Dominick Cruz and the ACL Blues

I once heard a professional football player comment that recovery from injury is the most lonely, humbling experience an athlete can endure.  The pulse of the sport continues to beat, and there is no one athlete, no matter how great, that can stop it.  Such is the case with UFC Bantamweight champ Dominick Cruz, who is recovering from a series of knee injuries.  Of his misfortune, Cruz commented ”The UFC is a machine, and machines never stop.  And yes, needless to say, this sucks for me.” 

The Injury

While rehabbing from anterior cruciate ligament (ACL) knee surgery, Cruz suffered a second devastating injury to the same knee in November of last year, in which he tore the replaced ACL.  In a December 2012 interview with UFC Tonight, he explained that the original surgery used a cadaver ligament to replace his ruptured ACL.  (Cadaver ligaments are called allograftsmeaning the tissue was donated from another human body.)  Cruz then had to undergo a second surgery.  This time, his surgeon used a patella tendon graft, taken from Dominick’s patella tendon.  (This is an autograftor tissue donated from one’s own body.)  This is the type of ACL reconstruction surgery that Georges St. Pierre had.  The patella tendon graft is considered the gold-standard for ACL reconstruction.

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The premise behind use of cadaver ligament replacement is that there are fewer incisions, less tissue disruption (as is the case when the patella tendon is used for ACL reconstruction), less scarring, and recovery time is reduced.  Also, the athlete tends to have less pain in the knee following surgery.  We know that pain and swelling in the knee can impair the function and strength of the quadricep muscles, which are the primary power muscles of the leg.  If there is less post-operative knee pain, the quads will recover quicker, which is an important early rehabilitation goal following ACL surgery.  Theoretically, an athlete can return to sport-related activity sooner with the cadaver graft compared to the patella tendon graft.

From Cruz’ comments as well as those from his trainer, they believe that Dominick’s body rejected the cadaver graft.  However, allografts aren’t usually at risk for rejection, because the tissue cleaning process removes most of the protein substance that is responsible for rejection.  I think there could be another reason for failure of the original surgery.

Cadaver ACL grafts may take longer to fully heal within the knee than the patella tendon graft.  At the same time, the athlete is experiencing less pain in the knee (compared to a surgery which harvests the patella tendon).  With the cadaver graft, Cruz may have quickly regained full strength of the quad muscles and full mobility in the knee with limited pain, possibly in as little as 3 months following the surgery.  He could have been tempted to accelerate his activity level with respect to training.  The combination of accelerated training and an incompletely healed cadaver graft is disastrous.  To be fair, Cruz noted in his interview that he was following his training regimen and was wearing a brace on the knee when he sustained the second injury.  I feel that this scenario is more likely than rejection of the original cadaver graft.

Cruz had his second knee surgery in the late November/early December 2012 time frame.  I do not expect Cruz to return to the cage anytime in 2013, as would have been the likely scenario with the patella tendon autograft surgery the first time.  

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