Injury Daniel Menzel - 4th ruptured ACL

[betchsta]

Andrew Krakouer.

Does jail time count ;-).

 

[SJ]

Just read a very interesting article on LARS from Larkins. Relevant excerpts in bold as follows:

http://www.drpeterlarkins.com/2012/03/lars-ligament-surgery-why-all-the-fuss/

LARS LIGAMENT SURGERY – WHY ALL THE FUSS?

Posted on March 1, 2012 by admin
The use of LARS artificial ligaments to assist with joint stabilisation operations has been in use in certain areas of Europe for over two decades, but has really only been on the radar in Australian sport (especially AFL) since 2008. It was during that year that Sydney Swans AFL player Nick Malceski elected to undertake the so-called “revoluntary” surgery after he ruptured his right knee ACL ( anterior cruciate ligament) in the February AFL pre-season period.
Since that time there have been several AFL players who have elected to undergo this knee reconstruction procedure, primarily on the basis that it allows for a much faster return to activity following the surgery. The circumstances surrounding the Malceski surgery were unique in that the inventor of the LARS technique, Professor Jacques Philippe Laboreau, was in Sydney at the time of the injury on a teaching tour and was able to provide direct input into the procedure undertaken by Malceski. In 2002 Malceski had sustained an ACL injury to his left knee and had undertaken a “traditional” ACL reconstruction, requiring him to miss the usual twelve month period from football participation. On the basis that he did not want to miss a substantial period of time from his career (effectively the entire 2008 season) he underwent LARS surgery on the right knee and was able to return to play in round 8 of the same season, essentially only missing a total of 15 weeks.
Subsequently, other AFL players have made this same decision to have LARS surgery and opt for a faster return. They include David Rodan (Port Power), Josh Drummond (Brisbane), Brad Fisher (Carlton), Brett Ebert (Port Power), Campbell Heath (Sydney) and Brett Staker (Brisbane). All of the players (with the exception of Brad Fisher), were recent acute injuries and made their return to football participation within the expected 3 to 4 month rehabilitation period. The appeal of the procedure appears obvious, although the intense support for the procedure from certain vocal supporters needs to be tempered by the fact that 3 of the 6 players who are currently still participating at AFL level (Malceski, Rodan, Staker) have all ruptured theirs LARS ligament and had to undergo a second revision procedure. Malceski and Rodan chose to use the synthetic LARS option again, whilst Staker opted for a conventional reconstruction procedure in September 2011.
So why has the LARS procedure not been universally embraced by all elite sports and AFL clubs? Historically an injury to the knee ACL in an elite sports person is a major setback and usually results in a period of absence from top level participation of somewhere between 10 and 18 months depending on the post-operative recovery period. This is clearly a significant disruption for an elite sports person and every season at AFL level there are several players who sustain this injury (17 in the 2011 pre-season and main season).
In Australia we have a large group of very experienced knee surgeons who have been well trained in traditional ACL reconstruction techniques using either the hamstring tendon or a patellar tendon to “recreate” a new ACL-like structure from the patient’s own biological tissues. This procedure has evolved over a number of decades since the 1970’s and whilst the procedure is not universally successful, the vast majority of players who undertake this procedure can return to the same or similar level of participation provided they undergo the appropriately guided rehabilitation. Having said that there is still a failure rate of the traditional ACL reconstruction procedure and figures vary from 10 to 20% re-rupture, particularly if the player has returned to the same high intensity sport which caused the original injury.
There are many other variables that determine whether a player has a successful outcome to ACL surgery. In particular factors such as associated meniscal and joint surface (chondral) damage can complicate the recovery period and lead to ongoing pain and disability in the athlete despite having a technically successful stabilisation procedure. Additional factors such as the type of biological graft tissue used, surgeon experience, patient genetics, patient motivation and type of rehabilitation programme undertaken all have an influence of the ultimate success of return to top level participation.
An injury to the ACL in sport is not unique to Australia and there has been a great deal of research on this procedure around the world. As experience with knee reconstruction surgery evolved, doctors and scientists during the 1980’s looked at a number of synthetic materials to try and make the procedure more straight forward and easier on the patient. Synthetic grafts such as Goretex, Dacron and various composite materials (e.g.carbon and polyurethane) were all tried, but ultimately failed or caused reactions in the knee such as swelling and foreign body inflammation. Understandably the use of synthetic materials went out of favour during the 1990s as a result of the failures and complications of these synthetic materials. To this day synthetic ACL graft devices including LARS ligaments are banned in the USA and only available in a very few centres in Europe.
The LARS system (Ligament Advanced Reinforcement System) was developed by French surgeon Professor JP Laboreau in response to the failures of other synthetic materials and was fine-tuned over a lengthy period of time in an attempt to find a material that was more suitable to ligament reconstruction surgery – not only in knees, but also in ankles, shoulders and other joints that had significant ligament damage. He was also keen to avoid the morbidity associated with taking human tissue grafts (e.g. hamstring tendons) from the active athlete and the lengthy recovery times required by the conventional operation.
