Less than a week after suffering a torn ACL and possible damage to his PCL, Zlatan Ibrahimovic is scheduled to visit Dr. Freddie Fu at the University of Pittsburgh Medical Center. Dr. Fu is well known for pioneering the double bundle technique to repair ACL tears, the method that most effectively restores natural knee movement patterns.
Although the knee is made up of two bands, the anteromedial and posterolateral, many surgeons opt for a single bundle operation that best corrects anterior and posterior instability. Since pivoting can still present post-operative problems in patients who have undergone a single bundle surgery, the double bundle was designed to correct excessive tibial rotation.
Dr. Fu has performed many of his 6,000+ ACL surgeries using the double bundle reconstruction. He has estimated that 5% of ACL tears primarily affect one bundle, meaning that most tears result in damage to both. Since the bundles cross each other from their insertion points on the tibial plateau to the femur, they’re usually injured together. The double bundle operation repairs the ligaments with a graft that closely approximates the native location and size of each bundle.
One complication that can arise from this procedure is impingement of the PCL, particularly if the graft is too large or the ACL insertion points are unusually small. It’s possible of course that Ibrahimovic will need his PCL repaired as well, but Dr. Fu’s approach of mimicking the natural bundle insertion points would significantly reduce the risk of impingement. In addition, Dr. Fu’s experience working with NFL players makes him well suited to customize the optimal approach for Zlatan’s 6’5” frame.
There are limited examples of 35 year old soccer players who have returned to full strength after sustaining an ACL injury. This, however, largely reflects the fact that most 35 year olds are not still competing in the top leagues, let alone scoring 28 goals in a season. French footballer Robert Pires tore his ACL when he was 32, and he went on to play five strong seasons with Villareal afterwards. He even came out of retirement for the debut season of the Indian Super League at age 41.
Ibrahimovic has taken tremendous care of his body to perform at such a high level this late in his career. With a successful surgery and 6-9 months of rehabilitation, he’ll likely be able to suit up for a team next winter. Speculation has already begun regarding his destination, and it’s likely that his full recovery would coincide with the start of the 2018 MLS season.
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