Kentavius Street Tears ACL in Private Workout with NY Giants
Kentavius Street, former defensive end for NC State tore his ACL in a recent private workout with the NY Giants. Typically occurs as a non-contact injury with a planted foot on the ground. Many times the athlete is shifting directions, where the body is moving in one direction and the knee is moving in the opposite direction. Usually the athlete will report a "pop" or the sensation of the knee giving away. On examination, a Lachman Test can be performed to check the stability of the ACL ligament, which is demonstrated below. Many times an ACL tear is associated with other injuries, such as a meniscus tear or lateral collateral ligament tear. Although the diagnosis can be confidently made by physical exam, an MRI is generally accepted as the appropriate test to confirm the presence of an ACL tear.
What is his Next Step?
In general, the recommendation for a complete ACL tear is to have a surgical reconstruction, although there are exceptions. There are several options regarding what type of repair is appropriate for the specific athlete. Considerations include the age of the athlete, as well as the intention to return to sports in the future. In Kentavius' case he likely will have arthroscopic surgery to repair the ACL using the hamstring tendon or the patella tendon. In the past, the general goal for return back to full sports participation was reported between 6 to 9 months. However, recent data suggests that we should potentially be waiting 1 to 2 years for return back to full contact sports participation. The focus has shifted away from a fixed time toward the need to meet functional criteria before returning back to contact sports.
What is the likelihood to play this season?
The emerging data suggests that full strength and neuromuscular control does not return back to normal for up to 1 to 2 years (see article below). The era of giving a definitive timeline to return has passed us by. We now more clearly understand that no matter how gifted an athlete you are, this process takes time. It is not simply strength, but a combination of agility, balance and neuromuscular control that helps to protect against a re-injury. If he is drafted, he could be available to play this season, but chances are he will not be ready. In addition, the chances of a second tear are high with a return this season compared to waiting out until next season.
Orthop J Sports Med. 2017 Dec 19;5(12):2325967117745279. doi: 10.1177/2325967117745279. eCollection 2017 Dec.
Clinical Factors That Predict a Second ACL Injury After ACL Reconstruction and Return to Sport: Preliminary Development of a Clinical Decision Algorithm.
Paterno MV1,2, Huang B3, Thomas S2, Hewett TE4, Schmitt LC5.
CONCLUSION:These findings recognize measures that accurately identify young patients at high risk of sustaining a second ACL injury within 24 months after RTS. The development of a clinical decision algorithm to identify high-risk patients, inclusive of clinically feasible variables such as age, sex, confidence, and performance on the triple hop for distance, can serve as a foundation to re-evaluate appropriate discharge criteria for RTS.