Study debunks longstanding medical myth that a torn ACL can’t heal

Personal trainer Danyelle Anderson ruptured the anterior cruciate ligament (ACL) in her right knee during a kickboxing class.

“My whole world came crashing down, pretty much,” she said.

She was told by an orthopaedic surgeon that it wasn’t possible for her ACL to heal and that a surgical reconstruction was needed.

Reluctant to have an operation, she decided to see if her knee would improve with physiotherapy.

Three months later, a follow-up MRI showed her injury had gone from a grade three complete rupture, where the ligament is torn completely in half, to a less severe grade one tear, where some of the fibres are continuous.

“So basically, my ACL has reattached and is healing,” she said.

Ms Anderson’s story comes as no surprise to University of Melbourne researcher Associate Professor Stephanie Filbay.

Stephanie Filbay’s study on ACL injuries has caused a stir in medical circles.(ABC News: Steven Martin)

In a study that has garnered worldwide attention, she re-analysed the results of a Swedish trial involving 120 patients, comparing the MRIs of those who had surgery with others who underwent rehabilitation without surgery.

“What we found, surprisingly, was that two years after injury, in those who’d had rehabilitation only, 53 per cent had signs of healing on MRI,” Dr Filbay said.

“Even more surprising was that those with signs of healing reported better outcomes than those who’d had ACL surgery.”

Evidence of healing was taken to be the presence of continuous ACL fibres where previous MRIs showed a complete disconnect in the rupture zone, as well as the ligament becoming thicker and tauter and taking on a more normal appearance.

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The findings have become a hot topic in medical circles, raising questions about whether changes are needed to the way doctors treat ACL injuries.

“Everyone’s heard of incidents where someone’s on a waitlist for surgery with a torn ACL and they get opened up by the surgeon and then the surgeon says ‘well, the ACL is healed’,” Dr Filbay said.

“People thought they were extremely rare, and what the research is suggesting is that this occurs more commonly than we thought.”

Challenging accepted medical wisdom

Some surgeons have reacted to the study with scepticism, pointing to the small number of young, physically fit adult patients involved in the trial, and the difficulties of assessing healing on an MRI.

A model of the bones of a human knee, with someone pointing out the position of the ACL with a pen.

Justin Roe points out the position of the ACL on a model of a knee.(ABC News: Jack Ailwood)

The ACL is a rope-like band of tissue that runs through the middle of the knee, connecting the thigh bone to the shin bone and playing a vital role in keeping the joint stable.

For decades, the accepted medical wisdom has been that the ACL can’t heal because of poor blood supply inside the knee joint.

“It has been a myth that the ACL never heals, something that’s been set in stone,” specialist orthopaedic knee surgeon Justin Roe said.

A man in medical scrubs and a cap sitting down inside a room, across from a journalist.

Justin Roe says it’s a myth that the ACL never heals on its own.(ABC News: Jack Ailwood)

In practice, he said, doctors have observed that ACLs heal in some cases, but not in others.

“And that’s the holy grail — predicting who it does heal in and who it doesn’t,” Dr Roe said.

Surgical reconstruction has been viewed as the gold standard treatment, offering a more predictable outcome.

“We have good surgical techniques that have developed over the years, so we can say with confidence to patients that with a successful ACL reconstruction, they can get back to sport 70 to 80 per cent of the time,” Dr Roe said.

Dr Filbay said her research showed that patients treated non-surgically returned to sport at similar rates.

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Michelle Heyman’s Matildas recall highlights Australian football’s striker problem

When news broke in January that Matildas captain Sam Kerr had torn her ACL, keeping her on the sidelines of the sport for the better part of the next year, a question that had been simmering in the background of Australian women’s football for the past few years suddenly reached boiling-point.

How can the country’s greatest ever goal-scorer be replaced? Which player is ready to step into the 30-year-old’s golden shoes? Who is next in the production-line of Australian strikers?

This question was being asked even when Kerr was fit and healthy. Since the 2019 Women’s World Cup, doubts were festering that the Matildas had become too reliant on the Chelsea forward, and that the team struggled to find the back of the net without her.

Sam Kerr’s ACL injury has put a spotlight on Australian football’s ongoing struggle to develop strikers.(AAP Image: Richard Wainwright)

The 2022 Women’s Asian Cup quarterfinal against South Korea was a case in point: Kerr started that game and had a handful of open-net chances which, for some reason, she failed to finish. The Matildas lost 1-0 and exited the competition at the earliest point in their history.

The question was the subtext to Kerr’s calf injury on the eve of the 2023 Women’s World Cup, too: how on earth would the team perform without their star player? Who else do we have waiting in the wings to take over?

