Torn ACL (Anterior Cruciate Ligament) of the Knee

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Do people appreciate how amazing it is that Philip Rivers (quarterback for the San Diego Chargers) played on Sun., Jan. 20, 2008, just six days after having arthroscopic surgery? Aside from the fact that he likely had some cartilage debris cleaned out and the rehab time is measured in weeks, he still had a torn anterior cruciate ligament (ACL).

For regular people and pseudo-athletes, the days after arthroscopic knee surgery are spent reducing knee swelling and starting range-of-motion exercises. This process is hampered by a couple of physiologic barriers.

When the knee is invaded, the muscles around it tend to shut down involuntarily. The quadriceps muscle in the front of the thigh tends to get immediately weaker, and since it is one of the stabilizing muscles of the knee, it is a big deal when this muscle decides not to work. The next barrier has to do with hydraulics. The knee joint has its largest volume of fluid when it's flexed at 15 degrees. When there is even a little fluid, straightening it out combats the law of physics that says "you can't compress fluids."

Rivers gets out of surgery and presumably hops into the training room and is attacked by the physical therapists. Appreciate that for mere mortals, physical therapists can be kind and gentle, but when they want the patient to do something, they can become relentless therapists. Pushing the body to its limits is not something regular patients do. Putting it into perspective, a routine course of rehabilitation in the first week might have a patient trying to get the pedals on a stationary bicycle to go around without resistance...once.

But not only does Mr. Rivers have to get his range of motion back, he also needs to get his quadriceps muscles refired, start weight lifting, and begin walking/running on his knee. Oh, by the way, we didn't forget that he has a torn ACL that will continue to cause problems with all these activities. And then in less than a week, he performs in a brutal game at an elite level.

The body is capable of some wonderful things. I am amazed by marathoners who run sub-five-minute miles and skiers who go downhill at 70 mph, but I am also amazed by patients who have their chests opened for cardiac bypass surgery and leave the hospital in four or five days.

Medicine tends to experiment on elite athletes because their drive can overcome perceived hurdles to recovery. We see what the body is capable of doing, and then we make regular people do what we thought was unthinkable. How amazing is that?

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