ACL tear can happen to proathletes or the teenage competitive soccer player scrimmaging in a Carlsbad park on a sunny  San Diego Sunday afternoon.Isaiah-Pead-acl-tear

Arguably the most volatile position in the NFL is the running back. Injuries, everyday wear and tear, and age can shorten the career of a running back. For Isaiah Pead, the end could be near. He was a top five running back in the 2012 NFL draft. He has been off and on injured, had some off-the-field issues, and has been overall underwhelming when he is available to play. Unfortunately for Pead, his career outlook just got even bleaker as he has suffered a season ending injury during a preseason kickoff return. Pead was running down field full speed when his feet got tangled and he went down. The result: an ACL Tear.  This knee ligament injury will stop you in your tracks.  Most athletes report hearing and feeling a pop and then they go down.acl-tear-san-diego

The ACL or anterior cruciate ligament connects the front of the shinbone (tibia) to the middle of the kneecap (patella). The main purpose of the ACL is to provide rotational stability and to prevent the shinbone from getting too far ahead of the thighbone (femur).

Sometimes ACL tear can occur as a result of direct contact with the knee, but more times than not, an ACL tear is a non-contact injury such as in the case of Isaiah Pead. The cause of this non-contact injury is often due to rapid direction changes, sudden stops and decelerations, as well as incorrect landing and pivoting. The symptoms of a ACL Tear include knee pain, knee swelling, knee discomfort, knee tenderness, and decreased range of motion in the knee.

If a knee injury has occurred, an orthopedic physician will compare the structures of your injured and your non-injured knee and in most cases this is sufficient enough to diagnose ligament tears. However, the doctor will sometimes schedule an x-ray and an MRI in order to dismiss potential confounding problems, to validate the diagnosis, and to determine the degree of the injury.

Treatment for an ACL tear is dependent upon the severity of the injury. Grade I sprains involves overly stretched but still in tact. Grade I sprains typically require keeping the weight off the affected leg. Once the swelling has subsided, a physical therapy regimen will be prescribed. These exercises are meant to strengthen the leg muscles that support the ACL. Grade II sprains involves the ACL being stretched to the point that it has become loose. Grade II sprains are a little trickier to handle because they may or may not require surgery depending on lifestyle of the patient. The non-surgical approach is similar to that of grade I sprain but generally this is a longer process since these sprains are more severe. The surgical approach involves the rebuilding of the ligament via a tissue graft followed by rest and physical therapy. Grade III sprains occur when the ligament has been completely split into two pieces. In grade III sprains, surgery is required to rebuild the ligament. The recovery time for ACL surgery is often six to nine months. The prognosis for surgical recovery is positive and many athletes are able to return to their respective sport at near pre-injury form.ACL-Tear-Grades

As for Isaiah Pead, there is a very good chance he will make a full recovery, but considering his career thus far, it is doubtful he will ever become the player we once thought he could be. Then again, sometimes a player needs to hit rock bottom before they can really begin to understand what it takes to make it, maybe this, will be his wakeup call.

If you have been told you have an ACL tear or are suffering from knee pain, contact our top sports medicine specialists at Orthopedic Surgery San Diego to obtain a consult and be treated they way you deserve!




One of the most common sports related injuries is a torn ACL (Anterior Cruciate Ligament). Many people think that ACL injuries happen mostly in contact sports but the truth is that a majority of ACL injuries occur without contact. One example of a non-contact ACL injury was during a recent major league baseball game. Los Angeles Dodgers pitcher Paul Maholm ran to cover first base on a relatively routine ground ball. Maholm arrived at first, planted the toes of his right foot on the edge of the bag and then went down riving in pain and reaching for his right knee. After watching the replay about a dozen times it is still hard to say that anything even truly happened. However, within a day it was confirmed that Maholm had a complete ACL tear. A simple misstep and his whole season is over.

The ACL is one of four major ligaments that help to align and stabilize the knee. The knee is the point at which thighbone (femur), shinbone (tibia), and kneecap (patella) meet. The ACL attaches the center of the kneecap to the front of the shinbone. The function of the ACL is to assure proper alignment of the shinbone and thighbone. In addition, the ACL provides very important rotational stability. Like many other ligament injuries, ACL injuries can be diagnosed by severity. Grade 1 ACL sprains are considered mild and involve the ACL being stretched but not detached. With grade 1 ACL sprains, the ACL is still capable of stabilizing the knee joint. Grade 2 ACL sprains are moderate or partial tears and occurs when the ACL is stretched to the point of becoming loose. Grade 3 ACL sprains are the most severe of the ACL injuries. Grade 3 ACL sprains occur when the ACL is completely torn into two separate pieces making the knee joint very unstable.