While head coach Tony Gustavsson was able to rapidly shuffle the team’s structure and rely more on other players like Caitlin Foord, Hayley Raso, Mary Fowler and Emily Van Egmond to step up in her place, Kerr’s memorable goal against England in the semifinal — the only bright spark in an otherwise fatigued performance from the rest of the team — left many wondering how much further the Matildas could have gone had she been available the whole time.

But there is no day-by-day countdown clock on Kerr’s return now, as there was last July. Today, we have certainty that she won’t make a miraculously speedy recovery to be fully fit for the Olympic qualifying play-off against Uzbekistan in about two weeks, nor for the Olympic Games in Paris in just five months’ time. The question has now come into full and urgent focus.

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Finding the right fit: Why breasts are a still a ‘taboo’ topic in sport, and what we can do to protect them

Fifty per cent of the population have breasts, but it’s still a taboo topic in locker rooms, according to AFLW All-Australian and premiership player Libby Birch.

And that taboo contributes to the fact that girls are less likely to play sport than boys, once they start going through puberty.

In her eight years playing at an elite level, Birch said “it’s only recently that I’ve received training on breast support and protection in the sport”.

Birch wants this to change, and for girls and women to feel comfortable talking about their boobs with their peers and coaches.

Three-quarters of Australian women experience breast pain

One of the big physical changes a girl experiences when she goes through puberty is a change in her breasts (amongst other things).

They become bigger, heavier and tenderness can develop. It can be an awkward and stressful process.

And nearly three-quarters of Australian women experience mastalgia (breast pain) at some point during their lives, according to Westmead Breast Cancer Institute.

Mastalgia is something women usually experience in their 20s and 30s during a menstrual cycle.

Associate Professor McGhee encourages more sporting organisations to have conversations around breast health. (ABC News: Justin Huntsdale)

Director of Breast Research Australia at the University of Wollongong, Associate Professor Deidre McGhee, is determined to make sure all breasts are “covered”, and is pioneering research on the barriers women’s breasts can have on physical activity levels and athletic performance.

“A bra is like a pair of shoes, they fit everyone differently,” she said.

She is pushing for sports bras to be included as part of a player’s uniform kit, rather than something that girls and women are expected to buy themselves.

Until recently, there has only been one large-scale study conducted on women’s breast injuries in contact sports.

Associate Professor McGhee said one of the reasons might be that when women are given a chart to show the location of their injury, the chart is often of a male.

“A lot of women also don’t always feel comfortable talking about their breast support needs or injuries because a lot of people in leadership and coaching positions are men,” she said.

“This makes them feel uncomfortable.”

Girls learning tackle techniques to protect breasts

In October 2019, the Australian Institute of Sport started the Female Performance and Health Initiative. The main goal was to improve knowledge and support in relation to girls and women in sport.

Since then, 14 modules and educational resources have been developed on topics ranging from a women’s menstrual cycle, through puberty and development, to breast health.

A woman leads the way in a running drill while junior players look on

Former AFLW player and now La Trobe University researcher Brooke Patterson takes junior players through a drill.(Supplied: AFL Media)

Former AFLW development coach and injury prevention researcher at LaTrobe University Brooke Patterson spends much of her time talking to coaches at a community level.

She teaches them how to train girls who are playing Australian rules on the best tackling techniques to prevent serious injuries including injuries to the breast.

“It’s important to talk about ways to tackle differently so you can better protect your breasts,” Patterson said.

“But it’s also important to help coaches feel comfortable doing that … without feeling like they’re stepping over a personal boundary.”

At the same time, girls and women need the confidence to ask for help or guidance.

But it’s not just up to coaches and girls playing sports.

A recent study published in Science and Medicine in Football found almost 60 per cent of elite female athletes have experienced an injury to their breasts, but only one in 10 go on to report it to either their medical oversight professional or coach.

Patterson and Associate Professor McGhee both believe physiotherapists and medical practitioners require upskilling across the board, to better equip them with the tools needed to identify breast injuries.

That way when a girl or women visits a clinic, problems can be diagnosed and treated with confidence, allowing the patient to feel heard and seen.

Is protective gear the solution?

Two AFLW players collide in a contest for the ball.

Birch wears breast protection when she plays.(AAP: Matt Turner)

Some experts also believe women could wear protective gear as a way to tackle the situation.

Due to the location of breasts, they are more vulnerable and susceptible to an impact injury during contact sport.

Suzie Betts is the owner of Boob Armour, a company that designed removable bra cups.

A woman wearing a sports crop top inserts a pink hard plastic cup into her bra.

