During the opening bout of the main card of UFC on Fuel TV 5, Duane “Bang” Ludwig, an MMA and Muy Thai veteran, collapsed with a knee injury. MRIs later revealed both a ruptured ACL (see ACL article) as well as torn menisci (plural for torn meniscus). FightMedicine spoke to Duane about his old injuries as well as his newer injury. Previously, we explained ACL injuries. Today, we will explain more about meniscus injuries, as they are even more common than ACL injuries in sports.
FightMedicine.NET: Can you tell us what injury you suffered at UFC on Fuel TV 5?
Duane “Bang” Ludwig: I suffered a torn ACL and torn meniscus in my knee. (For the ACL sugery) I’ll be using my own patella graft. This is my first knee surgery. With the meniscus repair, no weight bearing is allowed, but I start physical therapy for range of motion. My ACL surgery is scheduled for December 19th.
The top image shows a tear in Duane’s torn meniscus next to the metal probe. The bottom image shows what a more normal part of the meniscus should look like.
What would you say was the biggest injury you have sustained during training and how did you deal with it?
A completely broken jaw while sparring.
What was your doctor’s role in treating your injury?
I underwent surgery with a plates and a few screws.
Do you feel any lingering effects?
My jaw is a little misaligned
What would you say is the most common, but not mentioned training injury?
The tear in Duane’s meniscus is being pulled together and repaired with sutures
How can they be prevented or treated?
Double up on the shin pads
Do you have any advice on preventing injuries in MMA or training?
Take care of one another. It’s all about building skills so you can perform in the cage. It’s not about being the toughest guy in the gym.
What are the major differences in injuries in Muy Thai vs MMA?
The legs get a bit more beat up in Muay Thai.
What advice to you have for upcoming fighters in terms of trying to keep their career as long as possible?
Be smart and allow time to recover and repair the body.
Is there anything that a fighter is experiencing during the fights that the people at home can’t appreciate?
Haha. A lot.
What helps get you back on your feet and ready to fight quicker?
The above image shows Duane’s ACL ruptured from its attachment on the femur. The reddish round structure in the middle is the part of the ACL that has pulled off the femur.
Previously, we have discussed ACL injuries and the various graft options. Duane’s doctors chose to use the patellar tendon graft, which is considered the “gold standard”, although many surgeons are using hamstring tendons as well.
Duane also tore the meniscus in his knee. There are two menisci in the knee. The medial, or inner one, and the lateral, or outer one. They are large C-shaped rings of cartilage that act as shock absorbers in the knee. They also help the rounded ends of the femur (thigh bone) interact with the flattened top of the tibia (shin bone).The medial meniscus also acts as a secondary stabilizer of the knee when the ACL is ruptured.
The vast majority of times a torn meniscus can be treated arthroscopically, meaning with small camera and instruments through small incisions (called portals). He surgeon uses an arthroscopic shaver to shave down the flap of meniscus to a smooth border. This will usually take care of the pain in the knee unless something else such as cartilage damage and arthritis are also causing knee pain. Shaving the meniscus may also predispose someone to arthritis down the road, but leaving the meniscus alone will cause continued pain, and the initial injury may also have damaged cartilage so the resulting arthritis may not even have been from the meniscus shaving anyway.
Only the outer third of the meniscus receives a blood supply, so tears outside of this area cannot be repaired and must be shaved. However, if the tear is in the right place, the right orientation, and in a young patient, the meniscus may be repaired using sutures. The blood supply gives the tear a chance of healing by bringing reparative cells to the injury site. Still, however, some of these may fail.
Duane’s doctors chose to repair the torn meniscus first and limit his motion so that the repairs have a good chance of healing before reconstructing his ACL, since ACL surgery requires a lot of therapy and motion post-operatively. However, many surgeons will choose to repair the menisci at the same time as the ACL since the blood stirred up by drilling the bone tunnels for the ACL reconstruction may actually help the meniscus repairs to heal.
We would like to thank Duane for supplying us with his arthroscopy pictures and wish him luck in both his current recovery process and his upcoming ACL reconstruction!