|n|Austin

06-26-2009, 08:18 PM

Like RC said, we have a great team of doctors. Let's hope he understands he has to keep his quads and hammys strong or else

sexinthatsx

06-26-2009, 08:28 PM

I tore my ACL, I'm 11 weeks into rehab and the doctor said you have to have an ACL to play in competitive sports, especially a sport like basketball which requires jumping. I actually just talked to my physical therapist today regarding Dejuan Blair's situation, and he said that while he rehabbed well from his surgically repaired ACL, the scar tissue development actually helps because scar tissue itself is stronger than the ligament. However, the downside to the scar tissue is that it can cause the knee to become less flexible. If Dejuan Blair has been playing with "no ACLs" on both legs for two years, it must be that his knees are fine... he just needs to keep doing exercises relating to the range of motion of the knee in order to continue playing basketball effectively.

mingus

06-26-2009, 08:36 PM

my dad who's a doc says there's no way he doesn't have an ACL. wouldn't be playing if that were the case. says there's tissue there that replaces it or a plate, but impossible to have no ACL and play, esp. the way he does.

phyzik

06-26-2009, 08:43 PM

The only answer: He's an alien. Expect at some point that his knees fold backwards and he sprints down the court at 60mph to block a fast break shot downcourt. Spurs are fucking set! Alien power FTW!!

http://www.libertyfilmfestival.com/libertas/wp-content/arrival.jpg

ulosturedge

06-26-2009, 08:44 PM

Gutter92

06-26-2009, 08:45 PM

:lol I'm no doctor, but this sounds like a very poorly understood translation of whatever it was the Doctor actually said.

ESSENTIALLY ,it is :lol

Interrohater

06-26-2009, 10:26 PM

Obstructed_View

06-26-2009, 10:31 PM

But the main thing he said was that if someone with no ACL continued to play sports at a competitive level, he WILL tear the meniscus in his knee(s). Playing professional basketball with neither ACL - he said he would be surprised if someone went more than a couple of months without a meniscus tear.

That's odd, because Blair's surgery was in high school, so he's played two college seasons and missed one game.

jj cain

06-26-2009, 10:32 PM

Hines Ward doesn't have an ACL in one of his knees. He seems to do okay.

Elway & Thurman Thomas played 1/2 their careers without one also.

Extra Stout

06-26-2009, 10:35 PM

Something weird is going on here. Twenty-nine teams medically rejected this guy, and the diagnosis being spread through the media makes no sense whatsoever.

Spursmania

06-26-2009, 10:35 PM

This is annoying to read some of the posts making their own quacky diagnosis. Of course a person can play with no ACL's. The article above is 100% correct. In fact scar tissue can be absorbed leaving you with no ACL after surgery. This is where a little bit of knowledge is a scary thing... What kind of MD's believe it's impossible to play with no ACL's?

Jeesh...Quacks coming out of the fucking woodwork. Lol....

Obstructed_View

06-26-2009, 10:38 PM

:lol I'm no doctor, but this sounds like a very poorly understood translation of whatever it was the Doctor actually said.

If so, then ESPN misunderstood it too because that's exactly how they explained it last night. After the surgery, the scars from the repair are absorbed by the body leaving the knee with essentially no ACL. It's likely a fairly gradual process, allowing the rest of the knee to compensate, which is why guys are able to have success playing on them. Hines Ward had the same thing happen, only his ACL was injured in an accident as a child, and he's 33 years old, playing pro football for ten years. The condition wasn't caught until he was an adult when they scanned his knee and said "you don't have an ACL."

Jace

06-26-2009, 10:41 PM

The guy has to have ACLs lol. He would have tore up the rest of the part of his knees somewhere in college if he didn't. Trying to play basketball without ACLs is like trying to drive a car without wheels. Sorry it just won't work. There must be so much scar tissue that has grow around his original ACLs that they can't make it out the way it should look like on an MRI.

