Malik Nabers will have a long road to recover from torn ACL | The Injury Report - video Dailymotion

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00:00This is the Injury Report, presented by NYU Langone Health.

00:05Every Giants fan knows the terrible news by now.

00:08Wild receiver Malik Nabors is out for the rest of the year after tearing his ACL.

00:12So what does that mean for his future?

00:14And I'm going to get Jets fans an update on running back Braylon Allen,

00:18who sprained his MCL on Monday Night Football.

00:21Today's Injury Report is all about the knee.

00:24We got Dr. Michael J. Alea, sports orthopedic surgeon at NYU Langone.

00:30Health with everything you need to know about these guys returning to play.

00:35Little dad joke there, but this is nothing to joke about for both franchises.

00:40I guess we'll start with Malik Nabors.

00:42First and foremost, what's going on, Doc?

00:43But there's this viral picture that's going around the Internet of Nabors

00:48hanging with his favorite rapper, NBA Youngboy, after he tore the ACL.

00:53He's got the brace over his jeans, and then he also has a crutch under his right side as well.

00:59So why doesn't he need surgery right away?

01:02And what's that process and timeline going to be like to fix the ACL?

01:07Well, first, it's good to see you.

01:09It's good to be back.

01:09It's good to talk to you.

01:11I understand what a lot of people are going through seeing Malik Nabors kind of go down like this,

01:15especially as a Giant fan myself.

01:17It's difficult to fully grasp this.

01:20But, you know, you see him on the sidelines with his favorite rapper.

01:24It's always a good thing that he's up and on his feet.

01:26He's getting around, walking, ambulating.

01:28So those are all good things.

01:30Now, the reason that we don't go into surgery right away, typically after an ACL is torn,

01:34is because what happens is the knee fills up with blood.

01:37And that inflammatory process is almost like an initial hit on the knee, where it gets very

01:44inflamed, and you want to get the knee swelling to be gone before we go in and do a reconstructive

01:49surgery on that knee.

01:51Not only do we want the swelling to go away, we also want the patient's motion to be nearly

01:55normal.

01:55Full extension, full flexion, minimal pain.

01:59We wait until the knee is sort of biologically quiet before we intervene surgically.

02:04Because if you go in too early and give a second hit, then you could potentially make

02:08the patient a lot stiffer.

02:10And if a patient like Malik Nabors, who relies on his knees for high-velocity impact type plays,

02:16if you make that patient's knee more stiff, then they're not going to have the outcome

02:20that they want.

02:22High-velocity impact plays have less impact on grass.

02:28And everyone is blaming the turf at MetLife Stadium for this injury.

02:32He ain't the only high-profile football player to suffer a non-contact season-ending injury,

02:39Doc.

02:39So I know you're not a real turf expert, but can field turf kind of add to the risk of

02:45these injuries and these athletes, meaning the wear and tear, and maybe not giving out

02:51like grass does?

02:53So the answer to that question shortly is yes.

02:57It has been shown in several studies in great journals like the American Journal of Sports

03:02Medicine that, particularly in the NFL, there is a higher risk of non-contact knee injuries

03:07like ACL tears when you're talking about turf.

03:10Now, we're not talking about an exponentially higher rate of tearing.

03:15We're talking about a small increase in the rate of tears in ACLs when you consider turf.

03:21So people still tear their ACLs and their knees on grass all the time.

03:25I mean, look at last night.

03:26Tyreek Hill sustained a devastating injury to the knee, and that was on a grass field.

03:31So knee injuries can certainly happen on grass.

03:34But the reasons why they might be a little bit more common on turf is because the surface

03:39grip of turf is very high, right?

03:41So the cleats grip the turf very, very substantially.

03:45And what happens with that is that the cleats don't release.

03:48So they kind of get stuck there.

03:50It's almost like a skier when the bindings don't come off and you twist the leg.

03:54Instead of the ski coming off, what happens is you rotate through the knee and the ligament

03:59tears instead.

04:01So that's one reason why ACL tears tend to be a little bit more common on turf is because

04:06of that low or poor cleat release.

04:09And then you think about the shock absorption also, turf tends to be a little bit harder.

04:14So the shock absorption is a little lower compared to grass.

04:17So if theoretically, if that grass can absorb shock a little bit better, then potentially

04:22the knees can be protected.

04:23I'm glad we have you on because the knee is your expertise.

04:27And you know now that ACL injuries aren't career ending like back when my dad played.

04:33So like the typical recovery or the timeline for a guy like Malik Neighbors or Elite

04:38athletes, they're coming back the next year, kind of some even bigger, faster, stronger.

04:44So what are the new surgical techniques that's been created to get these guys back out there

04:50faster after an ACL injury?

