New York Post – August 24, 2011
Terrell Thomas faces a more arduous journey back to playing high-level cornerback for the Giants than most ACL injury patients because his is a repeat injury in his right knee.
Thomas first tore his right anterior cruciate ligament in 2005 while playing for USC.
“Revision surgery is notoriously less successful,” Dr. Jonathan Glashow, a New York orthopedic surgeon and co-chief of Sports Medicine at Mt. Sinai Medical Center, told The Post yesterday.
Although a torn ACL is a major injury, it is fairly common and the success rate for a complete recovery is extremely high.
“The success rate isn’t what it’s said to be: 100 percent,” Glashow said. “It’s probably about 85-88 percent and it’s probably about 75 percent with a revision. Revisions clearly do not do as well.”
The difficulty Thomas faces is that he will have fewer options for how to best repair the damage caused when teammate Jason Pierre-Paul collided with him as the two were pursuing Bears quarterback Jay Cutler on a play late in the first half of Monday night’s preseason game.
“The ACL that’s in there, people think we actually fix; we don’t,” Dr. Glashow said. “You get a new piece of tissue.”
Where that tissue comes from is the issue. Typically, new tissue is harvested from the patella tendon, the quad tendon or the hamstring tendon in the same leg as the damaged ACL. A piece of tissue is taken to make a graft that replaces the original ACL. Dr. Glashow said the next step is to employ an allograft, a graft that uses tissue from another human body, which in this case would be a cadaver.
“The problem with a cadaver tissue is it takes much longer to heal and we don’t like players playing before a year to 18 months when you take a cadaver,” Dr. Glashow said. “You’re probably not going to use an allograft unless the player really wants it. I’ve done them, not wanting to, in professional athletes, and they’ve gone back. I have people playing in the NFL with cadaver graft in them. It’s not a first choice.
“The other option is to steal it from the other knee. If it’s his right knee and his left knee is healthy you can take the patellar tendon from the other knee.”
Dr. Glashow has not examined Thomas and does not know which procedure was used in 2005 to reconstruct Thomas’ right knee. As a New York knee surgery specialist Dr. Glashow regularly performs procedures for many types of knee injuries.
“Unfortunately it’s not so uncommon,” Dr. Glashow said of repeat ACL tears. “The problem is if he’s already taken his patella tendon, do you really want to weaken his front muscle more by taking his quad tendon on the same leg? You take some risks then. It’s a double-edged sword. In some ways you’re robbing Peter to pay Paul.”
Dr. Glashow also cautioned that other injuries in the knee that may have occurred in conjunction with the ACL tear — such as damage to the meniscus or articular cartilage — can affect the outcome of the surgery.
“If that’s been affected one has to fix that as well with microfracture or some kind of cartilage transplant technique,” he explained.
The prognosis remains that Thomas can make it back for the 2012 season, but the repeat injury is troubling.
“It’s not the same thing as having a virgin tear of your ACL,” Dr. Glashow said. “The odds of coming back are not as successful.”