Not really, from the reports his body absorbed the scar tissue and his ligaments are just gone. The ACL is a stabilizer, maybe he is just a freak and can live without?

PM5K

06-26-2009, 10:43 PM

I’m convinced that no fewer than 6 teams erred by siding with caution on draft night.

Didn't read all of the comments but I agree with that statement, once you drop out of the first round guaranteed money, the risk of taking a player like Blair is a lot less, someone should have been smart enough to take him before we did.....

Ariel

06-26-2009, 11:10 PM

I´m not a doctor nor do I know anything about medicine, but no matter how ridiculous that sounded to me, I did hear RC say that Sean Elliott played his entire career without an ACL on one of his knees, so I would assume it IS possible that someone would play in that condition at a professional level. Still, it does sound scary that someone with Blair´s weight and style of play would have to do so without ACLs on BOTH knees. But judging from RCs statements, he´s acknowledging the seriousness of the situation, and in spite of that they´re willing to roll the dice, which is a judgement call that may very well work out even if he plays no more than one or two seasons.

Extra Stout

06-26-2009, 11:28 PM

OK, I'm slow when it comes to the medical stuff, but let's see if I understand:

Blair has no ACL's; therefore, his quadriceps and hamstrings have to be much stronger in order to compensate. So far, they have compensated well enough for him to succeed for a couple of years in college. However, because of the absence of the stabilizing ligaments, his femurs and tibias are going to have more of a tendency to rub back and forth against the knee cartilage under heavy use, and the long NBA season will induce far more wear-and-tear on his knees than the college season does. So, one might expect the mileage his knees can take to be reduced by a large fraction before the menisci give out, and his NBA career therefore to be relatively short.

Is that right?

Tully365

06-26-2009, 11:43 PM

My guess about what the original analysis meant to say is that his ACLs developed scar tissue to such an extent that the entire ligament is now solid scar tissue to the point where an MRI cannot actually detect the ACL itself. The confusion comes with the original statement that the scar tissue got re-absorbed by his body, leaving him essentially without ACLs. This wording makes it sound like the absorption process made the scar tissue, along with the ACL itself disappear, which now doesn't seem to be the intention of the diagnosis, but rather that the ACL itself has "disappeared" in a mass of scar tissue.

Spursmania

06-26-2009, 11:53 PM

^^sigh^^

Tully365

06-27-2009, 01:19 AM

^^sigh^^

Next time I'll use dick and jane baby talk for you so you won't feel excluded.

GSH

06-27-2009, 01:24 AM

If so, then ESPN misunderstood it too because that's exactly how they explained it last night. After the surgery, the scars from the repair are absorbed by the body leaving the knee with essentially no ACL. It's likely a fairly gradual process, allowing the rest of the knee to compensate, which is why guys are able to have success playing on them. Hines Ward had the same thing happen, only his ACL was injured in an accident as a child, and he's 33 years old, playing pro football for ten years. The condition wasn't caught until he was an adult when they scanned his knee and said "you don't have an ACL."

The guy I called is an orthopedic surgeon. He e-mailed me a couple of links this evening - one from the Orthopaedic Journal at Harvard Medical School, and the other from the American Academy of Orthopedic Surgeons. But what the hell, they're probably all quacks.

He said that it is possible that the comment about scar tissue being re-absorbed, etc. was because Blair had an allograft done on his knees, where they take tendon from a cadaver to repair the torn ACL. And that it is fairly common for them to "not take", leaving the person ACL deficient. He said that he can't imagine any surgeon simply removing the torn ACL and then recommending that he continue to play competitive basketball.

And, for the record, he mentioned Hines Ward. He said that Ward is a very unusual exception for being able to compete like he has. But he has played through tremendous pain, and has gone through stretches where he was on the field but not really able to perform. AND he has had surgery for a torn meniscus. The reason he brought Ward up to begin with is because the doctor said that he "had no ACL", when what he meant was that he had torn his ACL. And that statement has led people to spread the myth that Ward was born without an ACL in one knee.

