LSU ACL Study Aims To Advance Sports Medicine Into New Era 'This Is A Big Deal' - LSU

LSU ACL study aims to advance sports medicine into new era; 'This is a big deal' | LSU | theadvocate.
com 12/1/18, 7(20 PM
LSU ACL study aims to advance

sports medicine into new era; 'This is
a big deal'
BY BROOKS KUBENA | bkubena@theadvocate.com
Dec 1, 2018 - 5D15 pm
The knee was normal, and that was the news.
Tight end Jamal Pettigrew stepped through footwork drills, blocked

dummies, pivoted and cut through routes in the LSU indoor practice facility
— standard stuff, except for one thing: Pettigrew had only surgically
repaired his torn anterior cruciate ligament (ACL) four months before,
which, according to experts, meant heʼd returned to football activities
nearly twice as fast as the average athlete.
No brace. No problem.
The College Football Playoff committeeʼs infatuation with LSU did not end with
the Tigersʼ 74-72 seven-overtime loss to Texas A&M.
A few days later, outside linebacker KʼLavon Chaisson wore sweats as he

tossed around a football during pregame warmups at Kyle Field in College
Station, Texas. Heʼd suffered a torn ACL against Miami on Sept. 2, tweeted
a picture post-surgery Sept. 20, and less than two months later, tweeted a
video of himself sprinting across LSUʼs outdoor practice facility.
Plenty of torn ACLs with high-profile NFL athletes have played out publicly.
Tom Brady. Jamaal Charles. Adrian Peterson famously returned to the
Minnesota Vikings from a 2012 ACL tear in nine months — and that was
widely considered unthinkable.
https://www.theadvocate.com/baton_rouge/sports/lsu/article_a53d8b56-f579-11e8-97cb-4f7c6e3f6b6c.html Page 1 of 12
LSU ACL study aims to advance sports medicine into new era; 'This is a big deal' | LSU | theadvocate.com 12/1/18, 7(20 PM
What was going on at LSU?
Back at Tiger Stadium, athletic training director Jack Marucci leaned

forward in a stadium-seat chair in his office to explain: For nearly two
decades, LSU has been practicing an ACL surgery that the consensus of
sports organizations considers far too risky.
The results, Marucci said, have shown that LSUʼs decision was both
innovative and safe.
Over 17 years, LSU has repaired the ACLs of 39 football players, and only
one player suffered a re-tear — a success rate (97 percent) that equals or
exceeds the success rates that have been reported from the nationʼs
standard method of surgery.
Hereʼs what sets LSU apart: Marucci said the average time that it takes for
an LSU player to return to practice from surgery is 4.8 months — a timeline
several sports physicians consider impressive.
Now the LSU athletic training staff is collecting data from those former
players to produce an official report, which could persuade other collegiate
and professional football organizations to buck the standard surgery and
advance sports medicine into a new era.
The report, Marucci said, could be published three months from now.
But this is no new battle between scientific ideologies. The standard has
been set for decades.
“Everyone is afraid to go against the establishment,” Marucci said. “Thatʼs

why weʼre going to publish … this is a big deal.”
ATLANTA — In the years when LSU has not been in the Southeastern
Conference Championship Game, the game often factors into where the Tigers
wi…
The alternative
The story begins in April 2002, when LSUʼs backup quarterback, Marcus
Randall, tore his ACL during the spring game.
The ACL, one of the ligaments that connects the femur and the tibia, is
located on the inside of the knee joint. It essentially stabilizes the knee and
helps someone pivot and cut. When the ACL tears, it cannot regenerate. So
the ligament must be replaced with other muscle tissue.
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The ACL is pointed out by Dr. Brent Bankston, an orthopedic
surgeon at Baton Rouge Orthopaedic Clinic and LSU's team
physician. The ACL is located on the inside of the knee joint, and it
stabilizes the knee when someone pivots and cuts.
BY BROOKS KUBENA | bkubena@theadvocate.com
By the 1990s, physicians across the United States had standardized cutting
out the middle third of the patellar tendon — which stretches from the
kneecap to the tibia — and using it to replace the ACL.
Dr. Brent Bankston, LSUʼs team physician, was prepared to perform the
patella surgery on Randall, which would require a recovery time of at least
nine months — likely cancelling out Randallʼs chances of playing in the
upcoming season.
But Bankston said then-LSU coach Nick Saban suggested an alternative.
Saban remembered that when he was at Michigan State, a player had

