Today’s knee injuries aren’t the career-enders of old

MINNEAPOLIS – The play called for a reverse punt return, an odd decision since the Chicago Bears already held a comfortable lead on the New England Patriots in the 1985 Super Bowl. Bears returner Keith Ortego signaled a fair catch before deciding to hand the ball to Leslie Frazier, whose left foot got stuck in the Louisiana Superdome’s turf.

Frazier’s career was over.

He suffered extensive damage in his knee, the most severe being a torn anterior cruciate ligament, which required reconstructive surgery. He spent the following season on injured reserve for the Bears and then failed a physical in training camp in 1987. He accepted a tryout with the Philadelphia Eagles, but he wasn’t the same player and retired.

“I just couldn’t get my range of motion,” Frazier said. “I couldn’t sprint.”

The Vikings coach reflected on his experience with ACL surgery an hour after witnessing All-Pro running back Adrian Peterson sprint up a steep hill abutting the team’s practice field at the five-month mark of his ACL rehabilitation.

Frazier smiled and shook his head. “It’s a totally different procedure than when I had mine,” he said. “It’s no comparison. The cut on my knee looks a lot different than the cut on Adrian’s knee.”

Advances in technology and rehab protocol in ACL reconstruction the past two decades have improved the long-term prognosis for athletes and enabled them to return to competition significantly faster.

A normal timeline for return from ACL surgery now is six to nine months.

Doctors note that ACL surgery and rehab vary by patient, but the injury has become so common that nearly 100,000 reconstructions are performed in the United States each year, according to medical literature. Athletes still view ACL surgery as a significant career setback that promises a long, arduous recovery process. Many also acknowledge that they didn’t feel completely normal until their second full season after surgery. But medical improvements and overall awareness of the injury provide a much brighter outlook nowadays.

“You put the best technology with the most motivated person, you get some spectacular results,” said Randy Twito, a HealthPartners Medical Group physician who practices at Regions Hospital.

Twito, a veteran surgeon, has witnessed the procedure’s transformation over the years. One example: Previously, patients had their knee immobilized in a cast after surgery so that it would stiffen. Now, many patients awake from surgery with their knee in a machine that stimulates range of motion in order to avoid stiffness.

“It’s such a perfect science now so they’re efficient,” Vikings head athletic trainer Eric Sugarman said.

Dr. David Fischer, a Minneapolis-area surgeon, began performing ACL surgery in his practice in the late 1970s when, he notes, “we really didn’t know much about this injury at all.”

Surgery was performed on an open knee because arthroscopic technology was still developing. Surgeons experimented with different tissue grafts to replace the torn ligament, including synthetic material, allografts (donor tissue from a cadaver) and xenografts (animal tissue). Eventually, doctors found the most successful grafts come from the patient’s own patellar tendon or hamstring tendon.

Advancements in science, technology and surgical techniques over the years made surgery less invasive. Doctors also gained a better understanding of the ideal placement of the graft inside the knee. Those improvements led to better results and more confidence that the knee could withstand physical punishment at the same force as preinjury.

Fischer credits Indianapolis-based Dr. Donald Shelbourne for revolutionizing ACL surgery and rehab protocol in the early 1990s. Shelbourne determined that an aggressive approach could accelerate the rehab timetable without jeopardizing the graft, according to Fischer.

“That was an observation that grew into what we have now,” Fischer said.