GSH

06-27-2009, 01:38 AM

Like I said - Hines Ward is an exception out of thousands. He's had surgery for a torn meniscus. His season isn't 82 games long. And we all know the difference between a regular season injury and a playoff injury. I never said Blair wouldn't be able to play. Just that I understand better why he was seen as risky.

Rehab status: Ward played most of the 2007 season with an injured knee and waited until after the season to have corrective surgery. There was a time when Ward, a converted college quarterback and former third-round pick, felt the need to prove himself in offseason workouts even when he was hurt.
=======
Things got worse when a doctor examining his left knee at the combine looked up and said, "Damn, son, you have no ACL."

"That's great," Ward said. "Then I can't tear it."

"No, that's not great," the doctor said.
=======
Ward had surgery on his right knee Jan. 9 to repair a torn meniscus and said he will be good as new in about four weeks. He said the MCL and PCL in his right knee were torn Sept. 23 against San Francisco, causing him to miss two games. The meniscus was torn at St. Louis Dec. 20. He missed the season finale in Baltimore, then had his most productive playoff game with 135 yards on 10 catches in a loss to Jacksonville.

"I played all year on that one knee," Ward said. "As time went on, the knee got worse because I never let it rest ... That's why I didn't practice on Wednesdays and Thursdays, we were trying to let the PCL heal."

Ward said he talked to coach Mike Tomlin and his trainers about the option of surgery during the season vs. the risk of playing and making the knee worse. He preferred to play.

Obstructed_View

06-27-2009, 01:44 AM

The guy I called is an orthopedic surgeon. He e-mailed me a couple of links this evening - one from the Orthopaedic Journal at Harvard Medical School, and the other from the American Academy of Orthopedic Surgeons. But what the hell, they're probably all quacks.

And Super Bowl champions have teams of guys who can't read an MRI.

He said that it is possible that the comment about scar tissue being re-absorbed, etc. was because Blair had an allograft done on his knees, where they take tendon from a cadaver to repair the torn ACL. And that it is fairly common for them to "not take", leaving the person ACL deficient. He said that he can't imagine any surgeon simply removing the torn ACL and then recommending that he continue to play competitive basketball.
In the case of Ward and Blair, both situations were discovered some time later. There's never been any mention of a doctor removing anything, and no recommendation as the discoveries were made while the player was playing at a high level.

And, for the record, he mentioned Hines Ward. He said that Ward is a very unusual exception for being able to compete like he has. But he has played through tremendous pain, and has gone through stretches where he was on the field but not really able to perform. AND he has had surgery for a torn meniscus. The reason he brought Ward up to begin with is because the doctor said that he "had no ACL", when what he meant was that he had torn his ACL. And that statement has led people to spread the myth that Ward was born without an ACL in one knee.

I've never heard the suggestion that Ward was born without an ACL. He was in an accident when he was a kid. There was a story about it in ESPN the magazine.

Ward may have complications, but he's played well enough to become the Steelers all time leading receiver, has won a Super Bowl MVP and is still playing NFL football at a high level ten years into his career, not including three years playing three positions at Georgia. If he's the example, then I'm not backing away from my statement that Blair is more than worth the risk of a mid-second round pick.

Ariel

06-27-2009, 01:54 AM

Interesting quotes:

http://espn.go.com/trainingroom/s/2000/0209/345747.html

Some players may choose to avoid surgery and simply strengthen the leg through rehabilitation exercises (most often hamstring strengthening exercises). NBA basketball star Sean Elliott, of the San Antonio Spurs, partially tore his ACL when he was 14. He has competed successfully without surgery. People generally can walk and run without an intact ACL, but sudden cutting and twisting is often difficult. For this reason, most high-level football and basketball players who wish to continue competing may be better served having a torn ACL reconstructed. Studies show that more than 50 percent of players with a torn ACL will have recurrent problems with swelling and collapse of the knee. These problems can lead to cartilage damage and eventual arthritis in the involved knee.
http://vault.sportsillustrated.cnn.com/vault/article/magazine/MAG1140695/3/index.htm

