So Logan Paul apparently injured himself battling Roman Reigns in his match against the WWE
universal Champion at Crown Jewel in Saudi Arabia.
B1: table jump
By now, there are a number of physicians that have described the injury, and how it occurred.
BX: screen capture of following channels
Brian Sutterer Fantasy Doctors
Matthew Harb Bone Doctor
This is not that.
In this video, I am going to talk about what happens next for Logan Paul, assuming that
his injuries are as described–
B2: Logan listing injury
and what this means for his future in the WWE and other martial arts.
B3: we fine, week max
As a knee specialist orthopaedic surgeon, this is what I fix every day, so today you,
and Logan, are gonna learn.
So this is how it went down:
Video of Charles calling me to tell me about the injury
Video about me looking up Logan Paul injury.
B4: Logan jump angle 2 IMAGE: Main Twitter Pic (add a sound effect
that signals we’ve arrived)
OK, so now that we are up to speed.
Let’s talk about what happens right now.
In the immediate short term, Logan will need to have confirmation of the diagnosis of his
suspected injury.
In his twitter post, he stated that he was diagnosed with
IMAGE: Main Twitter Pic (show image to the side and list injuries to right)
an acl tear, MCL tear, and likely meniscal tear.
If true, this is a combination about which you may have heard in the past, the terrible
Triad of O’Donoghue.
B5: Terrible Triangle
Classically, O’Donoghue described this triad of injuries to involve the ACL, MCL, and the
medial meniscus.
B6: force through here
However, a study conducted in the 1990s determined that the more common presentation involved
the ACL, MCL, and the lateral meniscus.
The knee is a hinge joint allowing the leg to extend and bend back and forth with minimal
side-to-side motion.
It consists of 4 bones and an extensive network of ligaments to help maintain normal function
(https://www.physio-pedia.com/Knee).
The ACL is the main stabilizer preventing the femur, or thigh bone, from falling off
the back of the lower leg, while the MCL is the main stabilizer on the inside of the knee,
preventing the knee from opening up like a clam shell.
THe menisci, medial and lateral, are cartilage structures that behave like shock absorbers
on the inside and outside of the knee, respectively.
Getting back to Logan,
B7: Knee MRI (DJ, play while Chris talking– mask Logan’s face onto the guy getting a
knee MRI.
Whichever 7 seconds makes most sense.
he will obtain an MRI to verify that this is the combination of injuries that has occurred,
and that no other serious injuries have occurred that might require surgery.
Once his diagnosis has been confirmed, Logan and his physician will discuss a course of
action best suited to the combination of injuries he has suffered.
Generally speaking, the choices include non-operative and operative treatment.
Yes, I did say non-operative treatment.
B8: surgery is not necessarily
Non-operative treatment would include an extended course of physical therapy that would progress
from management of inflammation and swelling, through establishment of knee range of motion,
to restoration of strength and knee proprioception, before eventually returning to competitive
sport.
B9: non surgical treatment may be best…
(this is too long, but see how you can use it…)
B10: Logan highlights – the juxtaposition of the woman saying don’t engage in high
risk activities followed by logan flying around
While this an “option”, proponents of a non-surgical approach should slow their
roll a bit.
Although some studies suggest that non-operative treatment is adequate for normal knee function
after ACL injury, only a small percentage of patients will be able to return to a similar
level of activity as before their injury, after completion of a course of non-operative
treatment.
Patients who find success after this aporGiven the level of activity to which Logan seeks
to return, I doubt that this will be sufficient for him.
B11: More logan highlights
Which leads us to the other option.
Most high level competitive athletes will elect to proceed with an operative course
of treatment for their ACL injury.
And yes, while there are other injuries that are present, the ACL tear is the injury around
which we focus our treatment.
Of the injuries present, it is the one whose repair is the most complex and takes the longest.
Once decided to treat his injury operatively, Logan and his surgeon will have to decide
which graft to use for his reconstruction.
Here, there are 4 choices:
IMAGE: Logan Leg Kick (point to these locations on Logans body)
the hamstring tendons, the patellar tendon, the quadriceps tendon, all of which are autograft
coming from the patient, and an allograft tendon, which comes from a donor.
Each has its own advantages and disadvantages.
Generally speaking, autografts, grafts taken from the patient themselves, are more favourable
than allografts, or grafts taken from a donor.
These would be preferred for Logan’s treatment.
Hamstring and patellar tendon grafts are by far the most common choices of grafts used
for ACL reconstruction.
Hamstring grafts can be harvested from the back of the leg, in isolation (the semi tendinous),
or in pairs (semi tendinous and the gracious).
Patellar tendon grafts are harvested from the front of the knee just below the knee
cap, most times with attached bone at one or two ends.
Both grafts offer similar functional outcomes, but patellar grafts are slightly stiffer,
and have a slightly reduced chance of rerupture.
This comes at the price of an increased chance of post-operative knee pain after recovery.
While the frequency with which these grafts are used is comparable, the patellar tendon
tends to be used more frequently with professional athletes as a result of the attached bone
segments which optimize graft attachment in the tunnels.
Quadriceps tendon grafts are a newer option that can be harvested from the front of the
knee just above the patella.
