If you’re a sports fan, you can probably list the top pitchers, the top quarterbacks . . . and the top orthopedic surgeons. A franchise’s success—and an athlete’s next contract—hinges on how quickly injured superstars return to the field. Here’s how doctors are turning what would have been career-ending injuries a decade ago into speed bumps on the way to Canton or Cooperstown
Injury: Herniated Disc
Intense pain from the inflammation and breaking of the discs that provide cushioning between spinal vertebrae. Classic Casualty: Larry Bird Massive disc herniations sent Bird to the bench often and forced his retirement in 1992, when he was still a top scoring threat. When his back went, so did the Celtics. Vintage Repair: Full or partial removal of the disc or vertebral bone
Recovery time: Six months to never
Modern Comeback: Randy Johnson Twisting his 6’10” frame to throw 100mph fastballs has damaged three discs. Microsurgery helped the Arizona Diamondbacks’ hurler return at age 43, fastball and all. Future Fix: Microdiscectomies, the removal of just the injured part of the spinal disc, are becoming less invasive and better at alleviating the pain of pinched nerves. But the procedure still results in a loss of cushioning between vertebrae, making the back less resilient to general wear and tear and more likely to break down again. Now doctors are testing ceramic and metal-alloy prosthetic discs to replacea€”and even enhancea€”the cushioning lost through age and overuse. In the next decade, computer-assisted image-guided surgery and minimally invasive robotic surgeries will improve the precision and safety of spinal surgeries, which means shorter rehab time and improved function for the athlete.
The common crack will slow an athlete for at least a month; severe breaks, even longer. Classic Casualty:Joe Theismann
In 1985, a linebacker snapped both bones in Theismann’s lower leg, an injury that ultimately ended his career. Today’s therapies could have had him back on the field within a year. Vintage Repair: Immobilize the bone with pins and screws or in a cast
Recovery time: Weeks to months, depending on the location and severity of the break
Modern Comeback: Dwight Freeney
A broken foot ended the Indianapolis Colts’ speed rusher’s stellar 2007 season. Electrical stimulation of the bones is helping him get back to 100 percent more quickly. Future Fix: Osteoporosis isn’t an athletic problem, but research in this field could help mend broken bones faster. Promising treatments involve stimulating production of hormones such as calcitonin and estrogen to increase bone density and strength. Regulations on performance-enhancing drugs won’t allow for artificial boosts of these hormones, however, so doctors are experimenting with injecting bone-building drugs into fractures and electrically stimulating the tissue, which helps speed the healing process. In the lab, scientists may have identified a wonder drug in the form of a protein scraped from pig bladders. In small studies, the protein extract has regrown not only bone but also connective tissue, nerves and skin.
Torn Anterior Cruciate Ligament
Injury:Torn Anterior Cruciate Ligament
The primary stabilizer of the knee, a damaged ACL prevents explosive stops and starts, rendering a runner useless. Classic Casualty:Jamal Anderson
In 2001, this Atlanta Falcons power running back went from NFL best to out of the game for good after a torn ACL robbed him of his speed and lateral running abilities. Vintage Repair: Open surgery and replacement with a ligament from a cadaver
Recovery time: Two years: one year to play, another to play well
Torn Anterior Cruciate Ligament
Modern Comeback: Philip Rivers
Rivers tore his ACL during the playoffs in January, but modern surgery and rehab had him back in the huddle for the San Diego Chargers training camp this spring. Future Fix: The biggest obstacle in ACL rehab is teaching someone how to use his new knee. When a foreign ligament is spliced into a patient, the body loses the ability to control the muscle groups that bend the knee or know where it is moving through space without looking, a sense called proprioception. The longer it takes to reconnect the brain to the knee, the more the muscles will atrophy, making a comeback even harder. New physical-therapy techniques, mostly repeating motions that target specific muscles, are getting patients on their feet faster. Healing the ligament could cut out the relearning process completely, so researchers are experimenting with regrowing damaged tissued with collagen matrices and stem cells. Stem-cell-rejuvenated ligaments, combined with faster proprioception training, could reduce recovery time to six months.
