With Mauricio “Shogun” Rua’s upcoming fight against Brandon Vera, the shadow of Shogun’s multiple ACL surgeries still looms over him. It’s unclear exactly how many surgeries Shogun has had, but it seems that he has had at least 2 surgeries to repair an ACL tear or rupture. MMA ACL injury is a common surgical injury and the surgical outcomes and decision-making process could affect your MMA or combat sport.
The ACL, or anterior cruciate ligament, is one of two ligaments that crisscross in the middle of your knee. The knee is basically composed of the femur (thigh-bone) on the top, and tibia (shin-bone) on the bottom, with the patella (knee-cap) in the front. The ACL acts to prevent the tibia from moving forward away from the femur and is most important for sudden movements like cutting or twisting.
Unfortunately, MMA ACL Injury where the ACL tears completely means it can’t heal or grow back on its own. And if you plan on continuing in sports, you will need it “reconstructed” – which means replacing it with a new ACL graft created by a surgeon. The main categories that most people don’t understand but can have significant outcomes on their surgery are: 1) Graft Choice 2) Surgical Technique 3) Rehab.
What graft you and your surgeon choose after an MMA ACL injury can have different potential outcomes depending on the type of graft selected. This is something that has been and will continue to be debated by surgeons. Traditionally, for ACL tears most surgeons would take a tendon from your patellar tendon, which is where your quadriceps runs over the top of your patella (knee-cap) and attached to your tibia (shin-bone). You can feel it if you bend your knee and feel just below your patella. When this graft is used, a piece of bone is taken out of the patella and another piece is taken from your tibia with a strand of patellar tendon in-between. This graft is thought to have the easiest chance of it healing where the ACL used to be since it has bone on the end and bone tends to heal better to bone than tissue heals to bone. Unfortunately, a common side effect is pain over your kneecap, especially when you kneel down, which is something grapplers do all the time. The other issue is that there may be some quadriceps weakness, which are the muscles that straighten your leg, so theoretically this could weaken the “snap” of your kick
Another graft option for a complete ACL tear is to use part of your hamstrings, which are the muscles behind your knee and help to bend it. This avoids all the pain from the front of knee, but as you might guess, it can weaken the strength of bending your knee. Unless you are using the back of your knee to choke someone out, I am not sure how this would really affect your MMA game. In addition, it doesnt’t have bone on the ends of the graft so it may not heal as well to the femur or tibia.
The third option after complete MMA ACL injury is to use an allograft, or a cadaver ligament. Different ligaments can be used depending on what the surgeon prefers. This method avoids all the pain of harvesting the graft from your own body (which is the most painful part of the surgery) and can make your rehab easier. The down-side is that there is a risk of disease transmission, but I think that in today’s age this is something like one-in-a-million (don’t quote me on the specific numbers). Another down-side is that since it’s not your own tissue, it may not integrate as well as your own tissue and thus may have a slightly higher chance of failing. This may not be the best choice for a younger, elite athlete.
The next thing that may affect your outcome is the surgical technique. This is something that is completely up to your surgeon. Basically, it’s how they drill the holes in your bones and pass the graft into your knee. In the old days, the tunnels were put more straight-up and down; nowadays, most surgeons change the angle to a more “anatomic” angle.
The final thing that you must face is your rehabilitation. ACL injury rehab is not easy. The first thing to do is focus on your hamstrings and then work your way up to your quads. The quads are the first to go even before surgery, so it’s important to keep up your quad strength before and after your surgery. You should be walking pretty normally without a brace by 3 months after your surgery and by 6 months doing some light jogging. By 9 months to 1 year you could ideally get back into your sport, but keep in mind that some people only get up to 80% of their original quad strength back after ACL surgery.
Which brings us back to Shogun’s upcoming fight against Vera. Shogun has had not only one surgery for an ACL tear, but also a second one which makes the chance of it failing even greater. In addition, he likely will never reach the same level of strength he had before his surgeries. Back in Pride, Shogun was known for his devastating kicking power. Unfortunately, we will never have the Shogun from Pride fighting in the UFC, but so far the Shogun we have seen has done pretty well. Even recently, ESPN’s Sport Science measured his kicks at an amazing 2749 pounds of force! Brandon Vera, however, is known for his striking ability, and ACL surgery can limit your ability to move laterally out of the way of oncoming kicks. On his feet, Shogun’s clock is ticking thanks to his injuries and surgeries. For Shogun’s sake, let’s hope his knees outlast his UFC career.
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