Before Adrian Peterson, taking a year to recover from anterior cruciate ligament (ACL) reconstruction was expected. Peterson tore his ACL in 2011 and returned to game play only 8 month later. And he didn’t return quietly. In his first game back, Peterson rushed for 84 yards and two touchdowns. He later went on to win the 2012 NFL MVP award for his work that season. Suddenly a year to recover sounded like a long time.
Patriots running back Dion Lewis tore his left ACL in this play against the Redskins on November 8, 2015. Up until that point, Lewis had been a major contributor to the Pats offense.
He had ACL reconstruction surgery November 18, 2015 with Dr. James Andrews, the same surgeon as Adrian Peterson. Lewis spent the winter and spring recovering and made an appearance in June for off-season workouts. In May, it was reported that sources close to Peterson thought he was about a month away from being game-ready. Unfortunately, the running back suffered a setback over the summer and in August Jeff Howe of the Boston Herald reported that Lewis would be undergoing a second minor “clean-up” surgery and would be starting the season on the Pats PUP list.
So, why do some athletes recover from ACL reconstructions in 8 months and others require second surgeries with extended recovery times? One obvious answer is that different bodies heal at different rates, but that doesn’t necessarily explain it all.
The ACL is a rubber band-type structure deep within the knee that prevents the tibia (shine bone) from moving forward in relation to the femur (thigh bone). The ACL is very important in any sports which involve quick changes of direction as well as changes in speed. In a recent study published in the Orthopaedic Journal of Sports Medicine, Christopher C. Dodson, M.D. and others collected data on ACL injuries that occurred between 2010 and 2013. They found that 219 NFL players suffered ACL tears from 2010 to 2013. ACL tears were most common in wide receivers, tight ends, running backs, fullbacks and linebackers. When the knee buckles during an ACL injury, other structures can also be harmed. In particular, it is very common for the discs of cartilage in the knee called the medial meniscus and lateral meniscus (shown in blue in the above figure) to be torn as well. Once the ACL is torn, it cannot be sewn back together. Surgeons used to treat ACL tears that way but eventually they realized that the ACLs were never healing. In order to get a functioning ACL after a tear, surgeons need to replace the ACL with either a tendon from the patient’s own body or a donated tendon from a cadaver. If there is an associated meniscus tear, the surgeon would either attempt to repair the tear or shave out the portion of the meniscus that is damaged.
Rehabilitation after ACL reconstruction focuses on regaining range of motion, reducing swelling, and strengthening muscles (particularly the hamstrings and gluts) to protect the new ACL from tearing as the athlete advances back into activities. A study published in 2010 in the American Journal of Sports Medicine which evaluated return to play time for NFL players after ACL reconstruction, found that these athletes returned to the field after an average of 10.8 months of rehabilitation.
Not every NFL player returns that quickly, however. Some athletes have setbacks. The most common complication after ACL reconstruction is called arthrofibrosis. This is a condition where the body does too good of a job healing after surgery, resulting in excess scar tissue formation. The extra scar tissue makes the knee stiff and can be painful. Arthrofibrosis is often treated with a second knee scope to “clean out”the excess tissue. I suspect that Dion Lewis was dealing with scar tissue that was inhibiting his ability to progress his rehab and this ultimately led to a second knee scope in late August.
In the past week, Dion Lewis has been spotted by reporters in the Patriots locker room. He’s not wearing a brace and seems to be walking normally. Hopefully this is good sign that his recovery after surgery #2 is going as expected. If that is the case, we may see the running back out on the practice field sometime later this month as he works his way back to being game-ready. Lewis’ major strength is his athletic quickness and ability to juke player after player for long gains. Let’s hope that when #33 returns to the field, he’s the same elusive player he was in 2015.
Follow me on Twitter @jessdeede