Six months on the sidelines: the long road to recovery after an ACL injury

By Colleen Brown

For a girl, co-ed indoor soccer games are fast, tough and usually painful. You get beaten up by boys with 40 pounds and 6 inches on you.

I love it.

I thrive on the attention of the crowd outside the clear walls. It’s packed with almost 50 people: fans for my game, plus the next two teams and their fans.

My team’s down a goal late in the second half. I’ve got the ball on my foot, heading straight for the net. A big, mean defender who’s been targeting me all night steps in my path. He has a grin plastered on his face and I want nothing more than to blow past him. Blood rushes in my ears as I pick up speed. Cheers from the crowd and shouts from teammates blur into background noise.

He comes in with a low sweep at my ankles, trying to trip me. After touching the ball past him, I tense and release the muscles of my right leg, jumping 8 inches off the ground in full stride over his ankle. It’s a move I’ve perfected over the years. I float for the briefest of moments, left leg outstretched, reaching for the ground.

I touch the turf and my ankle holds, but there’s a horrible crack.

I’m screaming before the rest of me hits the turf, clawing at my knee, the ground, anything to make the pain go away. My knee spasms with bursts of pain so intense I can’t find air to breathe.

The referee, my parents and coach are hovering over me. I can barely hear them speak as I spit saliva, curses and rubber pellets out of my mouth. My left leg hangs down, swinging limply as my dad and coach carry me off the field, red-faced and crying pitifully.

It’s deathly quiet in the cavernous room. All around me, people are staring, muttering their condolences and names of their favorite orthopedic surgeons.

The game goes on without me.

Another day at the office

Sports are an intrinsic part of my life. Growing up, I was always on a field, tennis court or in the ring with my horse. It was the winter of my junior year in high school, during a game of indoor soccer, when the impossible happened. I was invincible, the star of my team, riding the high that comes from pure adrenaline and doing what you love. And that’s when I tore my ACL.

The ACL, or anterior cruciate ligament, is the cornerstone of the knee. It crosses through the center of the knee, stabilizing movements and limiting dangerous over-rotation. Tears usually result from rapid twisting motions, awkward landings or violent hits. About 150,000 ACL injuries a year occur in the US, according to the American Orthopaedic Society for Sports Medicine. The ACL, unlike a muscle, cannot heal itself. With today’s medicine, there is only one sure fix: surgery. After a torn ACL is removed and replaced, complete recovery requires six months to a year of intense, painful physical therapy.

The UNC-Chapel Hill Ambulatory Care Center is an orthopedic center where athletes, students and other patients are operated on for a variety of injuries. I met with Dr. Alexander Creighton, an orthopedic surgeon kind enough to let an inquisitive journalism student with no medical experience whatsoever into an operating room.

After donning a pair of scrubs and an extremely unfashionable hairnet and mask, I was allowed inside. The patient, who must remain anonymous due to medical regulations, was already under. I could hear his pulse monitor beeping like in emergency room dramas. Massive hospital equipment lined the walls. In the center sat the operating table, overhead lamps and two video screens broadcasting a camera feed. It looked like a cross between an operating room and an alien abduction chamber.

There were four people in the room: an anesthesiologist, two assisting nurses, and fourth-year fellow, Dr. Hannah Dineen, who was busy inserting a camera into the patient’s leg.

There are two main techniques to replace the ACL. A graft can be taken from the middle third of the patellar tendon, which stretches over the knee cap, or from the hamstring muscle. This patient had chosen a patellar graft, the exact same surgery I had.
With the overhead lighting dimmed and lamps spotlighting the patient’s exposed knee, Creighton made a four-inch downward incision starting at the middle of his knee cap. Unlike his TV stereotypes, Creighton did not hold out his hand and demand “scalpel.” Dineen peeled back the skin of the patient’s knee like an orange peel and held it open to expose the patellar tendon. They used a tiny surgical saw to cut through the bone in order to remove the section of the tendon. The room filled with the rancid smell of seared bone. I had to hold my breath as smoke and minuscule shards of bone flew into the air.

