- The Washington Times - Tuesday, March 4, 2003

First came the pop. Next came the pain.

During a match against San Diego last June, Washington Freedom defender Lindsay Stoecker felt her left leg buckle as she twisted her body to kick a ball out of bounds.

The diagnosis? A torn anterior cruciate ligament in her left knee.

Stoecker's afternoon and season was over.

"You can hear it and feel it," she said. "[Freedom defender] Skylar Little told me that she heard it, too. I was barely able to hobble off the field."

Nine months later, Stoecker is back on her feet. And back on the field. Following offseason surgery and rehabilitation, she's practicing with the Freedom and plans to play in the club's season opener at Carolina next month.

"[My knee] feels really good," she said. "Stable. As strong as can be expected. I'll be ready."

Stoecker's ACL story isn't unique. Thanks to recent medical advances, athletes across the sports spectrum are making full and increasingly rapid recoveries from an injury that once dashed skills and ruined careers.

Washington Wizards rookie forward Jared Jeffries, for instance, tore the ACL in his right knee in December yet hopes to be back for summer league games in July.

"It used to be a thing like this was devastating," Wizards coach Doug Collins said following Jeffries' injury. "[But] we expect him to make a full recovery."

Collins wasn't so lucky. A four-time NBA All-Star, the former Philadelphia guard blew out a knee in 1980. He never played again. Nor did Sixers Hall of Famer Billy Cunningham, the victim of a 1975 ACL tear.

In football, college legend Red Grange and former NFL greats Joe Namath and Gale Sayers had their careers cut short or dramatically curtailed by knee injuries.

"Historically, this was considered a career-threatening, if not a career-ending injury," said Dr. Benjamin Shaffer, team physician for the Washington Capitals, Freedom and Georgetown men's basketball team and an expert on knee injuries. "Nowadays, it's the inconvenience of a season-ending injury."

Indeed, ACL tears are no longer the physical equivalent of being traded to the Los Angeles Clippers. To the contrary, athletes often are able to recover from the injury with minimal losses of speed, strength and mobility.

Former New York Knicks and Bullets star Bernard King returned from an 1987 ACL surgery to make the 1990-91 All-Star team; since then, players like Indiana's Al Harrington, Portland's Bonzi Wells and Dallas' Raef LaFrentz have enjoyed successful comebacks.

In the WNBA, stars like Connecticut's Rebecca Lobo, Indiana's Tamika Catchings and Houston's Sheryl Swoopes are among those thriving in the wake of ACL reconstruction. Catchings was last season's rookie of the year; Swoopes was the league's third-leading scorer.

Likewise, NFL players like Baltimore's Jamal Lewis and Kansas City's Trent Green and Priest Holmes are making the most of reconstructed ACLs. Former Washington running back Terry Allen even rushed for more than 1,300 yards for two straight seasons (1995, 1996) while playing on a pair of mended knees.

According to an NFL study on ACL injuries published last year, almost all of the NFL players who suffered a torn ACL between 1994 and 1998 were able to play again following surgery.

"Over the last 20 years, we've learned a lot more about how the body heals and how the knee joint works," said Ravens trainer Bill Tessendorf, a NFL trainer for 29 years. "Physicians have more confidence in their repair work. The rehab is better. And athletes are better, too."

A 1½ inch-long ribbon of thick, fibrous tissue, the ACL is one of four ligaments that connects the tibia (shin bone) to the femur (thigh bone). It stabilizes the knee by preventing the shin from moving forward relative to the thigh.

ACL injuries take place when too much force is placed on the knee in a bent position, often during sudden changes of direction or when hitting the ground following a jump. Jeffries tore his ACL after stepping on Wizards forward Christian Laettner's foot and landing awkwardly during practice.

The injury makes it difficult if not impossible to pivot, cut and jump. The knee feels loose, a sensation often described as akin to walking on roller skates.

"You feel normal, but when you try to accelerate or turn, it buckles," Stoecker said.

Before operating on a torn ACL, doctors work to put range of motion back into the injured knee. The rule of thumb? If the joint can't bend before surgery, it won't be flexible afterward.