Grade 1 and some grade 2 ACL sprains can often be treated without surgery as long as instability symptoms are at a minimum. The process of healing involves a heavy regimen of progressive physical therapy but can often restore the ACL close to its pre-injury form. For a more severe tear or what is called a ‘complete tear’, surgical reconstruction is the only way to achieve pre-injury form if there are symptoms of instability. Instability is when the knee gives away or buckles. The ACL is replaced using a tendon graft typically from the patient’s patellar tendon, hamstring tendon, quadriceps tendon, or from various cadaver tendons. The success rate of ACL replacement is tremendous and many athletes come back after surgery and rehabilitation to perform similar to their pre-injury performance. One such example of this was Minnesota Vikings running back Adrian Peterson. Peterson nearly broke the NFL rushing record just one year after suffering a complete tear of his ACL and MCL.

As for the case of Paul Maholm, his surgery has not yet been scheduled, but should be scheduled soon. Given the recent success of professional athletes on surgically replaced ACLs, I have no doubt that we will see Paul Maholm on the mound for the start of the 2015 season.


Knee injuries are not only a ‘pain in the knee’.  It gets in the way of maintaining an active lifestyle.  I often tell my patients that the best way to avoid knee surgery is to practice good preventive habits – stretch well, warm up right, and limit direct impacts at both work and at play.

But injuries have a tendency to happen without warning, laying waste even to the best-laid plans. A knee injury can cause damage to the meniscus, cartilage, or ligaments of the knee.  Some recently published research has shown that the trauma leading an ACL tear causes damage to the cartilage that only manifests itself decades later.

The term “recovery time” has something of a fluid definition in orthopedic surgery. Typically it describes the wait time before a patient can resume his or her normal life, but it does not speak to the lingering aftereffects which may be more subtle, and which in the case of knee surgery can be far more extensive:

Famous athletes such as quarterback Tom Brady and alpine skier Lindsey Vonn have come back after ACL surgery, so how bad can it be? The truth is that surgery can restore knee function, but it does little to diminish the risk of arthritis 15 to 20 years down the line. Regardless of whether an athlete has surgery, the risk of arthritis skyrockets later in life from an ACL tear. Kids who tear their ACL today are often left with 60-year-old knees when they’re 30.

My San Diego orthopedic knee surgery practice takes care to minimize pain and accelerate healing with a number of cutting edge technologies. If you’d like to learn more, please contact me here today.


It is ACL (anterior cruciate ligament) week here at the San Diego orthopedic surgery blog.  ACL tear is a knee injury which can be devastating to an athlete.  it is certainly a season ender.

A recent newsletter I published on treatment options for knee arthritis prompted several patients to ask me to comment on various types of knee injury.   At the core of many questions were inquiries into how to avoid an ACL tear.  As it happens, the Web is rife with generic exercises, but few resources are available for parents and athletes who want to know what to avoid on the gridiron, court, or field once the sporting action has commenced.

ACL tears occur when the ligament that stabilizes the knee is torn or ruptured; this knee injury is typically due to a sudden stop or change in direction. The knee injury is extraordinarily common in sports such as soccer, football, field hockey, gymnastics, and skiing to name a few.  Women will find themselves in particular peril with this knee injury.  But simply changing direction won’t do it; ACL tears arise within a particular kind of stop. Understanding its mechanics is the key:

These injuries often happen when the legs get into a position called “dynamic knee valgus.” That’s when you come to a stop or quickly change position with your knee straight and turned inward, with your foot behind. It’s a common position as players maneuver around a field or court, or in a gymnast’s routine.

Cutting inward for a basketball crossover, slaloming hard on skis, or switching fields abruptly in soccer can all lead to a torn ACL. Sometimes concomitant meniscus tears or cartilage injuries can occur.  Although you don’t want to surrender a competitive edge by abandoning such maneuvers from your agility armamentarium, a little foresight  into ‘prehab’ can go a long way toward helping you discover some safer ways to shift your weight and avoid devastating knee injuries.

To learn more about knee maintenance and knee surgery options in San Diego, please contact my offices today.

© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow