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Karl
Senior Member
USA
914 Posts |
 Posted - Dec 08 2002 : 8:21:21 PM
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Tilla
Ricardo Fuller's knee? From PNE site
Sunday, December 08, 2002, 12:43:29 PM
IP:65.28.59.41
Want to know what is going on with Ricardo Fuller's knee? We interviewed club physio Andrew Balderston
to get the lowdown on cruciate ligament injuries
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What exactly are cruciate ligaments and which one has Ricardo injured?
The cruciate ligaments are two ligaments inside the knee that basically hold the thigh bone and the shin bone from moving forwards and backwards on each other.
There are two of them there is an anterior cruciate ligament, which is the one that Ricardo has injured and probably 90 per cent plus of footballers who injure their cruciate ligaments, injure their anterior. There is also a posterior one.
Thankfully for us the anterior cruciate ligament is the one that surgeons know more about and technically is the one that is easier to reconstruct.
How has knee surgery improved over the last 10-15 years?
Knee surgery is light years ahead to what it was 15 years ago. If you go back a lot of the surgery was open and now they are doing a lot through keyhole.
Ricardo had some keyhole surgery on Wednesday morning and the recovery after that is relatively quick.
With cruciate ligaments, 15 years ago, if footballers injured them they used to just whip their cartilages out because they didn't really understand a lot about the cruciate ligament and the significance of tearing one. The greatest explosion in orthopaedic rehabilitation (dealing with joints) has been in the anterior cruciate ligaments. So from that point of view we know an enormous amount about it.
Do you know where you will be sending Ricardo for his operation?
There are plenty of centres in England, at the moment it seems to be the fashion for footballers to go abroad back to their country of origin for the operations with surgeons that they trust. In an ideal world that wouldn't really be done because it makes the rehabilitation and follow-up treatments very difficult.
Say for instance he went to Richard Steadman in Colorado, you take him over there for the operation and then you go back to Colorado on a monthly basis for it to be checked on.
There are plenty of centres around, Roy Keane for instance had his done in Manchester. It seems fashion more than necessity to go abroad.
What are the most important factors to consider before and after surgery?
Ricardo can't have the reconstruction for 4-6 weeks. The reason for that is that they like the knee to settle down. When you tear your cruciate ligament it bleeds and obviously fills the knee full of blood. With Ricardo we knew from looking at him straight after the game that his knee was filling up with blood.
Normally what you would is have a scan to see the extent of the damage and then decide whether to go in or not. He had the scan on Monday and that seemed to suggest that everything was still intact. But when they went inside the knee his anterior cruciate ligament is intact but there is only 20 per cent of it left intact. So he has torn off 80 per cent of it, it is only being held on by a few fibres.
The trouble with those are that it doesn't take another huge injury to it to actually pull off the remainder of the fibres.
One thing I would like to clear up is that it has been reported in the paper that Ricardo has had a problem with that knee for most of the season. He has not had a problem with that knee whatsoever. He has had niggly problems with kicks to his thigh and he has had isolated bruises in his thigh. This is probably the reason you see him do an amazing burst and then afterwards he appears to be limping. But this knee injury is completely fresh, it was completely unforeseen, there is nothing you can really do to protect him against it. It seems to have been reported in the media incorrectly.
How long does it take to recover from this sort of injury?
Ricardo Gardner came back within five months, which is unbelievably quick. There are obviously very big risks coming back too soon. Each individual has different lengths of time even though they have the same operation. It is commonly quoted as six to eight months, the quickest we have ever got anyone back here is seven months for Lee Cartwright.
When will he be able to - stand on it, jog, kick a ball?
He will be able to stand on it the same day, after he has the operation, but with crutches. Jogging is normally around about six to eight weeks on a trampette but anywhere between two to four months before he can really run on it. Kicking a ball normally comes in about four months.
How will they go about rebuilding the knee?
There are several ways the knee can be reconstructed. Several years ago they used to use a synthetic graft but they found with that that the body almost rejected and had a problem with it.
Now they use actual body tissue. There are two ways it can be done, they can either take the middle third of the tendon at the front of his knee and they take a little bit of bone from his shinbone and a little bit of bone from his knee-cap. So you have a lump of bone on either end and the tendon in the middle and they can use that.
More common now, particularly the Americans seem to be using more of what we would call a hamstring graft where they take one of his hamstrings and one of the muscles on the inside of his leg and they basically have two strands that they then double over to make a four strand graft which is a very strong graft.
I have seen both forms of operation and I have rehabilitated professional footballers with this injury before so I have seen pretty much all the possible combinations of it.
Does it matter that 20 per cent is still connected?
