WHENEVER a player battles back from a serious knee injury, they are usually at pains to explain why they are better than ever.
“I'm stronger, definitely more powerful,” said Dexter Blackstock in 2011, twelve months after rupturing his anterior cruciate ligament.
“I can jump a lot higher now than I ever could before. I'm at least as fast and maybe even faster than I was before. In theory, at least, I've come back a better player.”
Yet three years on, the 28-year-old has managed just one full season and spent the last nine months on the sidelines with another – albeit unrelated – knee problem.
And he isn't the only one to suffer fresh trauma. This week, Brighton confirmed that midfielder Andrew Crofts would miss the rest of the season following a second ACL injury in the space of ten months.
Nottingham Forest captain Chris Cohen was even more unfortunate. Having ruptured the ACL in his right knee during a match against Derby in September 2011, the 27-year-old midfielder then suffered the same injury to his left knee in November 2013. Two weeks ago the right knee buckled again, ironically against Derby.
“It's devastating for Chris,” said Forest assistant-manager Steve Wigley. “You can't put into words how unlucky he's been.”
Yet is it really no more than the cruel hand of fate? Can it possibly be that a relatively rare injury can strike the same player three times by pure chance? Unfortunately, it seems not.
During the 2001 season, a study was carried out in the Swedish top flight in which players with a history of ACL injuries were compared to those without.
The results were stark. Of the 24 players who had suffered an ACL injury before, 50 per cent sustained another knee injury, compared to just 21 per cent of the 286 ‘healthy' players.
Overall, a previously injured knee was 7.9 times more likely to be afflicted by an overuse injury and 2.7 times more likely to suffer a ‘traumatic' injury – ie, a reoccurrence.
A study of college footballers in the USA discovered that 75 per cent of players who underwent a second ACL reconstruction did so in the opposite knee – as was the case with Cohen.
So what's going on? Some argue that a return to full-contact sport can overload tissues that haven't fully healed. Others that the initial injury causes permanent alterations in the way the knee moves. Yet more that simple over-exuberance – a desire to return to one's best – is the culprit.
But according to Frank Gilroy, a renowned knee specialist at Glasgow Sports Surgery, the answer could be much simpler.
“I've seen so many of these injuries and, to me, it's all about your tissue type,” he said. “If you look at female footballers, they've got a really high incidence of ACL. Some argue that is to do with the pelvic position and the way their legs fold in. But it's also to do with the fact that they are more ‘floppy' – their joints and tissues are more flexible and prone to hyper- extension.
“If you translate that to men's football, some players are more ‘floppy' than others, making them more likely to have an ACL injury.
“The good news is that having an injury doesn't make it more likely that you'll have a reoccurrence. The bad news is that the way you're built probably will.”
Which explains a lot – but is probably of little comfort to the likes of Cohen and Crofts.
