When Tom Brady tore the anterior cruciate ligament (ACL) of his left knee (as well as his medial collateral ligament) in 2008, the expected recovery and rehabilitation time for such an injury was eight to 10 months. Fast forward about 12 years to February 2022 and Super Bowl LVI. By the time of Odell Beckham Jr’s ACL tear, the optimal timeline for ACL surgery recovery and rehabilitation was down to six to eight months. Though separated by 12 years, Brady’s and OBJ’s ACL injuries demonstrate the seriousness of ACL repair surgery and the amount of rehabilitation needed to recover from it.
But now, thanks to a revolutionary new surgical procedure that’s gained favor in European soccer leagues, recovery and rehabilitation from ACL surgery could be possible in as little as four-and-a-half months. The concept, devised by Scottish orthopedic surgeon Gordon Mackay, uses what’s known as an internal brace (IB) to help repair and augment the injured ligament. That technique is in direct contrast to the traditional ACL repair and reconstruction approach which took a ligament from the patient’s hamstring to replace the injured knee ligament.
The upside to using the IB method, Mackay says, is that it protects the damaged ligament and allows it to heal without further weakening the knee joint. That’s important since the ACL is the main ligament through the center of the knee which serves to stabilize the joint. And, by protecting and reinforcing the damaged ligament and allowing it to heal, the IB procedure minimizes atrophy, speeds up early-phase recovery time, and significantly reduces the chances for re-injury.
The inspiration for the IB concept came from the external braces Mackay had noticed athletes wearing to protect their knees during games and to help stabilize them during recovery from injury. And it isn’t just for ACL injuries. IB surgery got former Saints quarterback Drew Brees back on the field just five weeks after tearing a thumb ligament in 2019 and allowed golfer Brooks Koepka to compete at The Masters in 2021 just four weeks after he’d dislocated his kneecap and damaged ligaments in his knee.
Though the IB was developed by Mackay in conjunction with American medical device manufacturer Arthrex – and it’s been adapted for use with 17 different body parts – its use for ACL repair has largely been confined to European footballers. And, while more surgeons are adopting the technique and there are over 200 academic papers on its effectiveness, Mackay cautions new ideas can often be slow to take hold.
“It is a big step forward and is transforming sports surgery around the world. I believe it is going to have a big impact on world football too,” Mackay told The Athletic. “It takes time to change approaches and attitudes, but the evidence is building.”
In addition to athletes, the use of the IB has been embraced by the United States military special forces to speed recovery from paratroopers suffering ligament damage in their ankles. However, while the IB has been applied successfully in other joints in the United States, it’s important to note that every ACL injury is different, and American football players face different stresses (think 300 lb. linemen) than European soccer players. Hence, more time and research may be needed before the use of the IB procedure for ACL repair is fully embraced in America.
Until then, Mackay intends to continue working toward even better ways to apply the IB procedure to ACL repair and other applications. That research has already led to the discovery that a second internal brace placed on the outside of the knee can potentially reduce the risk of reinjury even further.
Hopefully, you’ll never suffer an ACL injury, or any other ligament injury, in whatever sport you play. But if you do, as the IB procedure demonstrates, it’s no longer a career ender and you may not need a long, grueling recovery and rehabilitation to get back to 100%. And for that, you can thank Dr. Gordon Mackay.