That is what we would call a partial tear. The trouble with partial tears is invariably they will go on and become full tears. All that will happen is that when he has the operation that will just be tidied up. More than likely they will take that off, the good thing about having a part retained is that you can see exactly where the graft has to go from and to. They should be able to get it to the millimetre and in the right position. The success with this operation is commonly quoted between 85-90 percent. So it is fingers crossed.
Is it true that the knee comes back stronger?
It is a difficult one. When they do the operation because the ligament is right in the middle of the knee, invariably they end up taking a piece of bone from either side so you have actually a wider space for the ligament.
It may come back a little bit stronger because they are going to spend the next six to eight months specifically strengthening the muscles around the knee to try and give it as much support and stability as possible.
Technically speaking I think that is a little bit of an exaggeration to say that it comes back stronger. Perhaps they do more work on it and that may be why it is stronger but in essence if it was stronger we would be born like it. Nothing that we can do will strengthen it more with the soft tissue.
There must be an element of mental rehabilitation as well as physical rehab?
That is very, very important. When you are playing as well as Ricardo has played and then you are told that you are not going to be playing for the rest of the season obviously we can't even start to imagine what is going through his mind.
He has had a big operation in the past where he was out for a longer period of time than he is going to be with this. There are players at the club who have had cruciate ligaments reconstructed and I am hoping to get some of those to speak to Ricardo to try and pull him through this.
He is completely devastated with it at the moment but he is a tough resilient lad and he will come back.
Would you say that this is one of the worst injuries a footballer can get?
It is a strange one because they always say that ligaments are worse than breaking bones they always take longer. With a broken bone, if he had broken his leg he would be in plaster for six weeks, have it out for six weeks and would be back within three months.
I suppose that there are worse injuries. If you look at Chris Coleman at Fulham when he was in his car crash and he ended up having metal pins here, there and everywhere.
It is hard in that it is a huge period of time that he is out of the game, but he is young, he is dedicated, very committed, very focused, knows what he wants out of his football career and I am sure that he will knuckle down and work hard.
It is hard work, there may be people that read this on the website that have had cruciate ligament injuries. It does take a long time to come back. But they are able to dedicate the time required which is difficult for members of the public to do when they are holding down other jobs. But when you are working 6-7 hours a day on strengthening the knee and fitness work, over a period of time that is mentally very, very tough. He faces a lot of hard work.
More information can be found at the following link:-
http://www.steadman-hawkins.com/acl/general.asp#ligaments |
Karl |
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yaga
Starting Member
Jamaica
25 Posts |
Posted - Dec 10 2002 : 11:47:11 AM
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I`m not sure if the physio is not trying to cover up something but it was reported that Fuller`s knee was swelling up after each game and now they are saying he didn`t have a problem with his knee.
craig brown also said it and he did not know what the cause of the knee swelling was.
He also had a number of scans done on the knee and it showed nothing but it was still swelling up.
The boy had a problem with his knee before. |
yagga |
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Karl
Senior Member
USA
914 Posts |
Posted - Dec 10 2002 : 2:42:50 PM
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quote:
Originally posted by yaga
I`m not sure if the physio is not trying to cover up something but it was reported that Fuller`s knee was swelling up after each game and now they are saying he didn`t have a problem with his knee.
craig brown also said it and he did not know what the cause of the knee swelling was.
He also had a number of scans done on the knee and it showed nothing but it was still swelling up.
The boy had a problem with his knee before.
They are now claiming it was not the same knee. |
Karl |
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yaga
Starting Member
Jamaica
25 Posts |
Posted - Dec 10 2002 : 4:20:49 PM
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One doesn`t know what to beleive.
Fisrst he didn`t have a knee problem,
then he has knee problem but it is the other knee.
Something doesn`t seem right.
Maybe be the preston medical staff is trying to keep their job after damage to our prize asset , from what maybe negligence on their part.
They did not dispute the press reports that he had a knee problem weeks a back but they are disputing those reports now. |
yagga |
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Karl
Senior Member
USA
914 Posts |
Posted - Dec 10 2002 : 11:59:22 PM
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quote:
Originally posted by yaga
One doesn`t know what to beleive.
Fisrst he didn`t have a knee problem,
then he has knee problem but it is the other knee.
Something doesn`t seem right.
Maybe be the preston medical staff is trying to keep their job after damage to our prize asset , from what maybe negligence on their part.
They did not dispute the press reports that he had a knee problem weeks a back but they are disputing those reports now.
How about this? (speculation) There is no injury! Backroom deals! PNE does not want to lose "Willy Boo"! |
Karl |
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yaga
Starting Member
Jamaica
25 Posts |
Posted - Dec 11 2002 : 4:23:30 PM
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hope wily boo make a move to a premiership team when he returns in the summer.
while i`m happy for what craig brown did for him,
i don`t like how he was rushed into every match even when sick.
fuller needs someone who will protect him. |
yagga |
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Ricardo Fuller's injury - cruciate ligaments
