The NBA Player Without ACLs in His Knees

The ACL is one of the most important ligaments in a basketball

player

's knee, and when it is torn, it can be extremely detrimental to his NBA career. So how is it possible that a man has had a successful career in the NBA and is missing not only the ACL in one knee but also in Both, welcome everyone. I'm Dr. Brian Suter and my goal on this channel is to help teach you about the medical side of the sports world and in this video we will touch on the medical marvel that is DeJuan Blair, specifically this story.

Since he did not have an ACL in either knee, he was able to play a successful career in the NBA. I want to start with a basic review of ACL function and then we'll talk about how it is torn and why DeJuan Blair was able to play. successfully despite not having one inside the knee, there are four primary stabilizing ligaments on the inside of the knee it will be the MCL which runs north to south on the outside it will be the LCL meaning lateral which means external collateral ligament and then On deep in the knee will be the anterior cruciate ligament and then if we turn to the back, we will see the anterior cruciate ligament.

An injury to four of these ligaments can be quite serious for an athlete, but we usually think of the ACL. As one of the most severe due to the role it plays in stabilizing the knee joint, remember that ligaments are basically ropes, they are passive structures in the body made up of collagen that connect two bones to each other, so it is different from a muscle and then a muscle will fire and adapt or move or actively control what it is doing depending on external forces or its activation pattern. A ligament is just static, it's just there, it can't change and necessarily adapt or fire on command and we have to.

Look at the direction of the ACL to then understand the movement that that ligament or that cord is preventing within the body. This, of course, will be the femur or femur moving up and then the tibia or shin moving up. down, the ACL is shown here in red, so the ACL runs from the front or anterior part of the tibia to the back of the femur, so because of this front to back direction, the main function of the ACL is to prevent the tibia or shinbone from moving forward in relation to the femur, so if we draw a straight line down from the front of the femur, the ACL will prevent the shinbone from jumping forward, now there will also be a rotation component because if we look at the straight line of the ACL it is not perfectly in that plane, it goes from the inside of the tibia to the outside of the femur, so it will also help prevent rotational movements of the knee, so, If we look at a classic example of an ACL tear, we can understand what exactly is happening.

Here's this receiver planting his left leg, you can see his knee sinks in a little bit, but the most important thing is that after the ACL tears, you can see his shin, this prominence right here that's busted. forward in relation to the thigh bone and then as the weight comes off your foot we will suddenly see it come back up right there in that position so the movement in which the tibia has moved forward in relationship with the femur is because the ACL has been torn and then when the weight comes off the foot we see it come back up, the rotational component of what the ACL is doing comes into play because of that position where the knee comes in when the foot lands, that knee comes in and we can see this rotation of the shin, this rotation of the inner tibia in relation to the femur, which will also put additional stress on the ACL and then will help bring about your breakdown with the basic biomechanics of the ACL in mind which we will talk about next. what happened to Dewan and why he was able to prevent this from happening despite not having an ACL, but first I want to quickly thank the sponsor of this video.

This video is sponsored by geology. geology is a hair of skin awarded 22 times. and a body care company that creates simple, effective skin and hair care routines personalized just for you. Their products are based on a handful of powerful, proven, science-backed ingredients that dermatologists have trusted for decades, but perhaps my favorite and best part. The thing about Geology is simplicity, all you have to do to get started is let Geology guide you through a personalized questionnaire about your skincare and hair care routines. This ensures that you get exactly what you want to focus on without having to do all the work yourself.

I thought, my routine includes a daily face wash followed by a vital face cream in the morning, then in the evening I repeat the face wash followed by a nourishing eye cream and a repairing night cream, in addition to its skincare geology, it also offers some fantastic hair products. Care body washes and even deodorants right now will hook you up if you go to the link in the description and use the code brian70 you'll get 70 off their award winning skincare trial set but on top of that. You can also get up to 50 off a complementary body skin or hair care product, so simplify your skin care routine with products that are backed by science and have been really helpful and effective for me. .

Thanks to Geology for sponsoring today's video and Let's learn again that the story with Dewan is that he supposedly injured both ACLs in high school and underwent surgery to try to repair the torn ACL. Whenever we repair torn ligaments or tendons in the body, there are two ways to do it: do a reconstruction or a repair a repair is whenever you take the native tendon or the native ligament in this case and put the two ends back together you repair it which is already there a reconstruction which is what is done for an ACL today is when you take a different tendon or a different tissue from another part of the body and use it to reconstruct or reconstruct the ligament, so essentially you are doing a New ACL instead of joining the two ends.

