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Because players often have to wait a day before an arthroscopy or MRI can be performed and a diagnosis confirmed, they have some time to hope for the best. No player imagines the worst. "My first reaction when they told me what it was, was shock," says Price. "I thought, This is the worst thing you can have."
After a player hears the worst, he's left with two questions: Can the ACL be fixed? and, Will I ever be the same player again? The answers are usually yes and no, respectively.
Most of the body's ligaments can be sewn together after they've been torn. Tears in the collateral ligaments, which run along the sides of the knee, can be repaired this way. The ACL, however, is wedged between the tibia and the femur, within the joint, where it's bathed in a lubricant called synovial fluid. If an ACL were sutured together, some doctors believe the synovial fluid would prevent it from healing. Also because of its confined position, a stitched-together ACL would never fully regain its blood supply.
Thus, because the surgeons can't sew the ACL back together, they must find something to replace it—usually a strip of tissue from somewhere else in the body. In King's case, Dr. Norman Scott, the Knicks' team physician, used a stretch of the tough sheath that runs from the hip to the tibia along the outside of the thigh muscles. Although it was astonishingly successful for King, that technique isn't used very often anymore.
Besides Dawkins, whose knee was repaired using a technique similar to the one used on King, virtually every NBA player who has had an ACL reconstruction in the last three years has had a patellar-tendon graft. The patellar tendon connects the kneecap (the patella) to the tibia below. (Another tendon connects the patella to a thigh muscle above.) Through a 3-inch incision in the knee, the surgeon removes a band—about 3½ inches long and⅜ of an inch wide—from the patellar tendon. Then, while peering through an arthroscope, he places the tendon between the tibia and the femur and screws it into place, replacing the ACL. Says Lombardo, who performed a patellar-tendon graft on Manning and Krystkowiak, "What we put in there is similar to the ACL, but it's not exactly the same. It simulates, but it doesn't duplicate."
In time, one study has found, the body mysteriously transforms the tissue of the grafted tendon into ligamentlike cells. And in another example of anatomical wonder, until blood supply returns to the area, the synovial fluid that normally retards healing nourishes the graft.
When performed on young people-most of the members of the ACL club fit into this category—the patellar-graft procedure is successful more than 90% of the time. Its most common side effect is patellar tendinitis, or "jumper's knee." Because the patellar tendon that remains in its original place after the surgery is only three quarters of its normal width, it sometimes becomes irritated. So the drawback of the patellar-graft procedure is that it may leave players with two injuries to recover from—one suffered on the basketball floor, the other on the operating table.
Doctors have tried many other ACL-reconstruction techniques. In one the damaged ACL is replaced by a ligament or tendon from a cadaver. The risks are that the body will reject the foreign tissue or that the transplant could transmit an infection from the dead donor to the living recipient.
In another procedure, artificial ligaments made of Gore-Tex have been implanted. But they loosen up a few years after surgery or, worse, they break, as often happens with pro athletes. Says Lombardo, "There was a rash of enthusiasm for these techniques. But the best tissue is your own."
A damaged ACL doesn't have to be fixed—players are now competing successfully in the NBA with damaged ACLs. Anthony Daly, the Clippers' team physician, says, "You can lead a normal life without an ACL, but you can't play a cutting sport like basketball." San Antonio Spur forward Sean Elliott tore part of his ACL when he was only 14. Surgical reconstruction wasn't done at the time because it would have interfered with the growth of the bones in his knee. He still has more play in his knee than normal, but why correct that and take away a year of his promising career when he performs as well as he does?