ACL injuries no longer spelling doom for football careers

Michael Mauti has to laugh at what seems to be his good fortune.

"If I were lucky," he said with a forced chuckle, "I wouldn't be in this situation in the first place."

The former Penn State linebacker has had three ACL reconstructions -- two on his left knee and one on his right -- in the past five years. If not for that, he might have been a second- or third-round pick in April's NFL draft. Because of his ability to return from the surgeries, Mauti was selected in the seventh round by the Minnesota Vikings and has a chance to make the team.

A chance that might not have existed a few years ago.

At one time, a torn anterior cruciate ligament was a career-ending injury in football, but thanks to improvements in surgical procedures and new rehabilitation techniques, players seem to be coming back faster, and sometimes better, than ever.

Though it remains a devastating injury, many point to the biggest difference being the improvements in the rehab process, which often begins the very night of the injury.

According to Kevin Wilk, a reknowned physical therapist at Champion Sports Medicine in Birmingham, Ala., patients will walk on treadmills submerged in water that alleviate about 25 percent of the body's weight, move on to running on zero-gravity treadmills that use contained air to buoy an athlete like a hovercraft, and eventually graduate to running on solid ground and sports-specific skills.

Mauti suffered his third ACL injury in November, toward the end of an All-American senior season. Although he was unable to run for scouts at the NFL combine in February, he was in Indianapolis for interviews and other assessments. And of course, he was poked and prodded by just about every team's medical staff.

"I had 32 sets of hands on the leg,'' he said, "but everybody was real positive about it.''

Adrian Peterson returned to the Vikings for the 2012 season, six months after suffering an ACL tear in December 2011 and came within a first down of breaking the NFL's single-season rushing record.

South Carolina running back Marcus Lattimore's knee was mangled in late October (he suffered a torn ACL, MCL and PCL, further complicating matters), but he drew an ovation from scouts at his pro day this spring when he was able to participate in football drills. The 49ers drafted him in the fourth round, even though it was his second ACL injury and he might not play for them in 2013.

"It almost used to be that if a running back had it, oh man,'' Jets coach Rex Ryan said in March at the league's owners meetings in Phoenix of the changes in perception regarding ACL injuries. "Just look at the best running back in the league [Peterson] and see it. I think each case is probably a little bit different, and we'll still lean on the doctors. But maybe it's not as big of a deal as it used to be.''

Superhumans

The man who might be most responsible for making it seem "not as big of a deal'' insists that it is.

Dr. James Andrews, one of the most prominent orthopedic surgeons in the United States, a man whose patients include Peterson, Robert Griffin III of the Redskins, and Lattimore along with hundreds of other professional athletes, would be one of the most unexpected sources for skepticism when it comes to players returning from ACL injuries. Yet . . .

"The last thing I'd want people to be thinking is people are coming back quicker and quicker,'' Andrews said at his facility, the Andrews Institute, in Gulf Breeze, Fla. "The few individuals that you know of who have come back quickly are what I call 'superhuman' athletes . . . There are only a few of those superhuman athletes out there. Their healing potential for some reason is much better than the average patient, but you can't extrapolate their ability to come back from an injury to the average athlete.''

Not even to the average world-class athlete, as in a run-of-the-mill NFL player.

"They're all different,'' Andrews said. "There's still a big spectrum in how they heal and how they come back . . . It's hard to predict recovery from an ACL surgery, and to say that we're getting them back quicker than we used to would be false information from my standpoint.''

Many don't come back at all. A 2010 study published in the American Journal of Sports Medicine found that only 63 percent of NFL athletes who had an ACL reconstruction returned to play another game. Roughly two out of three. And two years after ACL surgery, Andrews said, about 55 percent of NFL players are no longer playing in the league. For the majority, an ACL still is pretty synonymous with the end of a career.

"That's the real fact,'' Andrews said. "It's not a good injury to have regardless of how good a job we do.''

The schedulemaker

The actual procedure for reconstructing an ACL takes less than an hour. The rest of it happens outside the operating room in lonely gyms and training rooms, where the knee is brought back to health. It takes only about four weeks for the bones that hold the new ACL in place to heal. It takes much, much longer for the muscles around the ligament -- the quadriceps, the hamstring, even the hip -- to strengthen enough to protect that new ACL properly.