A damaged ACL doesn't have to be fixed—players are now competing successfully in the NBA with damaged ACLs. Anthony Daly, the Clippers' team physician, says, "You can lead a normal life without an ACL, but you can't play a cutting sport like basketball." San Antonio Spur forward Sean Elliott tore part of his ACL when he was only 14. Surgical reconstruction wasn't done at the time because it would have interfered with the growth of the bones in his knee. He still has more play in his knee than normal, but why correct that and take away a year of his promising career when he performs as well as he does?

TDMVPDPOY

06-27-2009, 01:56 AM

super glue that shit now....

EricB

06-27-2009, 02:01 AM

:lol

I knew people on the forum wouldn't be happy with the Spurs getting a lottery talent at the 37th pick.

Damn, epitome of some people are never happy.

Tully365

06-27-2009, 02:19 AM

The reason he brought Ward up to begin with is because the doctor said that he "had no ACL", when what he meant was that he had torn his ACL. And that statement has led people to spread the myth that Ward was born without an ACL in one knee.

:lol Sean Elliott is part of that myth too.

BackHome

06-27-2009, 02:20 AM

Another player I forget his name but he played for the Chicago bears had the same surgeries and he was starting offenseive line player for the bears for a few years. He talked about how he increased his strength in his quad and glutts to compensate for the knees.

SnakeBoy

06-27-2009, 02:35 AM

My wife's a doctor. I asked her about it and she said "I'm a internist, how would I know?".

:lol I'm no doctor, but this sounds like a very poorly understood translation of whatever it was the Doctor actually said.

Maybe the doc said the acl got re-absorbed and scar tissue developed to stabilize the knee. That would make more sense to me.

I had a psycho pit bull that tore both acl's. The vet tried a synthetic replacement but the first time we let her out she took off after something and blew them both out again (2k wasted). The vet then said to just keep her inside and hope that enough scar tissue developed to stabilize the joints. Took awhile but that's what eventually happened and she was perfectly normal for 10 years after that and could still out run my other dogs.

lefty

06-27-2009, 02:40 AM

Like RC said, we have a great team of doctors. Let's hope he understands he has to keep his quads and hammys strong or else
Lakers doctors >>>>>>>>>>>>>>>>>>>>>>>> Spurs docs

raspsa

06-27-2009, 02:47 AM

We can only hope for the best. He will be in good hands. Going thru a couple of college BB seasons is great but the wear and tear of the NBA regular and postseason are far more gruelling.

DJB

06-27-2009, 02:48 AM

I eats my ACLs.

mingus

06-27-2009, 03:10 AM

i have a feeling that the doctors who work for the Spurs have the same exact sentiment regarding his knee issues as all the others, which is that it's in a pretty abysmal state . Spurs picked him because they desperately needed a big after trading away their others in the Jefferson trade, not neccessarily because they see the current status of his knee more favorably IMO . i don't expect much from him.

wut

06-27-2009, 09:27 AM

The Spurs only have a short window left anyway right? ....on top of the fact that he's a lottery talent for peanuts.

There's no risk here...even for Dejuan Blair, he gets to play for a great team and prove his worth.

No pressure situation for anyone.

ulosturedge

06-27-2009, 10:15 AM

He will be fine... the guy has played throughout college with no issues. We are just looking for as much immediate return type players as we can find atm. If we get 2 or 3 solid seasons from him then we made out big.

Whats more important is that we got a guy who feels like he's one of the best. This guy is going to come in with a better mindset and confidence then we got from Hill last summerleague. He has the tools already.

I'd take a guy who knows he can compete with the best of them with some suspect health issues over a guy who just has some upside potential but hasn't proven much and isn't sure how he compares.

We did great with our 37th pick. It was the right gamble considering our needs and our timetable for competing for a few more championships.