Injury Breakdown: The ABCs Of The ACL and MCL

by Abby Sims

Duke's Blue Devils emerged victorious over Butler on Monday to be crowned NCAA Champions, though Butler now occupies an elite position on the college basketball map. However, the Butler whose NCAA story ended far more disastrously than with simply losing the big game was West Virginia's Da'Sean Butler. The senior combo forward and Mountaineers leading scorer went down with a knee injury while driving into Brian Zoubek on his way to the basket with 8:59 remaining in the second half of the semifinal against Duke.

Anyone who saw the play and of course, the slow-motion replay, could see the pain that Butler was in, likely from the injury itself as well as the timing (not that there is ever a good time for a major injury). It isn't likely that the Mountaineers would have won the game had Butler remained intact, but this injury may have derailed more than his hopes for a championship. Butler's blown out ACL may have cost him millions by driving down his stock as a possible first round selection in the upcoming NBA draft.

Coach Bob Huggins initially indicated that Butler had sprained his left MCL (medial collateral ligament). However, West Virginia's Sports Information Director later announced that an MRI performed on Sunday revealed an ACL (Anterior Cruciate Ligament) tear as well as two bone bruises in addition to the MCL sprain. It seemed apparent from the moment Butler planted his left foot and his knee gave way that this was more than a mild sprain.

What is the ACL?

The Anterior Cruciate Ligament is the primary stabilizer of the knee. It is located between (and attaches) the rear outer base of the femur (thigh bone) and the top of the front inner tibia (the larger of the two bones in the lower leg). It is called the anterior (front) cruciate because it crosses another ligament (the posterior cruciate) that is located behind it, with the two ligaments essentially forming an "X". The role of the ACL is to prevent the top of the tibia from gliding forward. When torn, this motion is not checked and the knee becomes unstable, often buckling.

What is the MCL?

The Medial Collateral Ligament also connects the femur to the tibia but at the inner, or medial compartment of the knee joint. When Butler went down it appeared that his knee buckled inward, permitting excess motion at the inner joint (the foot and lower leg angled outward). This would be indicative of an MCL injury.

What is a bone bruise?

Muscles, nerves and bones can all suffer bruises, which are also known as contusions. Contusions occur because of trauma associated with impact, and the severity of that impact is one important determinant of the degree of injury and rate of recovery. Simple muscle contusions generally resolve in a matter of weeks, and the healing process involves muscle repair, regeneration and scar-tissue formation. All contusions result in localized inflammation as well as pain and they may also inhibit muscle strength. Nerve contusions can precipitate neuralgic symptoms, while bone bruises can be particularly debilitating as well and some studies indicate their relationship to arthritic changes over time.

The specific location and type of bone bruises suffered by Butler were not clarified in reports of the injury. Though they may have resulted because of the impact against Zoubek (in this case they would likely be more superficial) they may also have occurred at the bony surfaces of the knee joint in the course of tearing his ACL. When an ACL injury occurs, excess or abnormal motion (of one bone on the other) is permitted, allowing the bones to bump into each other, resulting in a contusion. The MRI was an important diagnostic tool used to identify the nature and extent of Butler's injuries, and if he suffered this type of contusion, it likely demonstrated abnormalities in the bone deep to the smooth cartilage that lines the joint.

Da'Sean Butler will have surgery soon and has a long road of aggressive rehab ahead. Therapy will focus on controlling any inflammation and swelling, restoring range of motion, muscle strength and flexibility, balance, and ultimately on movement, agility and plyometrics (jumping, etc). At the same time he will work to maintain his cardiovascular endurance.

According to NBADraft.net, Butler is ranked as the 21st-best prospect in the 2010 NBA Draft, while DraftExpress.com has him as 44th in line. In a mock draft that was updated after the injury, DraftExpress had Butler as the 14th pick in the second round. He was interviewed during the championship game yesterday and expressed confidence that he will play in the NBA next season. With a great attitude and work ethic, the advances in surgery and rehab today, and with youth on his side, it is very likely that Da'Sean Butler willachieve his dream.

Abby Sims is an orthopedic and sports physical therapist who has been in private practice in NYC for the past 30 years (you may be familiar with her husband, sportscaster & WFAN alum Dave Sims). Abby has a Masters of Science in Physical Therapy from Duke University and has extensive experience working with professional, collegiate and recreational athletes with musculoskeletal injuries – both non-operative and operative. She has also enjoyed lecturing at many medical conferences. Abby looks forward to responding to your questions or writing about topics that you suggest. For more information about Abby, or her practice,please check out www.RecoveryPT.com as well as www.AthletiSense.com.