No ACL, No Problem?

NBA Rookie DeJuan Blair of the San Antonio Spurs has started his professional basketball career with no ACL in either knee!  And he’s doing pretty well, averaging 8.3 points and 8.3 rebounds!  How is this possible?  I usually don’t read men’s pro sports articles regarding ACL injuries, but when I read the headline No Ligaments, No Problem: How can DeJuan Blair play without an anterior cruciate ligament in either knee? I HAD to check it out.

Playing without an ACL is a terrible idea, simply because it creates a significant risk for damage to the meniscus, which could lead to accelerated osteoarthritis and more pain.  Theoretically, it is possible to lead a normal life without this ligament, IF the muscles and ligaments that remain in the knee can compensate (no easy feat) for the level of activity the person wants.  Usually, this is only recommended for a limited-activity or sedentary lifestyle.  So how can a professional basketball player swing it?

Turns out, Blair’s surgeons tried to repair partial damage to both ligaments in high school, but were unsuccessful.  The theory is that his ligaments gradually deteriorated to the point of disappearing.  So how did he not feel the deficiency (and earn a spot on a professional basketball team)?

Since this was a gradual change, his muscles and other ligaments could have adapted slowly to the added strain. Without such an adjustment period—if his doctors had simply cut out the ligaments, for example—it’s likely he would have injured himself on the court quite rapidly. Blair is now thought to face a higher risk of damaging his knees (especially his meniscus) than athletes with repaired ACLs—and he may end up with osteoarthritis. -Juliet Lapidos, Slate

When moving, there are several structures in the knee that help the joint stay in place and function correctly and efficiently.  Without one of these structures, like an ACL, the whole kinematics (way the knee structures coordinate) is thrown off.  Combined with the fact that the meniscus is at a much higher risk of being injured, this is why playing without an ACL is NOT recommended for most patients.