By Walter Broeckx
I just read an interesting article about the injury that Theo Walcott sustained in the North London Derby last weekend. And as it was mentioned in the comment section earlier by one of our readers I think it would be interesting to have a closer look at this.
Now I must warn you that I am not a doctor or a surgeon so I first wanted at first to just copy what the media has reported about this and hope that their information is correct. But I have gone further. Because last year a study was published about this subject by two orthopaedic surgeons from the University of Leuven, the most famous university of Flanders.
When I looked it up I even found a link to the website of the University where they publish this and they also mention that the their study has been published in the Journal of Anatomy. Not really my daily magazine but well…. A link to the website of the University of Leuven can be found if you are interested in this.
http://www.kuleuven.be/english/news/new-ligament-discovered-in-the-human-knee
For those who are not that interested I will try to summarize it a bit.
The two orthopaedic surgeons have published a study in which they stated that they found a rather unknown ligament outside the knee capsule. A ligament that also usually is damaged when the ACL (anterior cruciate ligament) is torn. The unknown ligament is called the anterolateral ligament (ALL), if you are still with me.
Now when the ACL is ruptured (as with Theo) up to now the surgeons fixed the ACL and that was it. But then some people experienced problems when pivoting. Their knee remained unstable and they got new injuries. In technical terms they speak of so-called ‘pivot shift’, or episodes where the knee ‘gives way’ during activity. Not really ideal for top sport people of course.
So when the ACL is fixed but the ALL (the new one) not this would lead to this unstable knee after surgery. So the surgeons Johan Bellemans and Steven Claes have said that surgeons need to make sure that they not just fix the ACL but also should repair the ALL. Don’t ask me how as that is far away from my knowledge. Like I said I am not a doctor.
In the media in Belgium yesterday there was this article about Walcott and where the Leuven Surgeons talked about the injury. And they said that if the right technique would be used and the ACL and the ALL would be both repaired there could still be a chance of Theo being fit in some 4 months time. And that would mean that Theo could still play in the world cup.
Now I must say that I am not that keen on this idea but I am very keen on the idea that whoever does the operation on Theo repairs every ligament that has been damaged.
Now the doctors said that they cannot speak about the Walcott knee situation itself as they are not aware of how the situation is. So they didn’t want to speak about him specifically. But the general idea is that they think that a player that has a complete surgery now could still make it to the world cup. As they said it: If you repair all the ligaments quickly and correct, the chance of a substantially faster, safer and more stable recovery is much higher. They speak of a possible recovery time of less than 4 months.
Just imagine Theo making it for the last game of the season to lift the trophy with the rest of the team?
Now you might say that this is all fine and well but it will not really help us or Theo with what they found in Leuven. But I wouldn’t be surprised that Walcott and Arsenal would take the findings of the Flemish surgeons on board. Because in this article it was also mentioned that there has been made enquiries from within England to the surgeons. So it is fair to say that whoever will decide the treatment and the consequent recovery time might consider the help or use the expertise from the Leuven surgeons.
It probably will not help Arsenal this season. But in the long run having his knee ligaments repaired in the best possible way is important for Arsenal and for him personally.
People who have been reading my articles in the past know that I don’t like Fifa and the world cup. But I do understand that for any professional player it is very important to be at a world cup. Last world cup Theo was injured I think. And now again missing out with an injury would be a big blow for him. So I wouldn’t mind him being fit for the world cup. For Theo. Not for England. But just for him as a person.
I always liked him for his friendly character. He always seems to be a friendly, nice young man, well educated and not a silly type we sometimes see. So if there is one player who deserves to shine at a world cup it is Theo.
And after showing the spuds the score last weekend…he is turning in to an Arsenal legend. Can we get a statue of Theo showing the score outside the Emirates?
Nice work Walter. At the same time, given the large number of our players likely to be on World Cup duty and, from a completely selfish standpoint, I would prefer Walcott not to go and be in a position to start the season in full fitness.
It’s not as if England will win the World Cup in any case…….
Too many risks involved. Long term career is most important and he still has another World Cup in him.
http://www.notanotherarseblog.wordpress.com
No, there is zero chance. That is a good thing. Stop worrying about the World Cup. The real issue is whether he will be fully recovered by the start of next season, which is far from certain. Also, no guarantees he will ever fully regain his pace.
Greg,
Believe me the world cup itself is the least of my worries. Theo stepping on the field in an Arsenal shirt is my worry. And the sooner the better. For him and for Arsenal
Interesting Post, Walter.
I read that article somewhere and at the time it immediately smacked of opportunism by the surgeon involved, but I also hoped that if it was possible that it would give Theo a glimmer of hope.
Today I read that there have been dozens of surgeons who have come forward and offered similar services. Needless to say they have all been told politely but firmly that Arsenal will not require their assistance.
A footballers career depends on his health and fitness and Theo cannot afford to take and risks.
HenryB,
I also read the article from the Scottish surgeon. In this case the surgeons didn’t offer their help. They were asked their opinion by the media. An were asked for their opinion by people from within England.
