Mariano Rivera Tears his ACL:

Coach Girardi and Alex Rodriguez watched as Mariano’s knee simply twisted as he ran over the transition of the warning track and the grass near the outfield fence in Kansas City, MO last night.  Their worst fears were confirmed last night when an MRI revealed that Mariano Rivera had torn his ACL and his medial meniscus.  

Derrick Rose Tears His ACL:

Any avid basketball fan now knows that Derrick Rose has torn his Anterior Cruciate Ligament — or ACL.  ACL or Anterior cruciate ligament injuries are very common.  Let’s learn a bit more about  them…. using Mariano’s Derrick’s  ACL injuries as an example.  

What is the ACL and what options do Mariano Rivera and Derrick Rose have? 

 

What is the Anterior Cruciate Ligament:

ACL Tear _ Knee_ Howard Luks- Derrick Rose Injury

ACL Tear

When Mariano Rivera hit the field, and when Derrick Rose hit the court on the eve of the injury their knees were  “stable” and held together by four strong ligaments.  The ACL is one of the four major ligaments inside the knee that is responsible for maintaining stability of the knee during certain activities.  The ACL or anterior cruciate ligament is necessary for most people to participate in sports involving.

  • cutting
  • pivoting
  • turning or
  • twisting

How did Mariano Rivera and Derrick Rose tear their ACL? 

Most ACL tears occur as the result of a non-contact injury.  As you can see on the video, Derrick Rose’s ACL tear occurred when he came down on his leg at an unusual angle, twisted the knee and heard a pop as his leg gave way.  In Mariano Rivera’s case he simply twisted his leg at the transition of the dirt and the grass.    Most patients in my office with an ACL tear will note that they pivoted, twisted, or tried to rapidly change direction and then felt a pop.  What follows is pain, difficulty walking, and significant swelling.  

 

How do I know if I have an ACL tear? 

75% of people who present with a painful swollen knee, after a pivoting or rotational injury will have an ACL tear.  Most people who tear their ACL – or Anterior Cruciate Ligament will experience a pop or a snap after a fall, sharp turn, etc.  They will be unable to continue their activity and within an hour or so, significant swelling will usually occur.  Many people who tear their ACL will notice that their knee feels loose or unstable as the swelling starts to subside.    

Will Mariano Rivera and Derrick Rose need surgery to repair their ACL tear (s)?

Not everyone who tears their ACL requires a reconstruction to put a new ligament in the knee.   Elite athletes, or even weekend warriors who have a persistent feeling of instability — a sense that the knee is loose — will either require an ACL reconstruction or they will need to try a brace or simply give up the activity that leads to the feeling of instability.   Many adults with ACL tears lead active lives without any symptoms, pain or a feeling of instability.  

Derrick Rose and Mariano Rivera have  complete ACL tears… but partial tears of the ACL occur fairly often.  Sometimes enough of the ligament remain that you will not experience instability symptoms — but unfortunately many of you will have a feeling that the knee is loose, despite the fact that the ligament is only partially torn.   Most orthopedists will rehabilitate a partial tear patient aggressively before  considering if an ACL surgery is necessary.   In partial tears, many of us are capable of simply reconstructing or fixing the torn portion —leaving the normal portion of the ACL untouched.  

Are all ACL  tears Repaired or Reconstructed?

There’s no question that Derrick Rose and probably Mariano Rivera will have their ACL tears reconstructed.   Other adults have choices as I mentioned above.  What about ACL tears in children ?  As our children become more and more active, we are seeing more and more ACL tears in them.  A parent’s notion is to avoid surgery if their youngster tears their ACL.   Recent scientific studies show that children are at very high risk of developing secondary injuries such as a meniscus tears .  We know from the MRI results that Mariano Rivera already has a meniscus tear, which commonly tears when the ACL goes.   These secondary injuries can lead to arthritis, so it is important that you have a stable knee to minimize the risk of further injury down the road.  Children will not sit on the bench … nor can we tell them not to run around — so many academic Sports Medicine Orthopedic Surgeons will recommend early surgery in children to minimize the risk of them incurring a secondary injury such as a meniscus tear.   

ACL Reconstruction: For Mariano Rivera, Derrick Rose … and you too.

Holes drilled to prep for new ACL

New ACL in place

The way we perform ACL reconstructions or surgery to repair the Anterior Cruciate Ligament today is far different from the methods utilized in the past.    The procedure we perform today is called an Anatomical ACL Reconstruction — from a surgical prospective it is very different than the procedure we performed for decades.  The goal of the surgery today is to reconstruct your ACL so that is placed in exactly the same position your old one was.   An important caveat …. if you are considering ACL surgery, make sure your surgeon is well versed in the Anatomical Technique.  

How long will it take Mariano Rivera to recover from his ACL surgery?

We wish Mariano Rivera and Derrick Rose a speedy recovery.  Ultimately it will be nearly a year before  both Mariano and Derrick can return to sports after their ACL surgery.   Why do we make you wait so long for an ACL to heal?  Initially the pain and weakness in the leg will prevent any meaningful activity.  After a month or two both Mariano Rivera and Derrick Rose will likely feel good.  That’s when the surgeon becomes the “bad guy” —where you feel good and want to return to sports and we keep saying no. Why do we do that? 

The ACL that we placed in your knee will go through a process of regeneration or reorganization that will cause it to be very weak compared to a normal ACL.  That weakness will persist for at least 8-12 months or longer.   The longer you wait before returning to sports, the less likelihood there is that you will suffer a new tear :-( .  

So while we wish Mariano and Derrick a speedy recovery following their ACL surgery… we know it will be a while until we see their skills demonstrated on a pitching mound, or basketball court anytime soon. 

 

Recommended Reading:

Anterior Cruciate Ligament Tears

Partial ACL Tears

ACL Tears in Children

Meniscus Tears