Boob Armour is designed for female athletes to use in a range of sports.(Supplied: Boob Armour)

Questioning why mouthguards, shin guards and boxes are included as part of a “uniform”, but breast protection is not, Betts said she wants to see girls able to play sport with the same confidence boys do.

The current AFLW collective bargaining agreement, for example, stipulates boots and sports bras as requirement when it comes to a player’s “tools of the trade”, but clubs only have to pay for boots.

So, is it the players’ responsibility to protect their breasts, the clubs, or the sporting code?

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In a traumatic accident, Sean’s skull dislocated from his spine. He now lives with ‘the invisible disability’

Sean Gardner probably shouldn’t be alive.

The 43-year-old Gold Coast man suffered horrific injuries in 2019 when he fell while waterskiing at 180 kilometres per hour in New Zealand’s Waikato River.

The impact was like hitting concrete, and his skull dislocated from his spine.

Sean suffered fractures to his spine and ribs, a collapsed lung and bleeding on the brain.

Thanks to a series of almost unbelievable coincidences, he survived.

But while Sean’s body has healed, his brain has not.

The former specialist welder is now among roughly 2 per cent of Australians living with a brain injury.

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‘Stay with me’

Sean can only recall snippets of the trip to compete in the Bridge to Bridge waterski competition in New Zealand.

When he woke up after the fall, he was face down in the water and unable to move.

“I remember seeing the glow of my wetsuit, the darkness underneath me and the light above me,” Sean said.

“I just thought, ‘This is what it feels like to drown’ … It was very peaceful.”

Sean Gardners skull was dislodged from his spine.()

When he next opened his eyes, Sean was on a rescue boat, and a voice was repeating in his ear, “We’ve got you. Stay with me”.

Another blink, and he was in an ambulance with his wetsuit being cut off.

Sean doesn’t remember feeling pain or making the sounds that haunt his wife and friends.

“I remember being calm, but obviously I wasn’t on the outside,” he said.

“Everyone said it was the noises of a man just trying to survive.”

The trauma has left his wife, Fiona Daggot, with post-traumatic stress disorder and hazy memories of the ordeal.

The entire experience has haunted her, from the endless waiting and the relentless clock ticking as hours passed to the sickening suspense and the not knowing.

High-speed waterskiing left Sean Gardner with life-threatening injuries.()

“I was pretty much in survival mode,” Fiona said.

She has since learnt that no one knew what to say back then when everyone thought her husband would die.

But after he woke from the coma and took his first step toward his wife with a gentle kiss, time stood still for Fiona.

“It wasn’t until after he had got into a ward that we found out about all of the amazing coincidences that allowed him to survive,” she said.

Keeping Sean alive

Sean’s odds for survival were slim, but thanks to some fortuitous factors, the emergency and specialist care he received gave him a fighting chance.

“It’s like everything that happened was just for me to survive,” he said.

When Sean was rescued from the water, he was retrieved without moving his neck.

Also, a highly experienced team of paramedics who were first to the scene had a combined 70 years of experience with trauma incidents.

The accident also happened near one of only three hospitals worldwide with a trauma unit that specialised in caring for patients without moving the body.

Sean Gardner with wife Fiona Daggot.()

And finally, a prominent neurosurgeon was in town for a conference and was available to operate.

“They gave me a 5 per cent chance of surviving with no idea if I was going to have brain damage, or if I was going to walk or even talk ever again,” Sean said.

“I ended up walking out of the hospital 13 days later.”

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‘Life-changing’ support

Recovery has been physically and mentally brutal for the couple.

Sean’s brain injury affects his memory, mood and attention.

“It’s like you’re trying to spit something out and you can’t quite get it,” he said.

“Brain injury is the invisible disability because nobody can see it.

“If you saw me and spoke to me, you wouldn’t even know until you saw the big scar on the back of my head.”

Sean Gardner with his wife in hospital following the accident.()

It’s an issue Fiona initially struggled with as well.

“The hospital wasn’t doing anything [for the brain injury],” she said.

“They didn’t think it required any clinical intervention because nothing was showing up on their cognitive screenings.”

Fiona said brain injury symptoms could often be attributed to depression, pain or medication, and sometimes it felt like living with someone with dementia.

Marriage breakdowns not uncommon

Fiona contacted Synapse — a brain injury support service — to talk about her experience and frustrations.

Here Sean also found a community of other people living with a brain injury.

“It has been life-changing for both of us,” Fiona said.

“The physical therapy helped him walk, but this is the thing that probably helped our relationship the most.

“Having your life completely changed and the person you’re married to essentially become a different person — it’s really, really hard.

“But I guess I’m a different person too now.”

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