They didn’t say it was Arsenal who asked their opinion.
I will love to contribute towards a Theo statue outside the Emirates showing the Spuds the 2-0 score. Legend!
I am not disputing what you say.
I was simply relaying the content of an article that I read. Presumably you are not disputing that I read it? 🙂
an Arsenal players coming back from injury early….sounds like a first. The earlier we get Theo back, the better. He has had a lot of bad injuries, just hope he can get back and get a sustained period without injury.
ACLF this morning…quoting from physio room suggest he picks up 5 injuries a year, or 46 since he has been here! And unfortunatley, seems a lot of them have been serious rather than minor niggles. Shame, he really is some player
Gilly,
we could use the money they threw at him as a start? 😉
At the start of the season I thought we might have a campaign, for once bereft of our usual strain of injuries.
But no such luck. No sooner did we top the EPL table than niggling hurts began to emerge.
I only wish an in-depth survey could be carried out at Colney to see whether training, tactics, diet, medical treatment etc could be the cause of an above-average perpetual sick list at Arsenal FC.
Walter,
a propos what we were discussing earlier, Arsene has said the following:
“Arsene Wenger has told Theo Walcott there is no miracle cure which will salvage his World Cup dream.
Arsenal have put a timescale of at least six months on Walcott’s recovery from a ruptured cruciate ligament suffered against Tottenham in the FA Cup.
That prognosis rules him out of Arsenal’s title pursuit and England’s finals campaign in the summer, four years after he was surprisingly omitted from Fabio Capello’s World Cup squad for South Africa.
Walcott has had offers from surgeons who claim he could be back in time for Brazil, but Wenger is sceptical.
“That’s a disease you have everywhere in the world,” he said.
“There are always people who make miracles, but when you make more enquiries they never have surgery with a footballer to prove their statement is right.”
The next few months will show just how valuable Theo is to Arsenal. Probably any other player on the team could be replaced more easily. Theo’s ideal blend of natural pace and acquired knowledge on how to use it out wide and through the middle make him a very rare if not unique asset in the game. Can’t think of anybody as good at any price. I know he’d love to play at a World Cup finals but would much prefer to see him score a hat trick in the final of the 2018 competition when England loose a thriller 3-4 to the Republic of Ireland:)
Perhaps the Community Shield in August would be a good target for a return?
BTW
Has Theo played enough gamed this season to earn a medal when we win the league in May?
Every Gooner on the planet would contribute to that statue, make it happen pleeeeeeze.
Allez les Gunners.
Nicky,
Manure have an injury list longer than ours. Also have you seen the number of Wham players also out for substantial periods?
What would you say is the average number of players injured for Premiership clubs?
Walter,
I saw and read about the possibility too in some other place that I cannot now remember.
What occurred to me upon reading it was that it is not unlikely that the Arsenal Medical people are aware of the cutting edge development in the medical world and are already looking into whether or not Walcott ca take advantage of it.
Nonetheless, the safer and psychologically more helpful position to Walcott and the better position to take for planning purposes for Arsenal, Arsenal fans and England is still to assume the most realistic estimate of recovery time, based on current and established treatment procedures.
Personally, I hope and pray for and shall not be surprised to see Walcott’s name on Arsenal’s team sheet before the end of the season. This may or may not mean that the England coach will deem him fit or good enough to be included in his team for the 2014 World Cup in Brazil.
Walter,
Another matter that have had me bemused is how many who had not rated Walcott’s talent or “footballing brain” are now quoting his stats in 2012/13 and in the few games he had played this season as proof that his loss spells doom to whatever chances we have of winning any trophy this season. They have suddenly discovered how indispensable he is to the but, at the same time, they fail to mention how his contribution in the first half of the season had been curtailed by his abdominal injury and yet, Arsenal had managed to finish the half-season atop the league table. Case in point: Stan Collymore.
For the injury list for PL clubs see http://www.physioroom.com/news/english_premier_league/epl_injury_table.php
Shakabula Gooner (12.20pm),
THANK YOU!!!!!!
It is called revisionism. They never really believed in the guy and would use every little bit of mistake he makes to overly knock him. At the beginning of the season, they were on his back complaining about his lack of goals. Actually, Walcott had his abdominal issue as he was getting into form at the beginning of the season, so our current position is not down to him.
His return has been very productive with 5 goals in 6 games but it sounds shallow to start predicting doom for the team unless something is done to replace the guy. Other players will step up. That is the Arsenal way.
To be honest, those asking for the club to sign someone on the account of Theo’s injury are the same people who only ever sing that song (i.e. #buy, buy, buy #). All they are doing now is use the young man’s misfortune to further their own agenda. I am certain that AW will sign any player that can make the team better if they become available at the appropriate price. I have strong doubts, however, that he will buy anyone on the account of Walcott’s injury as the media and “buy brigade” will like us to believe.
Giroud is back, Ramsey is very close, AOC is back. Arsenal is going to be fine.