This is an all soft-tissue graft that has a similar functional outcome as the other
two autografts, but offers the stiffness of the patellar tendon graft without the post-operative
anterior knee pain.
Being a newer option, it has less studies that speak to its longevity, but it is certainly
becoming a more frequently selected option.
Once the graft has been selected, Logan will undergo an ACL reconstruction by his surgeons
favored approach.
Generally, this is an arthroscopic procedure where the graft is harvested and prepared
to look like a ligament.
Tunnels that will receive the tendon graft will be prepared in both the femur and the
tibia.
The graft will be guided into the femoral and tibial tunnels and will be secured on
both ends, by screws, cortical buttons, or both.
The meniscus will be examined and repaired if possible using one or more techniques.
Repairability of the meniscus is determined by the type of tear that is present and its
location.
Tears that are the most repairable are simple or horizontal tears that are in the red-red
zone, an area of the meniscus that has robust blood supply.
There are several techniques that can be used to repair the meniscus, but all-inside meniscal
repair implant devices are most commonly used.
Typically, the MCL is not surgically repaired for most patients unless there are additional
injuries or alignment issues that mandate this repair.
After his reconstruction, is when the hard work will begin.
Recovery from an isolated MCL injury without surgery would take 3-4 months before training
would be possible and up to 6 months for serious competition.
Recovery after ACL surgery, on the other hand, is a much more involved process and full recovery
would be on the order of 9-12 months.
B11: Highlights again (while chris talks)
However, even after “full” recovery, we can expect it to take from 18-24 months before
Logan returns to his prior level of athletic performance in the Ring
With that in mind, here are some tips for exercises he may perform during his rehabilitation
that will optimize his recovery.
1.
Restore full extension first.
This means symmetrical knee extension to the uninjured side.
Without this, everything else becomes harder including walking, running, and obtaining
a full range of motion of the knee.
B12: knee extension rice
Normally my go to exercise for this is seated weighted knee extension using a bag of rice.
I advise 20 lbs for 20 min twice a day.
2.
Bent knee isometric single leg holds to encourage reactivation of the quadriceps muscle and
to promote development of the VMO portion of the quadriceps.
You should work to progress time in a bent knee position.
Aim for 60-120 second holds.
As your time of hold increases, advance the difficulty level by bending the knee further
while balancing.
Do this exercise a minimum of three times weekly.
3.
Use single leg, closed chain strengthening exercises to restore symmetrical strength
and muscle bulk for the operative leg.
Suitable exercises include step-ups, touch downs, lunges, leg press, or single leg squat
variations.
Use these exercises two to three times weekly.
Always position your knee over the outside edge of your foot while performing these exercises.
Dynamic valgus is bad, and you don’t want to promote it during your rehabilitation.
Do these exercises three [times weekly.
4.
Include integrated balance, direction change, and proprioception neuromuscular training
to restore this functionality in the brain, and minimize future recurrences of injury.
Start these exercises in the mid- to late portion of your rehabilitation, after the
graft has had time to attach to the bone around it, and after full range of motion, and functional
strength have been restored.
Do these exercises a minimum of three times weekly.
5.
Include plyometric hops and jumps to prepare for a return to competitive activities that
include jumping, pivoting, and direction change.
You should start out with stationary vertical hops first and master landing mechanics and
control in the coronal plane before adding lateral and horizontal hops.
Use the same rules for knee position on take off and landing that you use for single leg
strengthening and single leg balance.
6.
Knowing when to return to sport after ACL reconstruction is a decision that is made
jointly between you, your surgeon, and your therapist.
In the past it was a time-based decision, but studies now show that athletes who return
to sport later than 9 months after surgery fair better with less change of re-injury
than athletes who return to sport sooner than 9 months.
Determination of readiness should be based on objective criteria from an established
protocol such as the Melbourne 2.0 Acl Rehabilitation Guide.
And once he is actually back in the ring, what can we expect in terms of success after
surgery and the likelihood of reinjury in the future?f
A 2016 paper in the American Journal of Sports Medicine looked at primary risk factors in
reinjury after ACL reconstruction.
This was a meta-analysis of 19 other studies between 1966 and 2015.
The authors found that the overall rate of re-injury after an ACL reconstruction was
15% with 7% to the same leg, and 8% to the other leg.
For those younger than the age of 25, the risk was even higher at 21%.
In addition, the rate of re-injury for those athletes who returned to sport was 20% (Simple
decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo
ACL cohort study).
That sucks, and to be honest, nobody wants that.
BX: Ain’t nobody got no time for that meme
So it will certainly be worth his while to take his rehabilitation seriously, follow
instructions, and invest as much time as possible in to his recovery if he wants to get back
to competing in the WWE in a reasonable time frame.
Now I’m sure Logan will have access to the very best doctors, physios, etc to help with
his journey but perhaps I can add something that he hasn’t yet heard.
In the very least we can use this as a teaching moment for anyone else in his position who
doesn’t have that sort of access to the best healthcare.
If you’ve suffered a knee injury yourself and you are looking for online resources to
help you with your rehabilitation, don’t forget to check out our Knee Health playlist
over on Human 2.0 Fitness here on YouTube.
I will leave a link in the description down below.
If you like the video, be sure to subscribe and send it to someone who needs to hear this.
If you didn’t, be sure to let me know why down below.
Outro