Despite Advances, Sports Injury Surgery Sometimes Not Enough

On a recent Friday night in Beckley, the Riverside Warriors battled the Woodrow Wilson Flying Eagles in the first football game of the season.

Senior Brody Bess was on the field. His appearance in the game is remarkable in that this past winter, he had not one, but two major knee surgeries following ACL tears.

The problem started in middle school.

“It felt like it would shift one way, then shift back the other, and I’d fall or something, and I just took it as I have a bad knee – no big deal,” he said.

But by his junior year of high school, he was wearing double knee braces. Then one game he made a hard tackle.

“It was one of the best tackles I’d seen him make but, whew, he was in a lot of pain after that,” said Sherry King-Green (Brody’s mom) during one of Brody’s physical therapy sessions.

Athletic trainer Kevin Dixon says having two ACL repairs in one year is a pretty rare occurrence.

“Lot of times you’ll see someone tear the same one, get it repaired, then tear it again or even you’ll see them get the right one repaired, then tear the left one,” said Dixon. “But to have both of them done at the same time, that’s pretty big. That’s hard to come back from.”

The anterior cruciate ligament, more commonly known as ACL, is a stabilizing knee ligament. Injuries to the ACL are one of the most common knee injuries in the United States and often occur while playing sports that require a lot of cutting or stopping and starting.

“Everyone thinks now with the medical advances that ACL is 100 percent return to play – like that ‘oh, I’ll just have surgery, I’ll be good, I’ll go back,’” said Dixon.

But that’s not always the case – 13 percent of ACL reconstructions fail,according to a 2012study. This is quite significant considering about 200,000 ACL-related injuries are reported each year, according to a 2015 study.

But newer techniques are allowing patients to recover faster from surgery with less pain.

“The theory is the less bone we take, the better for the patient, the less pain they have,” said Chad Lavender, a Charleston-based orthopedic surgeon. By taking less bone, he means reducing the size of the hole that the surgeon has the drill into the bone to attach the new ligament. The bigger the hole, the more pain and longer recovery time a patient has to endure.

One of Brody’s ACL tears was chronic – he’d been playing on it for years without knowing exactly what the problem was;  the other was acute and could be traced back to a recent injury.

This winter, both were repaired with the ambitious goal of returning Brody to play for his senior football season.

“Before I’d worry about twisting it the wrong way, or you know doing something to get it to – I don’t know how it feels – it’s like your knee shifts one way, then back the other,” he said in July right before the start of preseason football practice. “But I don’t have to worry about that anymore.”

During physical therapy and practice Brody felt “great” – more stable than he had felt in years. His coaches and parents noticed too.

“It was just like before, like he was never injured, he was playing excellent,” said Sherry King-Green.  

But then during the third or fourth play of the game, it happened again.

“It’s like my knee shifted one way and then shifted back the other and then gave out,” said Brody grimly. “Same thing I’ve felt for years.”

He hopped off the field and the trainer told him he had torn his ACL. But both Brody and Chad Lavender – Brody’s surgeon – weren’t convinced.

“Now I kind of think I tore my meniscus in my left knee because – just the side effects,” said Brody during an early morning conversation at the McDonald’s across from the hospital. It took Brody’s insurance three weeks to approve another MRI to confirm or deny Brody’s hunch.

“This is his future,” said his mother. “He knows if he is going to continue to play ball this is it, so I guess today’s the big day when we’re going to find out. And also we’re worried he’s going to have to go through surgery again, and it’s been a tough, almost one-year journey.”

They head over to the hospital to the appointment with Brody’s surgeon, Chad Lavender.

“So in my opinion, you tore your meniscus and your knee just wasn’t ready yet to return to play,” said Lavender.

Brody and his parents are silent while Lavender explains the options: have surgery to fix the meniscus, play injured, or stop playing altogether.

For Brody and his parents, two surgeries were enough, and the function of his knee over the long haul matters more than risking further permanent damage at this point.  

But deciding not to repair the meniscus also means an end to his football career and any dreams of college ball.

“I feel like spent brass now because I kind of just shot everything when I was younger,” said Brody. “And now that I’m bigger and stronger that I can play and be, you know, above average on the varsity playing field – now I’m all crippled up and can’t play. So that’s probably what I would change about my high school career.”

Brody is one of many facing this outcome.

A 2012 study found that only 63 percent of high school football athletes and 69 percent of college athletes returned to play after an ACL reconstruction. A 2014 study of division I college football players had better outcomes, with 82 percent of athletes returning to play after an ACL reconstruction.

According to the study’s authors, psychological factors play a big role in failure to return to play. I could find no recent studies for how many athletes tear a meniscus after an ACL, although anecdotally this scenario happened in my own family. My older soccer-playing brother tore his ACL his senior year of high school and his meniscus his freshman year of college.

So if you’re an athlete yourself or have a child who’s an athlete, you’re probably wondering, What’s the answer?

“We want the best for him. But we also – you know some people might look at us like we’re crazy,‘Why are you letting this kid do this?’ – but if they understood the love for the game, he lives, eats and breathes it,” said Sherry King-Green.  

The newer techniques are allowing patients to recover faster from surgery with less pain. That’s the good news and that was actually true for Brody – he was back on the field within a year of having surgery and his ACL reconstructions remained intact. But as Brody’s athletic trainer pointed out, having surgery does not guarantee you will be back to where you were before the operation.

Editor’s Note: 9/21/2016 This story was updated to change Shirley to Sherry.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.