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Reviewing Sidney Rice's Torn ACL, Concussion and Road to Returning in 2014

ATLANTA, GA - JANUARY 13:   Sidney Rice #18 of the Seattle Seahawks reacts during their NFC Divisional Playoff Game against the Atlanta Falcons at Georgia Dome on January 13, 2013 in Atlanta, Georgia.  (Photo by Streeter Lecka/Getty Images)
Dave Siebert, M.D.Featured ColumnistOctober 30, 2013

Monday Night Football did not treat Seattle Seahawks wide receiver Sidney Rice well.

After an unclear knee injury forced Rice to leave the game, the situation only became worse the next day.

First, The Everett Herald's John Boyle reported that head coach Pete Carroll said Rice had concussion symptoms. Later, Pro Football Talk's Twitter account announced the wideout also sustained a torn ACL during the game.

The NFL community certainly hopes for nothing but a full and speedy recovery.

That said, while the torn ACL will end his season, the concussion is also very concerning. A closer look at each helps make clear what lies ahead.

 

Examining Rice's Concussion and Concussion History

Boyle mentions Rice suffered two concussions in 2011 that forced the Seahawks to place him on injured reserve. He also sustained one in 2010.

As a result, Monday night's concussion symptoms—implying a concussion—marks at least the fourth such injury of his career.

Why does that matter?

Generally speaking—and depending on to whom one speaks—current theory holds that repeated concussions may make subsequent concussions longer lasting. Each concussion may also make it progressively easier to suffer another in the future.

That said, the word "may" in the above paragraph is an important one.

Each athlete, concussion and recovery are unique.

In other words, what holds true for one athlete—such as Kevin Kolb's most recent concussion reportedly threatening his career—does not automatically transfer over to another.

Concussions are reportedly threatening Buffalo Bills quarterback Kevin Kolb's career.
Concussions are reportedly threatening Buffalo Bills quarterback Kevin Kolb's career./Getty Images

Then again, heartbreaking situations like Kolb's are not uncommon either.

Over the coming days and weeks, the outstanding Seahawks medical staff will monitor the resolution of Rice's symptoms, motor function and cognitive status.

Eventually, the concussion should abate with time as well as physical and mental rest.

Once it does—which can require anywhere from days to weeks, months or longer—Rice can work on formulating a plan going forward into 2014.

 

The Dreaded Anterior Cruciate Ligament (ACL) Tear

According to ESPN.com's Kevin Seifert, NFL athletes are tearing ACLs in 2013 at an unprecedented rate.

Why?

The answer is likely multifactorial and includes—but is not limited to—factors such as differences in training, faster athletes, rule changes and sheer bad luck.

Unfortunately, that bad luck extended to Rice on Monday, and surgery likely looms on the horizon. ACL tears almost always require surgical reconstruction.

The ACL, highlighted here by the red circle, is one of the four main stabilizing ligaments of the knee.
The ACL, highlighted here by the red circle, is one of the four main stabilizing ligaments of the knee.

During ACL repair surgery, doctors usually harvest a piece of the patellar tendon—the part of the knee a doctor hits with a reflex hammer—and use it to replace the torn ligament.

Over the next months and years, the body actually transforms the tendon into tissue more closely resembling the native ligament through a process called ligamentization.

Rehabilitation, on the other hand, can require anywhere from eight months to well over a year.

A quick, unscientific survey of the league comes up with an average of nine to 10 months of recovery following recent ACL repairs, thereby projecting a return for Rice by approximately late August 2014. However, that same survey finds extremes on both ends, demonstrating the true variability of recovery times from athlete to athlete.

The above photograph shows one of the many movements made impossible by a torn ACL.
The above photograph shows one of the many movements made impossible by a torn ACL.

Following surgery, Rice will likely begin a slow, steady protocol of progressively intensifying range-of-motion, strength and agility exercises.

His innate, genetically predetermined healing ability and, just as importantly, will and determination are the most important determinants of a successful rehab.

If recent history holds true, there is no reason to expect anything but.

Whereas the ACL tear used to significantly alter or even end athletic careers, advances in surgical technique and rehabilitation sciences are making favorable outcomes more and more likely with each passing year.

 

Bottom Line

It's not very often that an athlete with a significant concussion history sustains yet another during the same game he or she tears an ACL.

Which injury hurts Rice more?

For now, it's far too early to say. The ACL is much more visible right now, but the concussion may prove more concerning in the long term.

Regardless, one thing remains certain—football aside, the Seahawks wideout is facing quite the uphill battle to return to his previous state of health and well-being.

Yet with any luck, he'll get there.

After all, isn't that what truly matters?

 

Dr. Dave Siebert is a resident physician at the University of Washington. Find more of his written work at the Under the Knife Blog.

For more injury discussion and questions:

Follow @DaveMSiebert

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