recovered much quicker because the surgeon had used hamstring tendons
to replace the ACL instead.
Bankston had performed the hamstring surgery on LSU basketball players

before. The hamstring surgery, Bankston said, was actually preferred in
basketball because players jump more often, and the surgery does less
damage to the knee.
But it hadnʼt been adopted in football because physicians knew the patellar
tendon was stiffer than hamstring tissue, and there was a concern that a
football playerʼs knee wouldnʼt hold up long-term.
“Saban pushed to go the other way,” said Bankston, LSUʼs team physician
since 1995. “We said, ‘Itʼs a recognized surgery; itʼs a good surgery; and
weʼll see how it goes.ʼ ”
Bankston performed the hamstring surgery on Randall, who recovered by

the beginning of the season and played in the final seven games, after
starter Matt Mauck suffered a season-ending Lisfranc injury.
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Advocate staff photo by Travis Spradling. Photo shot on 11/26/04.
LSU vs Arkansas football. Marcus Randall
BY TRAVIS SPRADLING
Randall played in 20 more games during his LSU career, throwing for 1,672
yards, 11 touchdowns and seven interceptions.
“He did great,” Bankston said. “And so we did another (hamstring surgery).
And another one. And every (ACL injury) since, weʼve done a hamstring.”
Perhaps youʼve noticed the results: Former LSU quarterback Zach

Mettenberger tore his ACL in the 2013 regular-season finale against
Arkansas, then returned three months later to participate in the universityʼs
pro day. Tigers running back Nick Brossette tore his ACL in 2015, and he
leads LSU in rushing this season with 922 yards and 14 touchdowns.
Dozens of autographed pictures from healed athletes hang on Bankstonʼs

office walls.
So why hasnʼt the hamstring surgery caught on?
It takes some historical context to understand, said Dr. Steve Jordan, an
orthopedic surgeon at the Andrews Institute in Gulf Breeze, Florida.
The patella surgery — referred to as “bone-tendon-bone” in medical circles

— had established staying power because it was reliable, and the hamstring
surgery had early failures because physicians were using ineffective
techniques that would later be improved upon.
“In the ʼ80s and ʼ90s, the bone-tendon-bone was a big player,” said Jordan,
who was the team physician at Florida State from 1991-2015. “That was the
only thing I did. That was the only thing sports surgeons did.”
The patella surgery, Jordan said, has its own issues.
When physicians cut out the middle third of the tendon, they also cut out a
piece of the bone where both ends of the tendon are attached. Then, when
physicians put the tendon where the ACL used to be, they graft the bone
ends to the femur and the tibia (thus the name “bone-tendon-bone”).
Anterior Cruciate Ligament (ACL) Reconstruction Animation
This technique heals rapidly, Bankston said, because the body quickly
recognizes the bone ends and restores blood flow to the tendon — an
essential part of the healing process. It's like a puzzle that recognizes the
correct piece has been appropriately placed.
The problem is, Bankston said, some studies have shown that up to 30
percent of patients experience some form of chronic pain in the spots
where the bone was cut. In some extreme cases, the kneecap will fracture.
That's what happened to Hall of Fame wide receiver Jerry Rice when he
played for the San Francisco 49ers in 1997.
“Iʼll give you many, many cases of athletes who have taken (the patellar
tendon) from their good knee and it still aches today,” Marucci said. “(It)
becomes the bad knee. That tells you alone, weʼve created a problem here.
We know that creates a problem. So why do we keep doing that?”
Jordan said the majority of physicians and sports organizations are still
biased against the hamstring surgery because of its early failures.
The earliest hamstring surgeries in the ʼ80s and ʼ90s, Bankston said,
replaced the ACL with a strand from one hamstring tendon: the
semitendinosus, which is not as stiff as the patellar tendon. Studies
showed, Jordan said, that this method had a re-tear rate that was 1½ times
higher than the patella surgery.
But over time, physicians started combining the semitendinosus with

another tendon near the hamstring — the gracilis — and that made the
graft just as sturdy as the patella tendon surgery.
In fact, Jordan noted, a study was published in The American Journal of

