Athletes Find ACL Tears Mentally Exhausting

Athletes Find ACL Tears Mentally Exhausting

OXFORD, Miss – Mary Kate McGuire, a former Ole Miss soccer player who graduated in 2022, tore her ACL towards the end of her collegiate career. McGuire said she injured her knee playing Alabama on October 6, 2022.

“There was a throw-in to me, and I went up against the player, and I landed like my knee hyperextended,” McGuire said. “So, I went down; I was like, oh, no, what's wrong? It was because I originally tore my ACL in 2017.”

McGuire decided to play in their next game at home vs. Texas A&M on October 9. She said her knee was not 100%, but it felt good enough to play through the injury.

The following week she was practicing drills when her teammate Ramsey Davis passed her the ball. McGuire attempted to score a goal and heard her knee pop.

“I don't know if that injury prior to that messed it up, maybe it was irritated, and I probably should have let it like calm down a little bit.”

McGuire says she can’t be sure exactly what caused her ACL to tear, but it did.

“I don’t know what the bottom line was, but I took a shot to score the goal, went right down, I knew I did it,” McGuire said. “It is one of the worst, possible injuries, you can pretty much have, I think breaking your leg is better than tearing ACL.”

Impact of an ACL Tear

An ACL tear can be more of a career-changing injury than a career-ending injury for collegiate athletes competing at such a high level of competition.

Dr. Heather Landry Shirley, program director of athletic training at Ole Miss, said the purpose of the ACL is to act as a stabilizer.

“Any time there is a high intensity or increased force or shearing force that occurs to that ligament at that joint, there's a very good opportunity that it can tear,” Shirley said.

“That can be anywhere from a rotational injury, a very common mechanism for that injury. It can be a quick stop and pivot movement, causing that rotation that would cause that force, tearing the ligament.”

Dr. Heather Shirley attends to athlete

The ACL is one of the strong bands of tissue that connects the femur to the tibia. It is one of the most important ligaments in the knee because it stabilizes the knee.

“It is a strong band made of connective tissue and collagenous fibers that originate from the anteromedial aspect of the intercondylar region of the tibial plateau and extends posteromedially to attach to the lateral femoral condyle” (ACLKneeInjury).

McGuire’s teammate Sydney Ash also tore her ACL and like McGuire had multiple ACL tears. One thing they have in common is recalling their knee hyper-extending.

Sydney Ash Tears ACL at Virginia Tech

During her first year at Virginia Tech, Sydney Ash played collegiate soccer at the Division I level. Ash recalls practicing with the team the day after it had poured down rain. Her coach had the team working on a defending drill at the grass field instead of their turf field, and Ash vividly remembers the grass field covered in mud with cones set up to run drills.

“I was running out to defend the girl with the ball and my foot got stuck kind of in the mud and… my foot just completely slipped forward. But my cleats like the studs of it were stuck in the grass and my whole body kept going forward but my leg was still locked in place.”

Ash said she feels like the normal ACL injury is when the knee goes one way, and the body goes another.

“Mine just completely hyper-extended completely backwards my body was going so fast, forward, and then my knee just kind of popped backwards. I don't know if anyone else heard it, but you can hear it in your head this like pop.”

After Ash’s teammate shared her experience with an ACL tear along with not having the nerve block helped give Ash a more in-depth understanding of how the process works.

“Before I even had my surgery, she told me listen, I was told from volleyball, don't get a nerve block, it slows down your recovery, the numbness does affect you in weird ways.”

Ash went into her surgery with her mind set on not getting a nerve block for her procedure. She said the doctors asked her why she did not want the nerve block to help ease the pain following surgery.

“I was just like, no, I mean, she told me not to get it, and she was back on the field playing well. So that was how my mindset worked on that one.”

Ash said she transferred to Ole Miss following the fall semester of her sophomore year at Virginia Tech. She had to wait until the fall of her junior year to play competitive matches on the pitch. Ash said she made it through a full week of practice in the preseason before facing adversity for a second time in her career at a team scrimmage on a Friday, two days before leaving for their match.

“I'm playing outside back, and there's a girl dribbling the ball at me, and she cuts inside, so I'm facing the out-of-bounds line and she's in front of me. She cuts this way, and I had my right leg out a little bit in front and I was already planted like my foot was already in place. It wasn't stuck or anything, but my foot was in place, and I just turned my body too much I think, and my foot stayed in place, but my knee and my hip shifted and completely popped.”

Both times she went down on the soccer field with ACL tears, Ash said she knew what had happened. She tried running after her knee buckled but found herself back on the ground realizing she just tore her ACL again.

“I just went through this awful recovery, like a year and a half ago. When I went through my first one, I didn't know what I didn't know. I didn't know how awful it was going to be after surgery. So, I just did it.”

ACL Injuries Are Emotionally Draining

Ash’s teammate McGuire had a similar experience having gone through an ACL injury. McGuire had an instant flashback to all the adversity she had to overcome in recovery from her first ACL tear.

“Honestly, it's more emotionally taxing on you than it is physically. When I went down, the amount of emotion, the tears, it's not even because of the pain, it's just because of emotionally and just like, ‘Oh my God, I can't believe this is happening.’”

This was a devastating time for McGuire because she had her hopes set on becoming professional following her season by entering the draft for the National Women’s Soccer League (NWSL) on January 12, and now looks ahead to trying out for a team in July.

“For me, personally, it was probably the worst time in my career for it to happen. It could have happened a year before,” McGuire said. “After two years, you are pretty much in the clear that you should be fine. But five years is like the big mark, after you turned your ACL five years like you're good, nothing's going to happen.”

When an athlete has a procedure done for their ACL injury, the doctor will take a piece from the hamstring, quad, or patellar tendon.