The LARS ligament is made from polythylene , and industrial strength polyester fibre which is specially treated to encourage the patients own tissue to grow in and around its woven porous fibres. It comes in different sizes for different joints and even has a left and right version for knee use. As such it is probably the most advanced and innovative synthetic material currently available. Nevertheless it still has problems with its longevity and requires precise technical skills to surgically implant it correctly.
The message that has been lost in a lot of the media coverage of the LARS story is that this ligament was developed with a very strict set of criteria in regard to choosing the appropriate athlete in whom to use the procedure. Furthermore the procedure was developed in Europe for sports that do not routinely have the great degree of athleticism required in modern AFL football and I believe this needs to be taken into account when considering the appropriateness of this type of surgery.
Laboreau developed the procedure for use in quite specific circumstances
Recent acute ACL tear
1.The original ACL tissue is still present inside the knee despite the rupture
2.Procedure to be performed by experienced LARS surgeon
3.The LARS synthetic tissue is only meant to reinforce the existing native damaged ACL and is not to be used as a stand alone stabilisation graft material
4.No or minimal associated damage to other knee ligaments and internal structures.
It appears that the specific and appropriate use of the LARS synthetic material has been lost in the media hype and hysteria promoted by certain individuals who do not understand the above criteria. The procedure was never intended to be used for revision ACL procedures when a previous operation has failed, where the injury is more than 3 months old, or where there is lack of native ACL tissue available to assist the LARS ligament during the healing phase. Some recent cases suggest the LARS ligament has a limited lifespan and will fail eventually, especially in those high demand elite sports people who return to play the same sport. The problem is predicting when that failure might occur.
There is no doubt the LARS ligament is appropriate in certain circumstances and is still widely used in Australia for reconstruction surgery in a number of patients. As a result of the publicity surrounding the Malceski case the number of LARS operations (all joints) rose from 35 in total in 2006 to 1645 in 2009. Of these 55% were ACL reconstruction procedures performed by some 288 surgeons around the country. There are obvious circumstances where the use of the LARS ligament in day to day reconstructive surgery may be considered and these would include :
1.Recent ACL tear
2.Plenty of native ACL tissue still left in the knee
3.Low demand physical activity patient
4.Minimal associated damage to knee
5.Need to return early to occupational pursuits, eg. self-employed tradesman
6.Older player towards the end of their contract or career who is prepared to accept that the ligament may not last for the life of their knee.
The enthusiasm demonstrated by the vocal proponents of LARS surgery for knee ACL in AFL players was somewhat dampened when David Rodan ruptured his ACL graft some 11 months after having had the original procedure. Interestingly the player himself felt that the procedure had been “successful” because he had been able to return to play in 3 months following his original injury in early 2010. Furthermore, the main “success story” for the procedure (Nick Malceski) ruptured his LARS ligament in February 2011 and he also elected to undergo a second LARS procedure which saw him return to play in Round 8 of the 2011 AFL season. Finally Brisbane player Brent Staker ruptured his right ACL in March 2011, underwent a LARS reconstruction procedure and returned to play at senior AFL level in round 17, but completed only 5 games before rupturing his LARS graft in round 23. He has subsequently undergone a traditional ACL reconstruction procedure and will miss the bulk of the 2012 season.
The LARS technique will continue to attract a significant amount of attention whenever an elite sportsperson suffers the tragedy of an ACL rupture. There is no doubt this procedure has its place in modern reconstruction surgery, but at the present time the traditional ACL procedure is more reliable and predictable and certainly is the procedure of choice for a young player early in his career. Furthermore, it needs to be appreciated that if a player undergoes a LARS procedure and it fails, it is not a simple matter of moving onto a more traditional operation as part of the revision. There are significant technical issues associated with the LARS procedure, including the type of bone tunnels and ligament fixation devices used, which can make it extremely difficult for a surgeon to subsequently attempt to do a hamstring or patellar tendon revision procedure.
Whenever a player sustains a significant ACL injury there needs to be a lengthy discussion undertaken regarding the options available to that player. The player, the club and the surgeon need to make a decision in the light of what serves the best interests of the future for that player. Inevitably that decision may involve a LARS augmentation procedure on certain occasions, but at the present time the consensus in AFL football is that the tried and proven traditional ACL operation will be undertaken by the majority of players in the forthcoming seasons.
drpeterlarkins.com

http://www.drpeterlarkins.com/2012/03/lars-ligament-surgery-why-all-the-fuss/

 

[you pick one]

I give the post a like SJ,but there is not much to like about the implications of the last bolded section.

 

[Jumping Jack]

Unfortunately I think we all know the outcome here - as hard as it might be to admit it. Menzel certainly knows - and the club certainly knows - Joel Selwood knew when he tweeted yesterday. The only variable is (a) the extent of the damage, and (b) the options re additional lars or full reconstruction.

Contracted to 2015 I believe, so the club will ensure the decision is made carefully with both a potential playing career - but more importantly (as seems to be lost on most) , the kids future with regards to health and well being. One thing we know - he's a t the right club and the best decision will be made I'm sure.

We all seem to forget that Lars was a punt in itself - so us horrible as this outcome is - it's not completely something will be a surprise. Same happened to previous Lars footballers like Roden and Malceski. Problem is - this kid has more talent than all of them put together.

The only positive I take from this is his age - 21. Tom Lonergan had no right to play again but he beat the odds and played in a premiership ................... let's hop Menzel gets that chance.

 

[MrRockett24]

Comeone...surely someone has heard something by now.....

 

[topic97]

The Ox did 3 or 4 knees? Might be worth Menz talking to him (for the mental side I mean, and he may already have), I read today he came back and won a B&F... Not all is lost

Just as long as he doesnt pick up any punting tips.....

 

[you pick one]

Comeone...surely someone has heard something by now.....

Don't be so impatient Rockett I reckon this has 12 months to run yet at the very least.

 

[Jimmy Yamazaki]

Scans confirm that Cat Dan Menzel has ruptured his ACL again. Expect a decision on course of action later in the week. From Twitter but not a 100% source..

 

[Willo_]

The worst is confirmed apparently...

My source is twitter.. Will be a matter of minutes until its out everywhere I am guessing

 

[Generalissimo]

F**k

 

[fpm84]

Word has leaked from the club that an ACL is confirmed. Apparently Menz will take a few days off to decide on his future.

 

[sauron256]

F**k

This.

 

[Crhferrari]

NO NO NO NO NO NO NO!!!!!!!!!

 

[footscore]

poor guy. Wish him the very best for the now and his future plans.
Helped make the game exciting again, even though it was only for a brief moment.

 

[BUSTER29]

To put it plainly,
That is ****ed.

 

[MisterMarcus]

 

[JUBJUB]

Andrew Krakouer.

He was still playing footy for the prison team [not a joke]

 

[Pure_Ownage]

Would the footy list gurus know if:
1. DM is uncontracted next year, and
2. if there is anything to prevent us delisting him and signing to a rookie contract next season?

Signed for 3 years when drafted (10, 11, 12), then signed a 2 year extension in 2012 taking him through til the end of 2014. Given that, and the fact CS made clear in recent comments that we would stick by him if it went again, I think there's little doubt Menz will stay on our (senior) list in 2014. The club will stick by him, it's only a matter of whether he wants to give it another go or not, and hopefully he does. Must be a very tough time for him.

 

[Topper]

Very sad

Maybe he should consider going down the Egan path. Concentrate on a career in coaching

 

[you pick one]

I think deep down we all knew this bit,It's where we go from here that's holding my attention at the moment,the poor bugger must be shattered.
I expect there will be lots of people consulted and a lot of soul searching done before he makes a decision on his playing future.

 

[_Me_]

He was still playing footy for the prison team [not a joke]

Should we start something uplifting for all wishes

As he will be having doubts etc and it would be great if a acebook page or something was setup for everyone to contribute and help lift his spirits

great if the team could dedicate winning the premiership this year to him

 

[_Me_]

Very sad

Maybe he should consider going down the Egan path. Concentrate on a career in coaching

he is diferent to egaqn, ashe was an artist on the field
think he will want to go again

 

[topic97]

poor guy. Wish him the very best for the now and his future plans.
Helped make the game exciting again, even though it was only for a brief moment.

Ditto.
Got to feel sorry for the poor bloke.
At least we know our great club wont leave him out in the cold & will throw all our resources at him to make sure he both gets the knee right & gets in the right headspace.

 

[dazbroncos]

Worst news possible. Menz should be given time and space to get away and think it over. Club should offer every option to him. And if that means traditional acl reco and 12 months off the game then. So be it. His ethic has been unconditional to this point so I have no fear paying him his due and money to be off - even if he walks away from it in 12 months time.
After all - it is a business sure but we are Geelong- and we take care of our own. If Maxy can go to Germany then Mendel gets his choice.

Personally - just ****ing gutted - I hope he gets the space he needs rather than a scrum everywhere he goes.

Go Menzel...

 

[MrRockett24]

The worst is confirmed apparently...

My source is twitter.. Will be a matter of minutes until its out everywhere I am guessing

OH NO!