The worst fears for Gutherson were confirmed on Monday when scans revealed he had ruptured his ACL late in the Eels game on Sunday afternoon. He will undergo a revision ACL reconstruction this week as he previously had his ACL reconstructed in the same knee (his right) in 2015. It is common for revision ACL reconstruction rehab to be slightly more conservative, which can lengthen return to play time slightly compared to a first time ACL rupture.
The fact this will be a revision for Gutherson can also influence the graft type that is used to reconstruct his ACL. As it is most common to use a hamstring graft from the injured leg for a first time ACL rupture (and cannot be reused), for a revision reconstruction the graft must come from another location. Autograft (own tissue e.g. opposite side hamstring tendon, patella/quad tendon), allograft (donor tissue) or LARS (artificial graft) are all an option for Gutherson. Allograft (6-9 months) or LARS (3-4 months) can accelerate the return to play time, but both graft types show evidence of increased failure rate compared to autografts.
Unfortunately, we don’t know if Gutherson suffered any secondary damage to other structures in his knee (e.g. MCL/meniscus) which would be one of the most influential factors on recovery time. As you can see in the table below NRL players commonly return within 6-9 months from injuries involving an ACL reconstruction. With the kick-off for season 2018 7 months and 1 week away, it will take an impressive rehab effort from Gutherson and the Eels medical staff to have him 100% fit to return for round 1.
Good time to bring this up again with Gutherson's injury. Doesn't take into account other damaged structures in knee, but good general guide pic.twitter.com/5lSOkGRzgt
— NRL PHYSIO (@nrlphysio) July 24, 2017
Smith received the best possible news with his scan results; a minor tear (likely grade 1 injury) of the pectoralis minor muscle. Usually, when we hear “pec injury” in relation to NRL players it is referring to the pectoralis major muscle, which is the large chest muscle important for a number of arm movements required in footy (particularly with tackling). The pec minor is a smaller muscle that lies underneath the pec major, and the primary role of pec minor is to stabilise the shoulder blade and shoulder position. Due to the position and role of this muscle, it is much less common to strain but also commonly carries a quicker recovery. Smith is only expected to miss 1-2 weeks of footy, which is the best case scenario considering the possible regular season ending injury he was suspected to have suffered.
After initial fears he had ruptured his ACL and was facing 6 months+ on the sidelines, Johnson received somewhat good news when scans revealed a rupture of his PCL and he was only facing 6-8 weeks out. After initial physical testing, the Warriors had announced they were “99% certain” Johnson had ruptured his ACL. In very rare cases the instability caused in the knee joint by rupturing the PCL can be mistaken for and ACL injury. This was also a unique injury mechanism, as many PCL ruptures result from a direct blow to the front of the knee or hyperextension of the knee joint. Johnson appeared to be running in a straight line with some minor direction change when the injury occurred, which I’m sure contributed to the confusion around his initial diagnosis.
Mechanism for Johnson PCL rupture still uncommon. Usually contact injury to upper shin with knee bent, or knee hyperextension with rotation pic.twitter.com/DmKnpRMeFr
— NRL PHYSIO (@nrlphysio) July 17, 2017
The PCL is the largest ligament in the knee, yet it is common to not need a surgical reconstruction even when a complete rupture occurs. The primary function of the PCL is to stop the tibia (shin bone) from sliding backwards on the femur (thigh bone). When the PCL is ruptured, this loss of function can be countered by an extensive quadriceps strengthening program which will perform a similar function. Luckily for Johnson, the PCL has little to do with rotational control of the knee joint (unlike the ACL), which means even without a PCL the knee can still be very stable. Long term Johnson will have to maintain his dynamic strengthening program to minimise the risk of long term problems such as arthritis. Some athletes do suffer a slight loss of acceleration in return from a PCL rupture, but no loss of running speed or direction change ability is commonly shown.
Stephen Kearney has indicated he hopes Johnson will return in 4 weeks rather than the initially estimated 6-8. As you can see below, it has been done in the NRL before but Johnson’s return is much more likely to be around the 6-week mark.
Some recent PCL rupture return to play times for NRL players. Shows 4 weeks possible for Shaun Johnson, but 6 weeks more likely pic.twitter.com/MbTXCOXVn1
— NRL PHYSIO (@nrlphysio) July 19, 2017
James Maloney fractured his third metacarpal (middle finger) in the Sharks game this past weekend and will have a plate and pins inserted during surgery this week. Surgery in these cases often speeds up recovery time, and he is hopeful of only missing 2-3 weeks of footy.
Another who received best case scenario news from scans, after initial fears he had suffered a fractured rib it was revealed Burgess had only sustained rib cartilage damage. Whilst this is still an extremely painful injury, it is one that is often a pain tolerance issue in guiding return to play. It is very common for players to receive a pain killing injection to play through a rib cartilage injury such as this, but giving an exact return date will only become clear as Burgess’ injury settles. Usually, return to play will be anywhere from 1-4 weeks.
Trent Merrin has suffered a high-grade MCL injury (likely grade 2-3) and is said to be facing 6-8 weeks on the sidelines. Merrin has been quoted in the media as hoping to only miss 4 weeks, which will be very achievable if his injury is only a grade 2. Most recovery times for isolated grade 2 MCL injuries in the NRL seem to fall in the 3-5 week range.
Chris McQueen is still battling a neck injury which has nerve involvement, and he has recently had a cortisone (anti-inflammatory) injection to try and settle his symptoms. If this does not settle soon, McQueen is facing surgery that comes with a 4 month recovery period (similar to Kyle Turner in 2015). Fingers crossed he can return to the field symptom-free soon.
Matt Moylan/Konrad Hurrell
Matt Moylan and Konrad Hurrell both suffered hamstring injuries this past weekend, with Hurrell facing 4 weeks on the sidelines (likely grade 2 injury) and Moylan said to still be a chance to play this coming weekend. Moylan had missed the previous week with what was said to be a minor hamstring issue, and in his return, he looked far from 100%. It is worth noting that hamstring injuries are one of the most common to linger if a player returns before 100% recovery and an aggravated hamstring strain is almost always more difficult to recover from. It will be interesting to keep an eye on Moylan to see how he approaches his return in the coming weeks.
As has been well publicised, Slater suffered a concussion after a late and high hit from Soliola this past weekend. It was confirmed post-game Slater had been cleared of a neck/facial injury and would go through the concussion protocol this week to determine his readiness to return to footy. It is worth noting once again that recovery from concussion is a very individualised process, and the length of time spent on the sidelines is not dependant on the traumatic nature of the injury mechanism. Players can miss multiple weeks from a minor blow to the jaw, or they could return the very next week after a heavy blow to the head such as the one Slater suffered. He will be best managed by the medical staff at the Storm and will not return until it is completely safe for him to do so.
Api Koroisau/Tohu Harris
It is worth mentioning Koroisau and Harris, as there has been little to no information on their injuries or time expected on the sideline. Hopefully, they are both named this week to end the conjecture.
The opinions given by the author of this article are given by a qualified physiotherapist, HOWEVER they are based on the information available to the author at the time of publication; are general; and are not based on any formal physical assessment and/or diagnosis by the author. If you believe you may be suffering from an injury similar to one commented on by the author, do not rely on the author’s advice as it may not apply to you – see a qualified physiotherapist for a full assessment, diagnosis and treatment plan.