Einstein's own sports medicine expert Brett Sweitzer, MD, joins Ike Reese on Sportsradio 94WIP this week to discuss the most important injuries of interest to Philadelphia football fans. Going into week 12 of the season, Dr. Sweitzer weighs in on Ryan Matthews' sprained MCL, what it means and how that differs from an ACL injury. Plus, he discusses Halapoulivaati Vaitai's knee injury and how rehab differs for people of different sizes.
Ryan Mathews sprained his MCL last week. What’s the difference between a MCL and an ACL, and how are they treated differently?
The differences between the MCL and ACL are commonly confusing to patients, but it’s important for us to clarify because there are some very important distinctions.
Fortunately for Mathews, the MCL is the less severe of the two injuries. The medial collateral ligament, the MCL is a thin flat ligament on the inside of the knee, just outside of the joint, that prevents the knee from bending inward. The MCL most often readily heals without surgery. The typical treatment is bracing with rehab and a return to sport typically within a few weeks, and sometimes even sooner.
The Anterior Cruciate Ligament, or ACL, is a thick cord-like ligament in the center of the knee joint that crosses from side-side and front-to-back, thus preventing both shifting and rotation of the knee. Thus, the ACL is critical to knee stability.
The ACL almost never heals on its own, so surgical reconstruction is typically recommended for these athletes. The recovery from an ACL injury ends up being many months and up-to-a-year or more, which is much different than an MCL injury.
Another key difference is that knee braces are quite effective at stabilizing the MCL-deficient knee, allowing for a quicker return to sport, but they are much less effective at protecting an ACL-deficient knee despite their popular use.
What this all means for Mathews and Eagles fans, is that Ryan was relatively lucky to have an MCL sprain rather than an ACL injury, and it’s very likely this will heal without surgery. I’d expect to see him back on the field wearing a knee brace in the near future.
Halapoulivaati Vaitai suffered a knee injury. He’s a big guy. How does the rehab for someone his size differ from someone smaller?
It’s probably cliché, but at Einstein we really do try to treat each patient as an individual rather than a diagnosis, and we tailor their treatment plan to their individual needs.
Of course, the same is true in this situation for Vaitai. Despite being a big guy, his athletic ability is quite different than the average person of his size. At the same time, the amount of force that he is putting across his knee joint on any given play is much more than that of a smaller player.
Interestingly, his ligaments and bones might not actually be that much different in size compared to that of a smaller player. It’s the muscle and other soft tissues that are the biggest difference in mass, and this is also what makes the rehab much more challenging. The physical therapists and athletic trainers will be challenged to help Vaitai mobilize his knee while protecting the injured tissues.
The key will be to help him understand how to offload the injury while maintaining motion and strength. They’ll constantly be working on biofeedback and helping him understand how to protect the knee during rehab.
They can also use special techniques to use gravity to their advantage, and often times it will take an extra set of hands with multiple staff to help perform the rehab exercises. These big guys also often need custom braces.
Ultimately, it becomes a team effort, but the timeline for recovery and the overall ability to heal from the injury isn’t much different from that of a smaller player.
Be sure to check back soon for next week's report. Have questions about your favorite NFL player's recovery? Post them here and our sports injury experts may be able to answer them on next week's show.