During an indoor lacrosse game in February, Tyler Eshleman sprinted down the sidelines, chasing a ground ball.
Out of the corner of his eye, he saw a defender hurtling toward him from midfield, but Eshleman, 17, didn’t brace for impact.
“I thought he was going for the ground ball,” he said. “It turns out, he was going for me.”
The defender leveled Eshleman with a shoulder-to-shoulder hit, sending him crashing to the turf. Eshleman landed awkwardly, knee-first.
By that night, swelling in his knee severely limited his mobility, so his father, Bryon, took him to the emergency room.
Doctors diagnosed Tyler with a torn anterior cruciate ligament, better known as the ACL.
He’d have to have surgery to reconstruct it, and would miss his junior season of lacrosse and senior season of tennis.
‘Robbing Peter to pay Paul’
ACL injuries are not uncommon for athletes: Each year, Americans suffer about 200,000 injuries to the ACL, which runs through the middle of the knee and is the main source of the knee’s stability.
Of those 200,000, about 100,000 have surgery to repair torn ACLs.
Travis Menge, MD, an orthopedic surgeon who specializes in sports medicine for Spectrum Health Medical Group and is a physician for the U.S. Ski & Snowboard Team, said the ACL is used heavily during sports like lacrosse, football, rugby, soccer and volleyball that require rotational and lateral movement.
“These are all agility sports that require significant cutting, twisting and pivoting, which places force across the knee,” said Dr. Menge, who performed Eshleman’s surgery.
ACL reconstruction surgery, especially in younger patients, typically involves using tendons from the patient’s hamstring, knees or quadriceps to replace the torn ACL with new tissue.
Historically, doctors have used patellar or hamstring tendons, but in the last five to 10 years, more have begun using quadriceps tendons.
Across 15 studies and more than 1,900 patients, quadriceps tendons have consistently shown as good of outcomes as patellar or hamstring tendons, and in many cases, better outcomes when looking at pain, stability and improved functional outcomes over time.
Dr. Menge—as for most of his patients—reconstructed Eshleman’s ACL using his quadriceps tendons.
“Doctors use patellar tendon and hamstrings often because that’s how they were trained and those graft options have been around the longest,” Dr. Menge said. “While patellar tendon and hamstring tendon remain a good option, I believe our recent medical literature demonstrates quadriceps tendon to be better.”
Four months after his April surgery, Tyler is doing remarkably well. Full recovery—including return to sports—typically takes six to 12 months.
“I last saw him June 26, just shy of three months out from surgery, and he had full range of motion, full strength, no pain and excellent stability in his knee,” Dr. Menge said.
Because the quadriceps tendon is bigger than the hamstring or patellar tendons, Dr. Menge said it promotes a faster recovery.
“Another benefit of the quadriceps tendon is it’s larger than the hamstring or patellar tendons, so you’re taking an overall smaller quantity of the tendon and there’s less robbing Peter to pay Paul,” he said.
Eshleman said he’s been pleased with how quickly he’s recovered.
“It’s been four months since surgery, six weeks since I had my last PT visit, and I’m basically back to doing every recreational thing I’d want to do,” he said, saying he’s biking, swimming and running.
“I have very few limits except for competitive and contact sports.”
‘Car is out of gas’
Getting back to nearly full strength took hard work, Eshleman and his providers said.
“We started physical therapy before surgery as part of a prehab sort of deal, and it was one of the most beneficial things I had,” Eshleman said. “Coming back to PT three days after surgery, it was like, ‘Wow, I can’t really do anything I used to be able to do.’”
Physical therapy started out with massages and simple range-of-motion exercises, Eshleman said. Over many weeks, it progressed to jogging, squats and other strengthening exercises.
Tarra Geertman, an athletic trainer with Spectrum Health Medical Group who works with Dr. Menge, said Eshleman’s commitment to the rehab process and his at-home exercise program contributed greatly to his rapid healing.
“It’s really important for patients to buy into the rehab process afterwards, especially with surgeries like ACL reconstruction,” Geertman said. “It’s really important to have a positive attitude and commitment to doing the exercise and strengthening program, and Tyler really excelled at that.”
Dr. Menge described Eshleman as “someone who’s an active participant in their care.”
“He has a very outgoing personality, very driven,” Dr. Menge said. “He’s someone who has been very diligent with his post-operative recovery program, and that’s the biggest thing.”
Eshleman has a take-everything-in-stride attitude. His mother, Chris, said the night of the injury, Eshleman downplayed its significance.
“He sent a text that said, ‘Phone is about to die and car is out of gas. And oh, by the way, I hurt my knee,” Chris recalled.
And even though she was nervous for his surgery, Eshleman had full confidence in the process.
“It’s not the end of world,” he said.
Eshleman said his goal is to play his senior year of lacrosse in Spring 2019.
“That’s the goal as of right now,” he said. “Whether or not I can compete at same level, that’s going to take a little bit of work I’d assume. … But I’m up for it.”