There are some newer techniques that attempt to repair the ACL that are being investigated, but when Dewan went through this they would have been doing a reconstruction, the challenge is that sometimes that graft that we call and put inside the knee to replace the ACL just doesn't work. It works, it doesn't cure it. it fades, it degrades, and you lose that structural stability because the ACL is no longer functioning, so this must have been what happened with Dewan. He had surgery to try to reconstruct that ACL, but the chart was never taken for some reason or the chart was re-injured. and then when the doctors looked again, they discovered that there was no intact ligament inside the knee.

One of the main reasons Dewan was able to be successful despite not having an intact ACL was the position he played as a center or forward. He wasn't doing a lot of cutting and pivoting and an ACL injury is something that normally happens to a cut and turn athlete and is more important in a cut and turn athlete. If we look at a classic example here with Derrick Rose, we can look when he was cutting, plant, that move was when Derrick Rose tore his ACL when Jamal Murray tore his ACL, it was the same type of thing that he was cutting, was planting on that left leg that he was trying to push off and change direction when he suffered his ACL tear, so while basketball is still an aggressive pivoting and general cutting sport, being a center or a forward is less of a cut and pivot position than something like a guard, it would be very difficult to imagine a guard being successful with both

knees

. have compromised the ACLS, but when you run a lot more in a straight line and jump the ACL it's not as important, but it's still really strange and that's where we have to understand the biomechanics of the knee and how your knee is able to functionally compensate when We look at our anatomy model here again, what I want to do is lift the hamstring muscles, of course, the hamstring muscles are located on the back of the thigh and every time the hamstring muscles contract, they will pull the leg up. in knee flexion, but it will also pull the tibia back, it will pull the tibia back in relation to the femur and remember that's basically what the ACL does: it prevents the tibia from moving forward, so, keeps it stabilized and helps position itself in a backward direction, which means that if you take an extreme example and think that the tibia will be pushed all the way forward, if you fire the hamstrings, the hamstrings will help pull the tibia back so active to re-stabilize it.

Within the alignment of the joint, now the hamstrings will not have as much of a rotational component, but will help actively stabilize the knee to prevent the tibia from advancing in relation to the femur, which again is the primary function. of the anterior cruciate ligament, this is why hamstring rehabilitation is one of the central principles of anterior cruciate ligament injuries. The people we see with weak, poor hamstrings might be more predisposed to an ACL tear because that hamstring can't actively help stabilize and support the ACL. There are also other muscles around the knee that help provide that active stability.

Remember that the ACL is passive, it cannot adapt, it does not change, it does not activate on command, but the muscles around the knee can activate on command for more functional stable stabilization. effects to compensate each time the anterior cruciate ligament was injured. In the case of someone like Dewan, they would have undergone a period of rehab and rest physical therapy after their surgeries, where they would have been working on these compensatory muscles and it probably wasn't a sudden change. situation where the ACL graft was never there, it was probably a very gradual process where things degenerated over time and when it's gradual like this it gives the body more time to compensate rather than being a sudden change, ridiculous and abrupt, and we've seen Other athletes with similar stories, right, Odell Beckham had his ACL reconstructed and then at some point he re-injured it, sprained it, it was probably a cumulative type of thing before he finally reached a critical point in the Super Bowl where it was completely torn and felt functional.

Again, there was a wrestler from the University of Iowa, Spencer Lee, who won national championships without an ACL in his knee, so we hear about these stories and they're definitely really unique, really unusual and definitely not the norm. , but it is also a good example of the power of the human body to compensate for this difference between passive stabilizers and active stabilizers and so remember that when we see athletes who suffer these ligament injuries, it is not just about the healing of the ligament from a surgical perspective, but it also allows your body to learn to compensate. strengthen these functional secondary stabilizers to help protect the joint when we think about the elbow, for example, in a pitcher who might have Tommy John surgery, there is an active stabilizer in the elbow joint called the flexor pronator muscle that is actually located above the UCL ligament and Whenever people have weakness or deficiencies in that flexor pronator muscle, it does the same thing: it puts the UCL ligament under more stress, which makes it more prone to injury, so it's part of the ways in which that we can help reduce the risks of suffering UCL injuries. good active stabilizers with that flexor pronator muscle to help support the passive structure of the UCL.

It's a crazy story and I love it because it shows how wonderful the human body is. Also, you have to give a lot of credit to that one because he would do it. I would have had to rehab that exercise, continue those routines to maintain that active stability when the ACL wasn't there to function, so that's it for the video. Everyone let me know, as always, any questions or comments below, I hope it was interesting. and until next time see you later