04:54So I think we're still in that era of tried and true surgery where our techniques have not

05:00changed very much over the past 15 years.

05:02Back when your dad hated ACL surgery, we used to do those with big open incisions where not

05:08only did we reconstruct the ACL, but we used to also tighten the MCL, take out the medial

05:14meniscus, which is just a, we know now is a horrible idea.

05:18Back when Joe Namath had his ACL done, that was the only thing we knew how to do.

05:23And it gave Namath maybe five years more on his career, but he needed knee replacements.

05:26Now we've got anatomic reconstructive techniques where we can go in and almost nearly perfectly

05:33reconstruct an ACL.

05:34Now we can't give the patient what God gave them in terms of what their ligaments look

05:39like when it attaches on the femur bone and attaches on the tibia bone, but we can give

05:44them a really, really anatomic reconstruction.

05:47We have some adjuncts in place where we can add to it, but those haven't really borne out

05:52as something that can get you back to play within the next, earlier than six months, six

05:57months for these high impact athletes is really still the earliest we can get them back out

06:01there.

06:01You look at Adrian Peterson and what happened to him maybe eight to 10 years ago.

06:05He came back from ACL surgery about six months after his surgery, and he had probably one

06:09of the best careers we've ever seen in NFL running backs.

06:12He came back at a level that was better than what he was preoperatively, which was nothing

06:17short of spectacular, but we've got such great physical therapists and athletic trainers

06:21that can get these players back early because we know what to do with their muscles, with

06:25their landing mechanics, with their rehabilitation.

06:28Surgery, we do great.

06:29You know, the surgery is the easy part.

06:31It's the recovery and the rehabilitation is the more difficult part.

06:35Now for the Jets fan that's still watching right now, I know it wasn't an ACL tear, but

06:40running back Braylon Allen sustained an MCL sprain during that loss in Miami.

06:45He's a big physical type running back.

06:47What's his timeline to be back to 100% and will this injury kind of slow him down when

06:54he does get back?

06:56I think it all depends on how bad the MCL injury is.

06:59And when we as orthopedic surgeons classify MCL sprains, we grade them into three different

07:03types.

07:04So a type one tear is a very small tear or just a sprain where the tissue might stretch

07:09out a little bit, maybe a little bit of fluid around the ligament.

07:12And that could be as easy and as quick as two to four weeks to come back from.

07:16Typically, the patient or the player just needs to feel comfortable and be able to do all

07:19their activities on the field without jeopardizing their health or the health of anybody else

07:23on the field that they're playing with.

07:25When it comes to a type two tear, which is a little bit more of a tear inside the ligament

07:28than it could be anywhere from four to six weeks.

07:31And when we talk about a type three tear, which is almost like a complete blowout or a complete

07:35tear of the ligament with significant instability when we test them on the examination table,

07:41that could be almost three months to recover from.

07:44So those injuries are typically about a three month recovery time.

07:47But, you know, I haven't heard too much about this injury.

07:50So my gut tells me it's probably going to be along those low grade highlights or one

07:54or two, and hopefully they'll be back on the field within two to four weeks.

07:58Yeah, they put them on the four week IR.

07:59So he will be back in about four weeks when that gets back to 100%.

08:04So back to the ACL, how would you treat a non-pro athlete patient if they tore their ACL?

08:12Well, you know, we always weigh into perspective what a patient's activity status is.

08:18So there are a lot of 25 year old, 30 year old, even 50 or 70 year old patients that have

08:24substantial pivoting as part of their lives or part of their enjoyment.

08:28And whether that be tennis or pickleball or skiing, I've got some patients that are elite

08:32skiers that are throwing down black diamonds or backhills skiing as if it's nothing.

08:38And those are patients that you have to treat like an elite athlete because part of their

08:42enjoyment and part of their lifestyle relies on it.

08:45So age, we say, is just a number.

08:47Their physiologic age is much more important.

08:51You know, how active are they?

08:52So in New York, where I practice, we have tons of weekend warriors and patients and people

08:58that want an activity status that justifies pivoting and cutting.

09:03So a lot of people get treated the same ways as the elite athletes do.

09:07They get ACL reconstructions.

09:09They get ACL repairs.

09:10There's lots of things on our table.

09:12I mean, for me, ACL reconstruction is a tried and true way to get a patient back into the level

09:17of activity that they want to do.

09:19And, you know, we treat every patient that comes through the door as an elite athlete.

09:23Unless they prove that they're not, we're going to want to give them the best functional

09:27outcome as humanly possible.

09:29That's elite service right there, Doc.

09:30That's why you guys are the best.

09:32Appreciate you hopping on with us.

09:34My pleasure.

09:35It's always good to be back.

Malik Nabers will have a long road to recover from torn ACL | The Injury Report

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