Most of the two-hour surgery was spent cleaning out the inside of the patient’s knee. They removed his torn ACL and other bits of delicate-looking pink flesh with a tiny cauterizing tool, burning his flesh away until it blackened like the skin of a seared pork chop. Another tool was used to hollow out the patient’s spongy pale yellow bone marrow. My continuously shocked expressions must have been amusing for the two other fellows observing the surgery.

After hollowing out a cavity, the new ACL was pulled into place with thin sutures, then screwed in. Dr. Creighton tested the strength of the graft, then Dr. Dineen stitched together the patient’s patellar tendon and the skin over his knee.

That was it: the surgery that put me in a world of pain and helped bring me back to sports. It was both fascinating and disturbing in its normalcy. It’s easy to forget that while an ACL injury is a life-changing experience for one person, to these doctors and nurses, it’s just another day at the office. It was clinical and gross and altogether fascinating. I wanted to be able to say good luck to the patient. He’ll need it in the coming weeks.

The road to recovery

The hardest part of my ACL recovery wasn’t the physical aspect, it was the emotional. Being forcibly grounded was traumatizing, like clipping a bird’s wings. Wanting to learn more about other athletes’ experiences, I met with Yuri Jean-Baptiste, one of the physical therapy trainers for the UNC-CH women’s soccer team, at the Stallings-Evans Sports Medicine Center. The center is state of the art, decorated in muted grays and Carolina blues, with therapy tables, whirlpools, ice baths, strange-looking machines and ESPN on every flat screen.

He explained how athletes are prevention tested for injuries the moment they step on campus. They have a regimen of workout plans and preventative therapy techniques to help lessen the risk for injuries. But despite all the world-class technology and training UNC-CH has to offer, last year, there were six ACL tears on the women’s soccer team alone.

Jean-Baptiste tore his own ACL, which he said gives him a unique perspective in helping current athletes.

“I think that especially in today’s society a lot of the time the athlete tends to identify themselves with their sport, position or place on the team,” Jean-Baptiste said. “So when that’s taken away that’s a huge mental, emotional blow to them.”

I ran into UNC-CH junior Kirstyn Waller in the lobby of the sports medicine center. Waller’s a member of the women’s rugby team, and had her own ACL surgery just five weeks ago. She’s no longer on crutches, but still wears her post operation knee brace. It’s is a heavy contraption that immobilizes the leg completely straight from upper thigh to calf. The brace is heavy and clunky and trust me when I say it’s horrible to sleep in.

“I was already really emotional with the whole process,” Waller said. “I was weeping as I woke up from surgery. I don’t even know why.”

Waller’s progressing well, but she’s got five more months of physical therapy before she’ll be able to step on a field again.

Recovery starts on an exercise bike, slowly pedaling until you can’t bend your knee any more for the pain. Everything is tight with inflammation and scar tissue. Your hamstring, quad and calf muscles have completely wasted away. Patients have to relearn how to walk, how to move up and down stairs. The goal is to bring their reconstructed leg back to a point where it’s just as strong as their healthy leg.

UNC-CH first-year Emily Pender had a similar experience in high school. Pender tore her ACL while rebounding during a basketball tournament the summer before her senior year. She’s completely healed, tall and strong, and plays center for UNC-CH’s women’s club basketball team.

“I guess I just landed wrong,” Pender said. “I would try and play every day. I would practice my walking in my hotel room and then go see my coach and try to prove to him that I was walking fine. Then when he left I’d limp away.”

The drive athletes have to get back in and play is what makes ACL injuries so terrible. They’re fixable, but the cost is six months of pain and frustration.

“It’s the young girls that hit you the hardest,” Creighton said. “High schoolers who have hopes for playing in college, or who just want to play.”

Girls like me, like Waller and Pender. Thankfully, it’s not an injury that will keep you out of the game permanently.

But it does come at a cost.

Edited by Hannah Smoot