It is not in Arsenal’s interests for Walcott to play at the World Cup. So a “quick fix” treatment which may backfire if he broke down at the WC would be a negative. Even with the most optimistic scenarios painted it is hard to see how he could be back this domestic season – and certainly not at full potency. Regarding games for a medal, I recall it used to be 10 (I remember Keown’s late sub appearances!) and pretty sure he has that, without checking.
More broadly, Arsenal always seemed to perform better in the seasons prior to a major championship than after, when they are even more injury-prone. Maybe. League titles in 98, 02 and 04 for example.
So lets seize the moment!
@HenryB,
It’s of small comfort if our sick list is no worse than others. It just seems worse, that’s all, particularly with poor Diaby.
I would love Theo to be fitter sooner rather than later for him more than anything else as I’m sure he wants to go to the World Cup. But if he doesn’t go to the World Cup I’m sure Mrs Walcott will be happy as this will enable him to be present for the birth of their first child.
From a personal view point Theo missing the World Cup is going to be good for Arsenal but that is being a little selfish as an Arsenal supporter.
As to replacements. I don’t think that a Walcott replacement as such will be be signed – again, just my view but I do think Arsenal need another centre forward. I’ve been saying that since the pre-season. If we get one, whether on loan or not then great. If we don’t I’m sure Mr Wenger knows what he is doing and probably has something lined up for the summer that cant be concluded in January. I still can’t help but have the opinion (and I am allowed to as a supporter!)that it leaves us open to risk. Let’s see.
Walcott is a fantastic player. If he had been playing against Dortmund, at the Emirates, that might have given Dortmund a little more to think about defensively. It might have changed their tactics for the night against us. We’ll never know but anyhow that’s why I like him fit and available. The opposition do not like to play against him.
Theo’s complete recovery is more important than any other consideration. I have no knowledge concerning the ACL or ALL ligaments, but hopefully Arsenal will employ the best surgeons available. I would rather see a fully recovered Theo return over a longer time base rather than have him rushed back too soon and have a serious set back.
Slightly off topic, Rosicky looks as if he will be extending his contract – good news; lets hope Sagna does the same.
Someplace back in UA, should be a link to a BBC article on this topic. How I read the BBC article, was that it was possible, or even likely, that in the past in some ACL reconstructions, because the surgeons doing the work did not know of the ALL, they might have even removed the ALL if it was still in place. Or if it too had of been damaged, they might have just removed the fragments remaining, instead of reconstructing it too.
When the ACL ruptures, the ends typically become very frayed. The ends cannot be reconnected (at the present time). The ligament is replaced. One option is to harvest a ligament (or tendon) from a cadaver. Tendons are more likely, in that they are longer and often stronger.
Infection and tissue rejection are reasonably likely in this method. Another option is to harvest material from the person’s own body. Less chance of rejection, but we have increased the chance of infection (multiple “wounds” to heal). Sterilizing the harvested tendon can weaken it. The place it was harvested from can become weaker as well. The news I read about Theo, was that they were considering the patella tendon (from knee cap to lower leg), they harvest about 1/3 from the center. A minor part of the hamstring called semitendinosus is also a common source. Wikipedia does mention that the site where the harvesting is done, can be lower in strength afterwards.
http://en.wikipedia.org/wiki/Anterior_cruciate_ligament_reconstruction
Another choice is to replace the ligament with something synthetic. There are two paths in biosynthetic repair: use a material which is permanent, strong and won’t be rejected, or use a material with serves as a template which the body then grows into. The wikipedia article talks about stem cells and a scaffold (I like the word template). If you are familiar with 3D printing, one of the plastics used is poly-lactic acid (PLA). PLA scaffolds are being investigated for some medical uses. As the surgeons are not talking about this for Theo, I gather is takes a while to “grow” enough tendon onto the scaffold, and eventually start breaking down the scaffold.
There was news in the last while about a woman having a new jawbone “printed” for her. The woman was from the UK, and the bone was made in Belgium. Titanium from powder metallurgy can be quite biocompatible.
http://mashable.com/2012/02/06/3d-printer-jawbone/
Wikipedia doesn’t seem to talk about scaffolds and stem cells with respect to where tendon might be harvested from.
In hip replacements, the part of the socket has sometimes been made with UHMWPE. There are UHMWPE fibers (Spectra, Dyneema). While they apparently are used for sutures (thread), it doesn’t look like anyone has investigated them for ligaments. It could be a problem of not being able to “fix” (anchor) the ends.
In terms of recovery time, I wouldn’t count on faster than 6 months. While 6 months of recovery may see an athlete back to playing (or at least practice), I wouldn’t count the injury as being completely healed yet. I suspect anyone coming back from ACL reconstruction is still more susceptible to additional injury if they get tackled from behind for quite a while after return to play (another 6 months?).
Let’s say that Theo was deemed “fit” for the World Cup at some point. Maybe there is another Shawcross out there among the teams at the World Cup, and he might think it easier to tackle him from behind once, instead of chasing him 40 times.