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A Sports Medicine Analysis: Torn ACL

David B. Schafer - December 9th, 2018


Green Bay Packers linebacker Jake Ryan has a torn ACL, a source told ESPN's Adam Schefter.

Ryan, who was slated to start at inside linebacker, was carted off from practice with the injury. It is likely he will miss the 2018 season.


"Yeah, it's tough, just seeing how much he had put into it in preparation. Unfortunately that's part of it, and you feel for him, but at the same time, I mean, the train keeps moving," Packers defensive coordinator Mike Pettine said Wednesday. "It's always something to deal with, and especially with how early it happened, too."


The injury occurred during an 11-on-11 drill late in Monday's practice. Ryan, 26, pounded his fist on the ground as he received medical attention.


The injury will accelerate the need for rookie third-round pick Oren Burks to play a bigger role on defense. Also, defensive back Quinten Rollins has worked as inside linebacker in the sub packages, and the Packers are high on undrafted rookie linebacker Greer Martini of Notre Dame.


Ryan, a fourth-round pick of the Packers in 2015, started 12 games last season, finishing with 79 tackles, a forced fumble and a sack. He has appeared in 43 games (27 starts) during his three seasons in Green Bay.

After extensive research I was able to identify that it was Monday July 30 th, 2018 during practice when the ACL Rupture occurred. ( cbssports.com)

Unfortunately I was unable to find a mechanism of injury for this specific athlete. It it likely that he ACL Rupture was due to some type of blow to the knee. ACL Ruptures are very common especially in soccer and football. Usually ACL tears occur due to an anterolateral blow to the knee. It is possible another player delivered this type of blow during practice.


Another possible MOI for this athlete could have been a violent and sudden change in direction or velocity during practice. Often times it has been reported that ACL tears can occur while changing direction suddenly or “cutting”.


Anatomical Structures involved in ACL pathology

Anterior Cruciate Ligament (ACL)

Femur

Tibia


Orthopedic examinations to test ligamentous structure in the knee include:

Anterior drawer test

Lachman test

Posterior drawer test

Valgus stress test

Varus stress test

Mcmurray test

Patellar apprehension test

Patellar grinding test

Plica test

Ober test

Extra/Surrounding structures

Posterior Cruciate Ligament (PCL)

Medial Collateral Ligament (MCL)

Lateral Collateral Ligament (LCL)

Medial Patellofemoral Ligament (MPFL)

Lateral Patellofemoral Ligament (LPFL)

Menisci (Medial and Lateral)

Patella

Patella tendon

Patella ligament

Patellar Retinaculum

Sub-patellar articular cartilage

Articular cartilage of femoral condyles

Meniscofemoral ligament


Jake received was seen by the team physicians for the Packers. After the initial exam an MRI was ordered to confirm an ACL pathology. I was able to confirm that ACL Reconstruction was done to repair the ligament, however I was unable to confirm the specific graft that was used or any other details regarding the surgery.


Jake was removed from playing until cleared by a doctor which prompted the diagnostic imaging and eventually the surgery. Jake was unable to play for the rest of that remaining season and alternate players were put in to replace him as this was considered to be a major injury in the athletic setting given the fact that he would need to spend at least 9 months recovering and rehabilitating his knee to get even half athletic function back.


Rehabilitation and Physical Therapy

I was unable to identify the name and/or practice of the physical therapist. The following are exercises that Jake likely did with his physical therapist in early and late rehab of his new ACL:

Range of Motion (ROM)

Heel slides (w/ or w/o band)

Knee hyperextension attempts (w/ towel)

(Laying prone) hanging lower leg off the table into gravitationally forced knee extension

Edema massage

Passive heel slides (PT is passively moving knee)

Passive knee extension or hyperextension (PT is passively extending knee)

Treadmill

Bike

Strengthening

Treadmill

Bike

Straight leg raises (All 4 directions, with added weight later into rehab)

Hip Proprioceptive Neuromuscular Facilitation (PNF)

Calf raises

Wall sits

Squats (w/ medicine ball)

Monster walks (lateral, forward, backward)


An ACL custom brace is almost always used to stabilize the knee during physical activity.

ESPN's Rob Demovsky contributed to this article. Link to original article page: https://www.cbssports.com/nfl/news/report-packers-lb-jake-ryan-tears-acl/


Lead image: Pexels.

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