Kelly Lyell

kellylyell@coloradoan.com

A torn ACL.

It’s one of the biggest fears for any athlete.

An injury to the most important ligament in the knee joint. It ends some careers and derails others.

CSU quarterback Collin Hill, a true freshman who had earned the starting job four weeks earlier, tore the anterior cruciate ligament in his left knee when making a cut while running for a 19-yard gain in an Oct. 8 game against Utah State at Hughes Stadium.

Running back Marvin Kinsey, another true freshman who was making a big impact in his first season with the Rams, tore his during a non-contact drill in practice Dec. 3.

The surgery to replace the ligament, located directly below and behind the knee cap, only takes about 1 ½ to 2 hours.

It's the recovery process that makes this such a dreaded injury. Even for college athletes with ramped-up rehabilitation schedules, healing takes about nine months.

“It was long days,” said Kevin Davis, a Colorado State University linebacker who tore his ACL covering a kickoff in a 2012 game against Hawaii. “While everybody else was practicing, you’re in the training room doing rehab, and it took me a while to do all the different exercises. I’d take breaks sometimes, go eat lunch and then come back.

“It was hard, and it took a long time.”

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Davis had setbacks along the way, tearing the meniscus in the same knee the following spring and sitting out much of the next season. He eventually came back strong, leading the Rams in tackles in 2015 and 2016 and earning a spot in the East-West Shrine Game this weekend as one of the top seniors in the country.

Robert Ruiz returned from an August 2015 ACL tear to catch 23 passes for 350 yards and three touchdowns and return 21 punts for 174 yards, including one for a 91-yard touchdown, this past season. Jake Bennett, CSU’s starting center for the past two seasons, had his 2014 season cut short by a torn ACL. Kory Sperry tore an ACL his sophomore season at CSU and went on to earn second-team All-Mountain West honors as a senior and play five seasons in the NFL.

“A lot of people come back and perform well on (repaired ACLs) afterward,” Ruiz said. “It’s going to be painful, it’s going to take a little bit of time. But as long as you work hard, do what you’re supposed to do, you can come back full speed and not really lose a step.”

Dr. Eric McCarty, an orthopedic surgeon and team physician and former linebacker for the University of Colorado, said there's good reason it's called the cruciate ligament, because, "it’s crucial for the stability of the knee in cutting and pivoting in sports..”

Americans tear about 200,000 ACLs every year, according to the American Orthopedic Society for Sports Medicine. Not all are surgically repaired.

Dr. Rocci Trumper, a surgeon with the Orthopaedic and Spine Center of the Rockies and longtime team physician for CSU football, performs about 220 ACL surgeries per year. He repaired Hill’s knee in late October and Kinsey’s in December.

The ACL, he said, “is not a really good healer.” So doctors repair torn ACLs by grafting a replacement into the knee using either a tendon or ligament from a cadaver or from another part of the patient’s body. Trumper prefers using a graft from the patellar tendon of one of the patient’s knees, cutting out the middle third of the tendon along with a small piece of the attached bone from the patella (knee cap) and tibia.

“We’re basically taking the tendon from an area that will heal itself, and we’re putting it into an area that will not heal itself, the ACL,” Trumper said. “For most high-level athletes, we use a piece of the patellar tendon because it tends to be the most dependable graft for restoring mobility with the lowest chance of re-tearing it.”

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ACL surgery is successful in about 95 to 96 percent of patients, but there's a slightly higher failure rate for competitive athletes —about 6 to 8 percent.

“They’re bigger, stronger, faster people playing against bigger, stronger, faster people,” Trumper said. “When we talk about failure, really what we’re talking about is they tear it again, and you can tear anything we put in there.”

Former CSU running back Kyle Bell has torn the ACL in his right knee three times and twice underwent microfracture surgery to repair patella damage that he said was a byproduct of the ACL surgeries.

Bell suffered the first tear just five days before the 2006 season opener. Running a full-contact drill near the end of practice, he was hit on the right leg by defensive back Darryl Williams. His foot remained planted on the field as his leg was pushed back.

Trumper repaired it a few weeks later, and Bell went on to play two more seasons for the Rams but never regained the speed, agility and explosiveness he had before the injury.

Bell tore the ACL again in 2009 while working out with the NFL’s Jacksonville Jaguars before what would have been his rookie season. His agent sent him to noted surgeon Dr. Richard Steadman in Vail. Steadman grafted a tendon from a cadaver where the ACL had been. Ten months later, while trying to get himself ready for another shot at the NFL, Bell tore it again.

More than six years later, the kneestiffens in cold weather.

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The precision of arthroscopic surgery, allowing surgeons to see a magnified picture of what they’re doingas they work, improved medical tools and rehabilitation techniques has cut the recovery time for ACL surgery for competitive athletes in half in the past 25 years, McCarty and Trumper said.

So, Hill should be able to do some non-contact work with the Rams during spring practices in March and April, although he probably won’t get a chance to compete with senior Nick Stevens for the starting quarterback job again until fall camp begins in August.

Kinsey won’t be able to participate in spring practices but could be full speed by fall camp, too, coach Mike Bobo said.

The rehabilitation process is grueling and begins with work to regain mobility within days of the actual surgery. Four months after the procedure, most athletes start running and doing exercises to start regaining strength and stability.

At six months, the knee will seem as good as new. But it isn’t yet.

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It takes another two to three months, Trumper said, “to retrain the joint on how to protect itself. You plant and pivot and jump and all those things hundreds and thousands of times, and when you land, your body knows how to protect itself. That gets goofed up for a while after surgery.”

Most failed ACL surgeries, McCarty said, occur in that six- to nine-month window, when patients resume their usual activities before the muscles, tendons and ligaments have learned how to again provide protection.

“You can definitely trick yourself into thinking you’re a lot more ready than you really are,” Ruiz said.

It’s like having a five-speed sports car without being able to put it in first or fifth gear. The explosiveness high-level athletes rely on doesn’t come back as quickly as they would like. And with how dramatically skill position players plant their feet and apply more pressure to the knee, it's common, Trumper said, that they're more effective their second year back from surgery than they are in their first.

Even though Hill and Kinsey will likely be playing again next fall, they might not be able to perform at the same level right away that they did before tearing their ACLs.

Follow reporter Kelly Lyell at twitter.com/KellyLyell and facebook.com/KellyLyell.news

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