That's where someone like Wilk comes in. Wilk is one of the foremost physical therapists in the country and has worked hand-in-hand with Andrews for years. When prominent players coming back from ACL surgery say they are "ahead of schedule'' or "on schedule'' in their recovery, it usually is Wilk who has made that schedule.

"For us, ahead of schedule means reaching certain milestones, almost like a road race,'' Wilk said from Champion Sports Medicine. "Sometimes you can start out ahead and fall behind. And then you can start out on track and end up really fast. Adrian Peterson, he started out kind of normal. He didn't really look to me like he was that far ahead. He looked great, don't get me wrong, but it wasn't like he was exceptional.''

Even with zero-gravity treadmills and other innovations, it's still hard to trim time off the rehabilitation. Wilk said the schedule is typically outlined at seven months and one week. That means Peterson, when he returned to football in August after surgery in late December, was actually right on time.

So was cornerback Darrelle Revis, who tore his ACL in September and was cleared to return to full activity last month. And Griffin, who had knee surgery in January, conceivably should be ready for the 2013 season.

"Peterson didn't come back faster,'' Wilk said.

So why the fuss?

"He just came back better.''

Smarter muscles

Craig Levitz, chief of orthopedic surgery at South Nassau Community Hospital, sat back in a chair in his Lynbrook office. With his eyes closed, he reclined, lifted his leg and placed his right foot flat against the wall. Had he undergone a recent ACL reconstruction, he might not have been able to do that simple task.

"I can sense where my knee and foot are in space,'' he said. "There are proprioceptors that live in the ACL, but when you tear your ACL, they're gone. The reconstructed ACL has nothing in it.''

Proprioception may be the most important word in returning from an ACL injury. It's the difference between Adrian Peterson and Bulls star point guard Derrick Rose, who has yet to play in a game since tearing his ACL more than a year ago. It is the sense of the relative position of neighboring parts of the body and the effort needed to create movement. In other words, it is what allows an athlete to feel like himself again.

The body must redevelop those fibers into the new ACL through repetitive activity.

"When you tear your ACL and you come back, the game is too fast for you,'' Levitz said. "You're used to seeing a guy [on the field] and your whole body goes that way before you think about it. When you tear your ACL, you have to tell your leg to go that way . . . The muscle loses all its memory when you tear an ACL. You've made a baby again. So you have to teach it.''

The Vikings did not use Peterson in any preseason games in 2012, but they did allow him to practice in training camp. That helped the muscle memory of those dizzying cuts and bruising bursts to return to his knee. And it took Peterson a little while to get going once the regular season began. He had one game with more than 100 rushing yards in his first six, and that was for 102. In his last 10 games, he ran for fewer than 100 only once.

"He did not show that lack of proprioception,'' Levitz said. "Most guys need that one year . . . He very well could have had muscles that were able to re-learn at a rate faster than the average guy's.''

A chance

Naturally, a player like Mauti draws inspiration from Peterson's 2012 comeback. And now they find themselves teammates in Minnesota. Perhaps the Vikings' firsthand experience with Peterson's injury gave them the confidence to select Mauti. After all, Peterson and Mauti already have shown they can come back from the injury and play at a high level.

"NFL players should expect to be back on the field the next season, without a doubt,'' Levitz said. "It's odd when they're not. NFL players who tear their ACL, there shouldn't be anything to worry about with today's technology.''

That's the biggest advancement in the procedure. It's not a guarantee, but it gives players a chance. They might not make the team. They might not ever regain their original form. But they have a chance to do it, which was not afforded to players of an earlier generation.

Players such as Bears great Gale Sayers, who came back from an ACL tear to lead the league in rushing, just as Peterson did, but never was the same player and had his career cut short by a second tear. He retired in 1971 at the age of 28.

"He was at a disadvantage with that injury compared to today, there's no question about it,'' Andrews said.

He folded his hands, looked down, pursed his lips and nodded softly.

"I'd have saved his career.''