The sport of MMA is plagued with injuries. Many of them are not career ending and may serve to just slow the fighter down for a night or two. Others are more dramatic and may come back to haunt the body even after repair.
An injury to the knee can cause that kind of suffering if not properly cared for. The Anterior Cruciate Ligament (ACL) is imperative for proper stabilization of the knee, and injury to the ACL is considered to be major. Doctor James Scoggin is an Orthopidic Surgeon and Sports Medicine Specialist based in Honolulu, Hawaii. He is also a Brazilian Jiu-Jitsu brown belt and has taken the time to talk to SciFighting.com about some of the things fighters should be aware of regarding the ACL injuries including causes, treatment and prevention.
Top Three Causes for Injury to the ACL
“ACL injuries usually result from a pivot or twist,” said Dr. Scoggin. “In my experience I have often seen them occur with the fighter resisting a takedown. I have seen that mechanism a number of times where the one fighter attempts a single leg takedown and the other fighter resists it with the one leg still planted on the ground. With the foot planted the leg can get twisted and that sort of a reoccurring mechanism.”
“I have also seen ACL injuries with passing the guard, the injury to the fighter who’s guard is being passed,” said Dr. Scoggin. If the bottom fighter fights hard enough to hold guard he can have the leg twist as the guard is passed.”
“The third thing that I think is specific to mixed martial arts is that sometimes people will plat their foot and kick like round house kick with the other foot and if their foot stays planted and their knee twists enough there is a possibility of tearing the ACL on the planted leg, said Dr. Scoggin.”
“Then there are sort of more random things like landing wrong, or occasions when your body is moving one direction and you pivot in the other direction.
In a nutshell it is usually a pivot or a twist on the planted foot and usually the twist/pivot/torque on the knee progresses until the ACL, which is the ligament in the knee tears.”
Famous Torn ACLs
“We have seen this in a number of fighters. Georges St. Pierre, I believe Tito Ortiz, Dominic Cruz and Mark Colemen. Those are some rather famous people who have torn their ACLs and it certainly can affect your MMA career,” said Dr. Scoggin.
St. Pierre tore his ACL in December of 2011 and had reconstructive surgery the same month. The injury was said to have started with a minor left knee problem and a pulled hamstring. Because of those injuries he believes he overcompensated with his right leg when he returned to practice. The tear happened during an attempted takedown during wrestling practice.
“Most orthopedic surgeons would recommend ACL reconstruction in a young, athletic patient,” said Dr. Scoggin. “The problem with not reconstructing a torn ACL is that the knee is unstable. The ACL is a major stabilizer of the knee so then it tends to give out or buckle over and over again. So in the course of an MMA event it can give out over and over again.
According to Dr. Scoggin there are three major problems with fighting through an ACL injury;
1. It hurts.
2. It can occur unpredictably and cause pain and cause you to fall to the ground.
3. It can cause repetitive damage to the knee.
“In order to reconstruct the ACL you have to create a new ligament. Unfortunately there is no way to sew together the old ligament that works very well. People have tried for years to do this and the history shows that they just don’t do well. They re-tear.
You can you use a strip of tendon from the kneecap. You can you use a strip of tendon from the hamstring or you can use what is called an allograft which is tissue from another individual meaning a cadaver or dead person. This is someone who is a tissue donor.
For someone who is an MMA fighter most people would recommend either the middle third patella tendon or the hamstring. The allograph more and more is shown to have a higher failure rate.”
The allograft may prove to be a better option for an older athlete or someone who had multiple ligaments torn.
If a person opts not to undergo reconstructive surgery they can anticipate continued instability of the knee and frequent pain as the ligament rarely ever heals on its own.
Recovery and Prognosis
Once a fighter sustains an injury to the ACL it can be well over a year until they return to the level of competition that they were maintaining when the injury occurred.
“I think most people would recommend that you stay away from mixed martial arts for 6-9 months depending on the individual, the type of graft and other injuries,” said Dr. Scoggin.
This time includes time away from all conditioning and fight training. During these months off, the patient will like undergo intense physical therapy to try and rehabilitate the knee smoothly.
“The goal is obviously to make it perfect however the reality is that I think most people, after having an ACL reconstruction recognize that the knee is not quite the same as it was before. I think one thing that happens to a lot of fighters and high-level athletes is that they lose confidence once they have injury. They always know that something happened there even though their knee may be stable again. Sometimes before you tear your ACL you think you are invulnerable and then once you tear it you realize you can be injured and you don’t want to do it again so you are a little more careful. Sometimes that affects the way people fight. I think we have all seen MMA fighters who have had ACL reconstruction and they come back and they are still good, but maybe they have just lost a little something in their intensity.
I think that happens in other sports too, like football and what not. Although Adrian Peterson of the Minnesota Vikings had his ACL reconstruction and the next year set NFL rushing records. That’s best-case scenario. That’s excellent.”
“I think it is important to stay at a high level of physical fitness,” said Dr. Scoggin. “Some people think that strengthening your hamstrings, not just your quads but your hamstrings also can dynamically strengthen your knee and thereby reduce your chance of injury. So keep your hamstrings strong. Stretching and staying flexible may be helpful too.”
In summary, the three things that may be of the most help in ACL injury prevention are:
1. High level of physical fitness
2. Hamstring strength
3. Stretching and flexibility
These are obsticals which may be overcome by a incorporating different elements of conditioning into a fighters normal training schedule, but Dr. Scoggin speculates that there may be one more factor that is unique to each fighter.
“I think sometimes it is important to understand your body mechanics and know when to give up on a position. If someone is trying to pass your guard, or someone is trying to take you down and you feel like you are in an extremely awkward position and you start to feel pressure on your knee sometimes it may be best just to give up on that position and advance to the next one instead of fighting for a lost cause. This is my opinion, but sometime I think people get injured when they are fighting to maintain a position, which they already know they are going to lose. It is better to advance to the next one rather than tear your knee apart and have the fight end for that reason.
The point is, recognizing which way your knee is supposed to bend or recognizing when you are in a bad position and then changing the fight to progress to the next step. Also make sure when you plan your foot to kick, that you are in a good position to deliver the kick without overly twisting your knee.”
Female Athletes at a Higher Risk
Cat Zingano is one female fighter who has already sustained a career-pausing ACL injury forcing her to undergo recovery while Meisha Tate took her place as a coach on Season 18 of The Ultimate Fighter.
“Female athletes are actually at a higher instance of tearing their ACL than male athletes in a sport. As more and more women participate in MMA this is something we may start seeing,” said Dr. Scoggin.
“No one really knows but people have speculated and have researched some of these things. One thing that people speculate on is that the size of the ACL is a little smaller in women relative to the muscle mass that they can develop. So, as female athletes train to higher and higher levels of performance, the ACL may not keep up and may be more prone to being torn. Some people think it is because of hormonal levels, and it can even vary from times of menstrual causing the ACL to become more stretchy or more prone to tear. It may be related to the width of the notch on the bone that the ACL fits in to. Some people have looked at the notch called the intercondyar notch and found in a female it tends to be a little tighter and smaller so it may get pinched and torn for that reason. It may be a combination of these things, but those are the main things where research is on going and the most likely that we know about at this point and time.”