Sports Medicine in 2016, which conducted a long-term, randomized trial to
identify which surgery was better.
“Only minor and mostly insignificant differences were found,” concluded the
study, which was written by Dr. Haukur Bjornsson.
But football organizations are stuck in their routines, Bankston said —

especially in the NFL.
Why wouldnʼt agents send their high-profile clients to established

physicians like Dr. James Andrews? Andrews, an LSU alumnus and the team
physician for the Washington Redskins, has performed patella surgeries on
dozens of notable players, including former Tigers tailback Derrius Guice.
“I have a good friend, the president of an NFL team,” said Jordan, who kept
the president nameless. “And he says, ‘I like the hamstring graft, but since
itʼs the NFL, I do patella.ʼ I go, ‘Why?ʼ ‘Well, theyʼre just judged by bias. If itʼs
not bone-tendon-bone, it may not be good.ʼ
“But if it hurts less and heals faster and is just as strong, itʼs too hard to
ignore, right?” Jordan added. “Now, to make it gospel, it would take a lot of
other programs doing the same thing and getting the same results.”
The LSU athletic training staff believes their upcoming study will give those
programs the persuasion they need.
“Theyʼll always come back, ‘Whereʼs the hard evidence?ʼ ” said Derek
Calvert, an associate athletic trainer at LSU. “Now we can say, ‘We have
that paper that shows 17 years of a Division I college and what theyʼre
doing.ʼ ”
'It could wake people up'
It was a rainy day, Stevan Ridley recalled — a slick day out on the second
session of LSU spring practice in 2009.
It was a run play — 35 zone or something — to the left, and Ridley bounced
the run to the outside. A safety closed in to attempt a tackle, and Ridley
tried to slow down so he could plant and cut.
His cleats dug in the ground. Slid forward. His right knee jerked.
Ridley never forgot the strange feeling knee as he jogged back to the
huddle.
“The best way I can explain it to people is, if you could imagine being upside
down and trying to balance all your body weight on your pointer finger,” said
Ridley. “You just put one finger down and press it real hard. You just feel like
you have no stability at all.”
Ridley remembers the MRI with Marucci; Bankston counting backward from
10 in the surgery room; then emerging from unconsciousness to hear
Bankston say just do what the trainers say to do and youʼll be fine.
“Of course, telling somebody that who just tore their ACL is kind of hard to
believe,” Ridley said.
Nearly a month into rehab, Ridley said he was running with a brace on his
knee and asked Marucci how long heʼd have to wear the brace.
“You can take it off right now if you want to,” Marucci said.
Ridley blinked: What?
“There was one point and time when I thought Jack Marucci was nuts, like
really crazy,” Ridley said. “But I was right back in it and rolling by the next
year.”
Ridley played in all 13 games in 2009, and he was named first-team All-
Southeastern Conference in 2010, when he rushed for 1,147 yards and 15