“When the high failure rate was noted in the 1970s, surgeons began adding a reinforcing strip of tendon or fascia to the repaired ACL to protect it, 4 and eventually moved to only using a graft—typically a strip of bone/patellar tendon/bone and then using two of the hamstring tendons (semitendinosus and gracilis)5,6 or part of the quadriceps7 tendon harvested from the patient” (Murray, 2021

).

McGuire said her doctor took part of her patellar tendon as a graft for her first ACL surgery. When it came time to discuss having her second reconstructive surgery, she said she would not have the nerve block injected into her quad. She did some research on the nerve block and said it can affect your quad muscles and the stimulation.

“The first time around, I had a hard time growing my quad muscle back because of the nerve block and so this time around, I didn't want to take a chance.”

“They took a piece of my right patella and put it into my left leg for the graft, and then my doctor did a technique that he's never done before,” McGuire said. “He took a piece of my IT band from my right leg and wrapped it around my ACL as well.”

McGuire in hospital bed after ACL surgery

When her doctor went in to do the procedure it was supposed to last an hour and a half but turned out to be a six-hour procedure.

“When he went there to look at my meniscus, it was torn in three different parts. So, he had to do more than he expected to do, so it was more demanding.”

She said the first few days out of surgery was a struggle and felt a high level of pain due to forgoing the nerve block. She was thankful to have the surgery at home because if she had not gone home the recovery time would have been more taxing on her.

“Due to not having the nerve block, I wasn't in severe pain, I actually had gotten an infection on my right knee.”

Infection on McGuire's right knee

McGuire said she was taken by surprise was the infection that showed up on her right knee. McGuire thinks that infection made matters worse. McGuire said the doctors ordered her to stay overnight so they could monitor the infection.

“I didn't have that the first time. During my first surgery, I got a nerve block, and I woke up from surgery I was out like I left the hospital just discharged in an hour. It's just crazy how much medicine and different things can make an impact on you, physically that way and then as well on your recovery and your muscles.”

Regaining Strength in Quad Muscles is Key to Strong Recovery

McGuire who has experienced multiple ACL surgeries, one with a nerve block and one without; would recommend patients to not take the nerve block.

“The quad is honestly the most important thing in recovery for your ACL because you lose all your muscle, so I wasn't allowed to walk because I had the meniscus,” McGuire said. “I wasn't allowed to walk for six weeks.”

Ash, too, believes having most of your quad strength the day after surgery plays a pivotal role in leading to a quicker recovery.

“They focused on getting your full extension back and full bending of the knee. First, they wanted you to be at the same extension on both legs. So, your ACL leg and your healthy leg, whatever your normal was, they wanted you back to that.”

Shirley said the initial phase of physical therapy is focused on regaining strength in the quad muscles.

“That neurological system has been disrupted, so anytime that you have a surgery, you're having to retrain the brain to activate those muscles,” Shirley said. That is a big focus from the start is to get those muscles firing as quickly and as effectively as possible.”

One of the toughest exercises for McGuire in the first two to three weeks of physical therapy was leg lifts. She said her physical therapist asked her to lift her leg and she couldn’t do it.

“I was like, why can’t I lift my leg up? And that's like the easiest, simplest thing to do in the world. So, that was frustrating, and then, just having my PT be like, relax, flex your quad and having to basically, retrain my whole leg to work in function again, it's very frustrating.”

Staying motivated was hard for McGuire when it came time to learn how to walk again because she understood how demanding the process was the first time around and learning to run without a limp.

“My first ACL surgery, I had the nerve block, and my quad didn't grow back properly, and to be clear to run, at three months, which is like the normal procedure, you have to have 70% of your quad muscle back compared to your other leg.”

“I didn't have that, so it took me a couple more weeks and then even when I was cleared, I was limping, when I ran and I was limping for months after, and I couldn't get it back.”

Ash said the doctor took a piece of her Patel on the injured leg and used it on the injured knee for both surgeries.

“I could feel my quads and stuff on both legs, I was able to start doing leg raises and stuff like that, literally the day after we started working on my bending,” Ash said. “I was able to bend my second knee a lot more than the first one.”

McGuire said her main goal the second time around was to make sure she had the best quad strength possible. She said it was the best feeling in the world when she was cleared to run.

“Of course, the first day when I ran, I was like hesitant, and slow robotics, I didn't want to do anything, but I feel like that first time, I started running normally, it wasn't even an issue,” McGuire said. “I didn't even have a limp at all the first time I ran like completely good, and then a couple of days after I was just completely running normally.”

McGuire said she was able to run up to three miles without a limp one month after being cleared to do that activity

“That so far has been like the best thing for me. Just because due to my experiences, I knew that was something that held me back in the past,” McGuire said

McGuire 4 Months After Surgery

“I'm running again, sprinting, lifting, doing pretty much everything. Soccer will start hopefully at the end of six months, but I'm progressing really well.”

Ash eventually made the transition to doing exercises related to soccer consisting of single leg jumps, along with exercises specifically for building muscle in her quad and hamstring. Ash said the biggest takeaway from her first experience was finding out that ACL injuries are common in athletes who have quad-dominant legs over hamstrings and that was her.

“So, they focus a lot on my hamstring, and then as I'm building that up, I got into later cutting without playing soccer, just cutting in place, cutting on cones, like changing directions pretty quickly.”

In Ash’s recovery at Ole Miss, they had her do plenty of running and once she fully recovered, she said she could run for miles. She did not do as much single-leg training as she did at Virginia Tech.

“I wasn't doing single leg jumping, I wasn't doing a bunch of band work, I wasn't doing like hamstring curls on one leg, I wasn't doing lunges on one leg, I wasn't doing force just on one leg.”