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Professional evaluation of Reggie Ragland’s partially torn ACL

Learn about ACLs, the grading scale of sprains, and get a likely prognosis for Ragland.

Yesterday’s news that Reggie Ragland has a “partially torn ACL” is certainly not the greatest news for the Buffalo Bills rookie linebacker.

But what exactly does a partially torn ACL mean? What are the implications for this year and for Ragland’s long term prognosis? To answer that, let’s start by examining and defining what the ACL is and the different grades of ACL injuries.

The Anterior Cruciate Ligament, or ACL, runs diagonally from the femur to the tibia, and prevents anterior translation of the tibia on the femur, as well as rotational stability. In layman’s terms, this means the ACL prevents the bottom leg bone from moving forward on the upper leg bone, as well as providing stability with rotation. It links the top and bottom leg bone together, and it is easy to see how injuring this can be detrimental to athletic ability. Without an ACL, people can typically walk and perform low level activities but have a great degree of loss of stability with high level activity. Now, some athletes have managed to play without a functioning ACL, most notably Hines Ward, who played his whole career without an ACL after unknowingly tearing it as a child.

ACL sprains, along with all ligament sprains, are graded on a 1-3 scale. This scale is generally:

Grade 1: The ligament is mildly damaged, slightly stretched, but there is no loss of structural integrity. Normal end point and no increased motion. This is treated conservatively.

Grade 2: Ligament is stretched to the point where it becomes loose, along with partial tearing of some fibers, making it difficult to fully support the knee as it should. This is usually referred to as a partial tear. With this injury, there is typically increased anterior translation, but a firm end point is noted.

Treatment protocols vary depending on the severity.

Grade 3: Usually referred to as a complete tear of the ligament. The ligament split into two pieces, the ligament has lost structural integrity, and the joint is unstable, and no end point is evident. This almost always requires surgical rehabilitation.

From the definitions above, it appears Ragland has a grade 2 sprain. This is a fairly uncommon injury, as the majority of ACL injuries are typically grade 3 full tears. Now, the question will be what course of rehab will be required? This is what his second opinion is trying to determine. They will probably initially try to determine the extent of the injury, not just to the ACL but also the meniscus, as about 50% of ACL injuries also involve the meniscus, other ligaments, or articular cartilage.

The prognosis for a partially torn ACL is usually favorable, and depending on severity, the rehab process can last anywhere from 8-16 weeks, with a likely time frame of 12 weeks, although it must be stressed that the timeline is highly individual and depends a great deal on the extent of the injury. The second opinion will probably be to determine the level of instability, and what rehab protocol is sufficient.

I am writing this before the second opinion is in and before any official word is definitive. But from the sound of things, unfortunately, we may be without our second round pick until well into October or early November, at the earliest.

(Nick is a physical therapist who specializes in orthopedic and sports related injuries. He will be writing some injury-related articles for Rumblings this season. We’ll often refer to him as our in-house injury expert.)