Torn Rotator Cuff
Injury:Torn Rotator Cuff
The tearing or detachment of the muscles and connective tissue of the shoulder robs an athlete of throwing power. Classic Casualty:Orel Hershiser
Hershiser fought through shoulder problems at the end of his career but could have kept his velocity had current techniques been available a decade ago. Vintage Repair:Total reconstruction, involving re-anchoring the labruma€”the cushion inside the jointa€”and stitching the rotator-cuff muscles back together
Recovery time: One year to never
Torn Rotator Cuff
Modern Comeback:Drew Brees
In 2005, the QB underwent minimally invasive surgery for his torn-up shoulder and returned to the gridiron in six months to lead the league in passing yardsa€”and the New Orleans Saints to the playoffs. Future Fix:Repairing the elbow’s simple, single-ligament hinge is a breeze compared with reassembling the dozen muscles that run through the shoulder joint. A career-ender just five years ago, a torn rotator cuff is now repairable (although most pitchers lose some velocity), thanks to better arthroscopic tools and clearer visualizations of the injury with MRI, CT and PET scanners. But the best medicine is keeping players off the operating table in the first place. A few Major League baseball teams are commissioning biomechanical evaluations of their pitchers’ throwing motion using motion-capture technology and joint-load calculations. Early results have revealed that pitchers whose delivery exceeds their shoulder’s peak force load don’t last long in the majors, and coaches have started using this data to tweak the bad habits of healthy players.
Ulnar Collateral Ligament
Injury:Ulnar Collateral Ligament
tear The UCL stabilizes the elbow. When torn, it’s impossible to throw a ball accurately or to impart enough spin on a baseball to make it dance through the strike zone. Classic Casualty:Sandy Koufax
Had Koufax pitched when UCL replacement surgery was an option, it could have prolonged his career. With another five years, even modest results would have crowned him the undisputed best of all time. Vintage Repair:Reconstruction using a tendon removed from the non-throwing arm or leg, known as a Tommy John operation
Recovery time: A year and a half
Ulnar Collateral Ligament
Modern Comeback:B.J. Ryan
Ten months after doctors reconstructed his elbow with modern, noninvasive surgery, the Toronto Blue Jays’ closer is back to finishing games with 98mph heat. Future Fix:The Tommy John operation was first performed in 1974, and the procedure hasn’t changed much since. New rehab programs like those used for ACL rehab, however, have reduced return times from two years to one. Some pitchers have returned in 10 months or less, and Tim Kremchek, the team physician for the Cincinnati Reds, thinks better proprioceptive rehab will reduce that to about six months. Surgeons have learned how to perform the procedure using smaller tools and incisions, and ceramic screws for anchoring the new ligament mean less damage and stress to the surrounding muscle tissue, so players can rehab at full tilt earlier than ever. Scientists are also experimenting with regenerating the UCL with stem cells, which might eliminate the need for surgery altogether.
The stress from a career of powerful motionsa€”or one violent collisiona€”destroys the joint, killing bone tissue and tearing cushion-providing cartilage. Classic Casualty:Bo Jackson
A hip replacement in his prime, in 1991, forced him from football and sapped his power and speed in baseball. Today, he might have gone back to excelling at both sports. Vintage Repair: Complete hip replacement with ceramic and metallic-alloy joints
Recovery time: Typically career-ending
Modern Comeback: Jason Isringhausen
Hip resurfacing before the 2007 season allowed the St. Louis Cardinals’ relief pitcher go from acouldn’t standa to aelite closera in six months. Future Fix: In nearly every sport, a hip injury has been the kiss of death for an athlete. Stem cells offer the best (if distant) hope for fixing hobbled hips, but advances in minimally invasive surgery have made the once-complex hip replacement almost routine. Stronger materials and improvements to MRI scanners and 3-D computer modeling have also led to better-fitting, stronger prosthetics. The biggest advance for quicker recoveries is a patch-job procedure called resurfacing, in which doctors use tiny tools to smooth rough spots in the joint and coat it with a low-friction ceramic substance. In the lab, researchers are developing and testing motor-oil-like lubricants that doctors will inject into the hip post-surgery to reduce pain from friction and further speed recovery.