When Virginia Tech cornerback Eric Green tore his left ACL last year, the team's medical staff had him running on a low-impact, underwater treadmill before surgery. Many injured athletes wear a passive motion device which gently bends the knee while they sleep.

In the past, by contrast, ACL patients were put into hip-to-heel leg casts that produced mixed results. Sayers, a famously elusive runner, spent 10 weeks in a cast and came back a shade of his former self.

"When you came out, we spent the next six weeks trying to straighten your knee," Tessendorf said.

To reconstruct a torn ACL, surgeons remove the damaged ligament and replace it with a tendon graft, usually taken from the patellar (hamstring) tendon in the injured knee.

Looking through an arthroscope, the surgeon places the replacement tendon between the tibia and the femur, then fastens it into place with small plastic or metal screws.

Over time, the tendon regains full blood supply and takes on the properties of a ligament. Rehabilitation consists of regaining motion, rebuilding strength and relearning sport-specific skills.

"I tell our players that it will be the hardest work of your life," Tessendorf said. "You're going to tear some scar tissue. When you start lifting weights, that [leg] is going to shake like a bowl of jelly. It's going to be sore. And you're going to love ice."

In the weeks following her operation performed by Shaffer Stoecker sweated through leg extensions; a little more than a month later, she was able to jog; by October, she was participating in noncontact drills.

Besides her achy knee, Stoecker said, the toughest part of her daily, one-to-two hour physical therapy sessions was being away from the game.

"I was just wishing I was on the field," said Stoecker, who instead fetched water during Freedom practice. "Rehab is so repetitive. It got so boring."

On average, it takes between six and nine months for athletes to recover fully following ACL reconstruction. But times vary.

Indianapolis running back Edgerrin James took 10 months to return from an ACL tear suffered in 2001. The Ravens' Lewis missed a little more than a year with a similar injury.

At the other end of the spectrum, Oakland's Jerry Rice played just 3½ months after suffering a 1997 ACL tear. Two years earlier, teammate Rod Woodson became the first NFL player to tear an ACL and return to action in the same season.

According to Freedom trainer Randy Rocha, quicker comebacks are usually the result of increasingly aggressive rehabilitation programs.

University of Miami running back Willis McGahee, for example, tore his left ACL and another knee ligament during January's Fiesta Bowl. A day after surgery, he was exercising and lifting weights with his reconstructed knee.

"Rehabilitation used to be conservative and nonfunctional," said Rocha, who also runs the MOST orthopedic and physical therapy clinic in Silver Spring. "Now, doctors have kind of given therapists and trainers the go sign to read off the athlete instead of going by a set protocol."

Even after successful surgery and rehabilitation, reconstructed ACLs tear again between 3 and 5 percent of the time. Lobo tore the same ACL twice in a six-month period. Former Atlanta running back Jamal Anderson returned from an ACL injury only to tear the ACL in his other knee during his comeback season.

Similarly, Maryland quarterback Chris Kelley has suffered three ACL tears over the last three years two in his left knee and one in his right.

"I rehabbed Chris, and by the third time, we got him back in three months," Rocha said. "That was because he was such a gung-ho athlete. And we knew his limits."

Medical innovations may push the limits of ACL repair even further. Doctors at Purdue University are reconstructing ACLs with patellar tendons from the healthy knee, a technique that allows injured athletes to begin strength training more quickly and can speed recovery by up to a month.

French skier Jean-Luc Brassard and BMX rider Mat Hoffman are among the athletes who have undergone a more experimental procedure known as LARS (Ligament Advanced Reinforcement System). Pioneered by a French surgeon and in use for more than a decade, the technique involves sewing the torn ACL to an artificial polyester ligament.

While LARS has yet to be tested or approved by the Food and Drug Administration experiments with Gore-Tex ligament replacement in the United States during the 1980s were unsuccessful the procedure has allowed some athletes to return from injury in as little as five weeks.

"There's no artificial time constraint," Shaffer said. "I have a patient right now who wants to go back and play basketball at three months and one week. I would guess that in the not too distant future, it will be down to a couple of months. The envelope continues to be pushed."

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