touchdowns as a junior. He declared for the NFL draft and was selected in
the third round by the New England Patriots.
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New England Patriots running back Stevan Ridley (22) high-steps
toward the end zone for a touchdown after catching a pass and
getting by Jacksonville Jaguars linebacker Russell Allen (50) during
the third quarter of an NFL preseason football game in Foxborough,
Mass., Thursday night, Aug. 11, 2011. (AP Photo/Elise Amendola)
AP Photo/Elise Amendola
Ridley led the Patriots in rushing in 2012 (1,263 yards, 12 touchdowns) and
2013 (773 yards, seven touchdowns). Then, six games into the 2014
season, a Buffalo Bills defender caved in Ridleyʼs right knee during a tackle
— a blow that Bankston said would have re-torn any repair.
And when the Patriots coaching staff asked Ridley where he was going to
get surgery, he told them he would return to Baton Rouge.
This time, Bankston performed the patella surgery because Ridley didnʼt
have enough hamstring tissue left in the right knee, and Bankston didnʼt
want to remove hamstring tissue from Ridleyʼs fully healthy left knee.
“If Dr. Bankston told me he wanted to take an ear lobe, Iʼd have let him clip
it,” said Ridley, now with the Pittsburgh Steelers. “It didnʼt matter.
Everything they said to be true was exactly how they said.”
But what about Ridleyʼs low production in the past four seasons with four
separate teams? The 19 games with 261 yards and one touchdown?
It has nothing to do with the knee, said Ridley, who added he has never
received a negative test from an NFL inspection, and he doesnʼt suffer from
any knee pain other than when he squats for several minutes to play catch
with his friendʼs sons — but who doesnʼt?
“Every time I go somewhere, what is the first thing they want to check out
on Stevan Ridley?” he said. “My knee. And every time they put it up on the
table, they yank on it. They pull it. ‘The knee feels solid. The knee feels
good. Who did your surgery?ʼ And I tell them.”
Former LSU linebacker Lamin Barrow said Ridley was the first person he
called when he tore his ACL during 2017 preseason camp with the Miami
Dolphins.
“No question,” Ridley told Barrow. “Go home. Just go back to LSU.”
And Ridley said heʼs told other NFL players, too, including Patriots wide
receiver Julian Edelman, who suffered a torn ACL in the 2017 preseason.
But as Ridley put it, players have relationships with their own doctors.
“I would not lie and send someone in the wrong direction,” Ridley said. “I
would want somebody to overcome and do exactly as I have done.”
Ridleyʼs case history will be published in LSUʼs report. Joined with the
stories of the 38 other football players, the report could have enough proof
to be a catalyst in sports medicine.
“I think it could definitely wake (people) up,” Marucci said. “I think it can
change the way they view ACL injuries in the future. And it should.”
ATLANTA — Southeastern Conference commissioner Greg Sankey said Friday

he is “very disappointed” in the scuffle that erupted at Kyle Field fol…
Nearly a week after the regular season ended, LSU picked up a commitment
from a highly rated quarterback.

LSU ACL Study Aims To Advance Sports Medicine Into New Era 'This Is A Big Deal' - LSU

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LSU ACL study aims to advance sports medicine into new era; 'This is a big deal' | LSU | theadvocate.

com 12/1/18, 7(20 PM

LSU ACL study aims to advance

The knee was normal, and that was the news.

Tight end Jamal Pettigrew stepped through footwork drills, blocked

A few days later, outside linebacker KʼLavon Chaisson wore sweats as he

What was going on at LSU?

Back at Tiger Stadium, athletic training director Jack Marucci leaned

“Everyone is afraid to go against the establishment,” Marucci said. “Thatʼs

But Bankston said then-LSU coach Nick Saban suggested an alternative.

Saban remembered that when he was at Michigan State, a player had

Bankston had performed the hamstring surgery on LSU basketball players

Bankston performed the hamstring surgery on Randall, who recovered by

Perhaps youʼve noticed the results: Former LSU quarterback Zach

Dozens of autographed pictures from healed athletes hang on Bankstonʼs

So why hasnʼt the hamstring surgery caught on?

It takes some historical context to understand, said Dr. Steve Jordan, an

orthopedic surgeon at the Andrews Institute in Gulf Breeze, Florida.

The patella surgery — referred to as “bone-tendon-bone” in medical circles

The patella surgery, Jordan said, has its own issues.

Anterior Cruciate Ligament (ACL) Reconstruction Animation

But over time, physicians started combining the semitendinosus with

In fact, Jordan noted, a study was published in The American Journal of

But football organizations are stuck in their routines, Bankston said —

Why wouldnʼt agents send their high-profile clients to established

'It could wake people up'

Ridley blinked: What?

Southeastern Conference in 2010, when he rushed for 1,147 yards and 15

to be a catalyst in sports medicine.

ATLANTA — Southeastern Conference commissioner Greg Sankey said Friday

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