Carl Gunnarsson’s ACL Injury: Prevention, prevalence, and treatment

When it comes to the St. Louis Blues and their fans, ACL injuries are a sore subject. Mention anterior cruciate ligament around here and you may get slapped with a toasted ravioli.

Before defenseman Carl Gunnarson tore his ACL against the Vancouver Canucks on Friday night at Scottrade Center, there were two words associated with Blues fans and this particular part of the knee: Robby Fabbri.

The 21 year old center hurt it during the 2016-17 season and missed the majority of the season. Then, in late September, Fabbri re-injured the same surgically repaired left knee. You’d have to look long and hard for a hockey player tearing the same ACL twice in one calendar year.

Gunnarsson was having a fine season (5 goals, 4 assists, +15) before the injury, and for a team who has dealt with numerous setbacks throughout the season, it was bad timing for the Blues and their playoff hopes.

So, how do these lower-body injuries happen and how common are they?

After infusing my body with a couple cups of coffee this morning, I spoke with Dr. Riley Williams III, a sports medicine surgeon from the Hospital for Special Surgery, about the ACL injury and the preventative measures as well as the treatment that goes into it. HSS is a world leader in sports medicine and rehabilitation.

STLGT: Gunnarsson is 31 years old and has been playing hockey for the majority of his life. For knee injuries, is there a way to prevent an injury to the ACL?

Williams III: Not common. Most ACL injuries occur when your foot is fixed on a surface and you twist. Imagine a running back pivoting or a basketball player coming down awkwardly after a rebound. That’s why it’s not as common in hockey. The main thing is the foot has to be fixed in space and the body experiences a twist. It’s a freak injury.

STLGT: What is the more common knee injury in hockey players?

Williams III: The MCL. Collateral ligaments from people getting hit up against the boards. You won’t see a non-contact ACL injury in hockey.

STLGT: Let’s talk about the recovery. When will Carl be 100% again?

Williams III: Typically, you’re looking at a six month recovery. He’ll likely be able to play next year. You replace the ACL with some donor material, typically a patella tendon graft or a hamstring graft. Orthopedic surgeons like myself don’t regard hockey as an ACL demanding sport, so he’d be able to skate without contact, at least if he was with me, in three months. Over last three months, he’ll increase load lifting and dry land training. It takes the graft six months to mature, so it’s a physiological recovery thing. At the end of the day, he’ll be able to resume a lot of technical training under my care in order to have a smooth return to the sport.

STLGT: Are there any long-term ramifications?

Williams III: There is some argument in the literature about whether ACL injuries cause some arthritis, but what we do know is that people with these injuries and surgeries will show some arthritic changes 15-20 years later. However, we simply don’t know what the cause is, meaning we don’t know if it actually was the injury that caused it. For a 31 year old, even if he was able to play until 40, he’d be fine.

STLGT: When it comes to the Hospital for Special Surgery, how far have you and the other physicians and doctors come in the past 15-20 years when it comes to sports medicine. What kind of innovations and advantages have been gained along the way in treating players?

Williams III: Our advantage is that we have so many surgeons to help with teams, so we have a volume advantage. It’s also created a very competitive environment. There are two main innovations. First, from the technical side, a lot of the instrumentation we are using today is a lot better than what we were using in let’s say, 1998. This allows us to more accurately place grafts in surgery.

Second, from the rehab side, when I started in 1992, we were casting ACL (injuries) for six weeks, meaning they all got atrophy and became stiff. Now, we do quite frankly the polar opposite. We mobilize these quickly and we are confident in our fixation and the way we repair them. It accelerates the interval by how the athlete feels good. When I talk to athletes, I tell them that I want to see them walking around four weeks after surgery as if no one knew they even had surgery. As a result, they spend most of the interval getting their coordination back instead of merely dealing with the stiffness due to the casting.

STLGT: What is the most common injury with hockey players?

Williams III: You see a lot of things around the hip and spine, due to the rotation in the sport. Not necessarily operative stuff, but strains and sprains. You also get a lot of MCL sprains from the crashing. Someone getting crashed into around the boards. It’s typically more of a side-to-side injury, basically a MCL and LCL injury. It’s not usually a surgery, so it heals within 3-6 weeks.

STLGT: Another Blues player, Robby Fabbri, suffered injuries to the ACL last year. He’s only 21 years old.

Williams III: Once your tear it, it’s a little more susceptible to injury. You can’t predict these kind of impacts. It is what it is. The takeaway here is that ACL injuries aren’t common. They happen. They are predominantly related to the contact in hockey. We, as surgeons, don’t regard hockey as a tough sport for players to get back from injuries. In hockey, the foot is never fixed, it’s always on that slippery ice, so it tends to protect the players.

The ACL injury happening three different times to the Blues, including twice with the same player, just goes to show you how unlucky this organization can be. Hearing “uncommon” and “Blues” in the same sentence is becoming too routine.

Here’s the good news. The Hospital for Special Surgery is ranked #1 nationally for orthopedics by U.S. News and World Report (2017-2018), so Williams III would be considered a Jedi when it comes to knowing how these things work, happen, and coming back from them. While the ACL tear is a setback, Gunnarsson should be ready by September-October and see another 8-10 years of action if chooses.

The Blues resume play tonight against the San Jose “you prevented our Stanley Cup run two years ago, asshole” Sharks tonight at Scottrade Center.

There’s a fresh St. Louis Game Time paper available, so contact your favorite Brad (gtbradlee@gmail.com) for 24 pages of goodness.

Thanks for reading and buy more bourbon.