Drake and Me: Both Canadian? Nope, but we did both tear our ACL!
“It buckled, popped. I was down. I remember slapping the ground. I couldn’t believe it. I saw the lights coming down. [And I was thinking] ‘Did I just fall?’ – Drake, describing his ACL tear in 2009
Anterior Cruciate Ligament (ACL) injuries are common atraumatic problems for many athletes – or wanna be athletes – like myself. However, ACL tears are not limited to just athletes and pseudo-athletes. Anyone who jumps up and down, runs around, and cuts or turns suddenly could be at risk – so that includes performers like Drake (pivot shift pattern). This injury, while performing, was actually Drake’s second ACL tear – the first resulting from the same mechanism that took out my left ACL – basketball.
Over 100,000 ACLs tears occur each year and most of these are atraumatic (do not result from contact) and occur during jumping, landing and turning movements (70%). The other 30% result from contact injuries, such as football blows to the lateral knee. The classic story for a non-contact ACL tear often involves the patient hearing/feeling a pop after landing from a jump and rotating.
The main role of the ACL is to keep the tibia (lower leg bone) from moving out in front of the femur (upper leg bone) and also stabilizes internal rotation movements – for example, if a person stops and pivots on their right foot to turn to the left.
My ACL injury occurred around 7am on September 28, 2016. I had just started playing basketball again and was feeling good that morning and into about hour 2 of a pickup game. I went up for a rebound, landed hard and turned quickly to pass the ball and POP. By the time I arrived home, my knee was the size of my thigh and I could not get the joint past 10 degrees of flexion.
ACL injuries are 3-8Xs more common in women athletes – the hypothesized reasons for this difference in incidence include both variation in the Q angle (angle of the femur-pelvis articulation) between males and females secondary to the anatomy of the human birth canal, as well as the actual size of the ligaments and increased ligament laxity secondary to estrogen.
The medial meniscus provides greater restraint to anterior translation than the lateral meniscus by acting as a buttress and 1 in 3 meniscus tears are associated with a concomitant ACL tear
Valgus stress invokes the medial collateral ligament (MCL) and, in contact ACL tears, the MCL is often injured as well along with the medial meniscus in a terrible triad injury (ACL, MCL, Medial Meniscus).
After an ACL tear, the knee usually becomes very swollen almost immediately with blood entering the joint space (hemarthrosis). ACL injuries can be treated operatively or non-operatively. Operative treatment is best for those that are active, have a meniscal tear that can be repaired, have other ligament tears in the knee, or have instability.
After my tear, I ultimately chose operative repair after first giving the hemarthrosis time to resolve and also participating in intense lower extremity training that allowed me to regain full range of motion and relatively good strength in the left knee. Given that I would still like to play a bad version of basketball, and more importantly coach my kid playing basketball, I was already leaning towards surgical repair when, on Thanksgiving, I was getting bags out of the overhead bin of a plane and had total instability resulting in a near fall into the aisle of the plane.
Operative repair should not take place until hemarthrosis resolves – otherwise, worse chronic pain can result after surgery. This is an important point and one that Lil’ Wayne was not apparently aware after Drake injured his ACL during the America’s Most Wanted music festival. Lil’ Wayne tweeted the morning after Drake’s injury that the rapper would have surgery that day.
Of course, that is way too early and, eventually, Drake had his ACL repair 1 month after injury.
There are options for graft type when considering ACL repair. In the past, your own (autograft) patellar tendon was used. However, frequent anterior knee pain made that option less desirable. Other options are cadaver allografts (i.e Achilles tendon) and autograft hamstring.
Most athletes these days go for an autograft hamstring, however, I have not yet given up on the idea of future triathlons and went for an Achilles allograft to cut down on the possibility of a tendinosis that can be worsened during transition from bike to run.
So, three months after initial injury, I underwent my Achilles allograft ACL repair as well as partial meniscectomy as well as resection of medial plica. What do I remember about the surgery? Well, the CRNA said “Give him 5” and I responded “Is that 5mg of Versed?”. Next thing I know, I’m waking up and realizing I have a sore throat and ask “Did I have an ET Tube?” (tube in your mouth to help you breathe).
Well, now it is movie marathons for a few days and then will get back at the rehab ASAP with goal of return to play, return to coaching, return to triathlons and, hopefully, no repeat tears…but, sometimes it’s good not to be Drake and, hopefully, I got my basketball tear but won’t end up with tear #2 while bouncing around during a live concert performance.