According to the American Academy of Orthopaedic Surgeons, nearly 100,000 people in the United States tear their anterior cruciate ligament every year.
Unfortunately for the Mid-Penn Conference, several high-profile football players have been added to that sum this season.
Steelton native Ted Yanchuleff has seen more than his fair share of teenage athletes exposed to ACL injuries.
Currently the manager of rehabilitation outpatient services for PinnacleHealth, Yanchuleff is both a licensed physical therapist and certified athletic trainer with a resume that stretches to 1977.
While all competitive athletes suffer initial shock and frustration upon hearing that crucial diagnosis, we asked Yanchuleff to take us through the necessary steps to help return those athletes to competition.
As athletes continue to get faster and grow stronger seemingly every season, high-velocity twisting of the knee in often violent, cutting sports like football has increased the odds of ACL injuries.
“Often you don’t have a collision when the ACL fails,” Yanchuleff said. “Normally, the foot is twisted or planted and the forces went in the wrong direction.”
The good news for those exposed to ACL tears is the recovery process has advanced considerably in the last 10-15 years. A patient’s perseverance and communication is the key.
“The athlete, therapist and physician all have to be on the same page,” said Yanchuleff, in regard to determining an appropriate rehab timeframe and protocol for each patient.
“High profile or elite athletes might be shut down for a year to protect their long-term career. It could be as little as six months in an accelerated program if the benefits equal the risk. The normal recovery time is nine months to a year. Rushing the high school athlete does not have the risk-benefit quotient that we’re looking for.”
RECOVERY PHASE 1: Weeks 1-6
Through every step of the recovery process, protecting the “graft” is vital, said Yanchuleff. Physicians have several options when reconstructing either a torn or ruptured ACL.
As always, several factors such as age, body mass, fitness before the injury and, most often, a surgeon’s preference, contribute to which method is used.
“Surgeons have a lot of choices, but the gold standard is the patellar tendon autograft,” said Yanchuleff. In this procedure, a graft, normally about 10 centimeters long, is harvested from the middle third of the patient’s patellar tendon.
After surgeons create a tunnel between the tibia and femur, screws secure each end of the graft to create the “new” ligament. Motion usually begins immediately.
“The bone on bone insertion starts to heal, but exercising too soon is bad. In those first six weeks following the procedure we want to work the knee is a controlled way. We’re very protective of the graft,” Yanchuleff said.
Typically, an athlete will work on strengthening quadriceps muscles as they wean off crutches and begin to walk independently.
Not including supplemental work on off days, rehab sessions also include measuring the laxity of the ligament. Patients also start moving off any pain medication in this time period.
RECOVERY PHASE 2: Weeks 6-12
Athletes, high school football players included, begin to see some progress in this phase of the recovery process. That, of course, comes with a warning.
“Like the first six weeks, we’ll continue to watch for swelling in the knee and start to increase the strength and endurance of the athletes,” Yanchuleff said.
“As we move to higher levels we want to see full range of motion. Again, we want to make sure that graft has time to mature, so we’ll control movement in the knee.”
While a few more progressive exercises may be introduced, athletes should be mindful of advice from both physician and physical therapist.
While a post-operative brace provides added stability, too much pressure on the knee too soon can prolong the rehabilitation process. Or worse.
Yanchuleff recalled the story of NFL Hall of Fame WR Jerry Rice, who pushed his way back to competition in 1997, just 3½ months after ACL reconstruction surgery. In his first game back, Rice fractured his kneecap, the same knee where the graft was harvested.
RECOVERY PHASE 3: Weeks 12-24
Now is the time to build more strength and endurance, “somewhere between 20-24 weeks,” said Yanchuleff. “The athlete might start jogging or increase their bike work, maybe even some light jumping or plyometrics.”
Another valuable aid in the recovery process is running or exercising in a pool.
“Starting to run in a pool, in water up to their chin, is great because it makes them buoyant so we’re not worried about doing much to the graft,” said Yanchuleff. ”With minimum weight bearing, you can increase speed and resistance.”
Some athletes will be fitted for a functioning ACL brace and most will crank up weight-lifting sessions to further advance the recovery process.
RECOVERY PHASE 4: Weeks 25-52
By this stage, the patient’s desire and work ethic have paid off. For the therapists themselves, the push to get athletes back to their competitive playing grounds kicks in.
“Somewhere between six and 12 months we get them ready for specific athletic integrity. We’d like to see that the strength of one leg is within 10-percent of the other,” said Yanchuleff. “We’ll continue to measure the laxity of the knee.”
Full range of motion is achieved with good stability, and the patient should have no swelling.
Performance protocols continue at full speed until the individual, and their physician, determines they are ready to resume their athletic careers.
Will a patient’s new ACL be as sound or better than the original?
“I don’t think you can do better than what nature gave you. But if you’re feeling better it might be psychological or because you’ve done the work to condition the knee, paid more attention to it,” Yanchuleff said.
“Functional, but not as good as the original.”
READ MORE: Three Mid-Penn Conference players in different phases of ACL recovery