Mariano Rivera was moving from the outfield to the warning track. As his foot came down on the new surface, the Yankees' legendary closer crumpled. For Dr. Neal ElAttrache, it was the classic type of ACL injury, where the brain is expecting one level of friction and encounters another.
"It's that the athlete is suddenly distracted or disturbed as they're ready to plant their foot," said ElAttrache, an orthopedic surgeon with the Kerlan-Jobe Orthopedic Clinic in Los Angeles, who performed knee surgery on Patriots quarterback Tom Brady in 2008. "The knee buckles."
In the NFL, ElAttrache noted that ACL tears were the 17th most common injury, but accounted for more time out than any other injury given the length of the recovery.
Rivera is just one of the prominent athletes who is currently out of the lineup recovering from a knee ligament tear. The Bulls' playoff hopes took a hit when Derrick Rose went down in Game 1 of Chicago's first-round series against Philadelphia (the Sixers won the series in six games). Rashard Mendenhall (Steelers), Iman Shumpert (Knicks), Wilson Ramos (Nationals) and Redskins rookie Jarvis Jenkins are just a few of the other professional athletes who have suffered the same injury.
ElAttrache said that although the injury has been in the news more often recently, the number of injuries per participants hasn't necessarily risen; there are just more people participating in sports.
Despite the advances in treatment, the most effective injury prevention is still strengthening the muscles around the knee. The way the ACL is used now, in sports that require planting and pivoting, there is no medical substitute.
"We are nowhere at the point where we would do a preventative operation," ElAttrache said.
When he sees an athlete like Rivera, ElAttrache evaluates if the initial injury damaged any of the surrounding structures of the knee. Then, the patella tendon, or sometimes two of the hamstring tendons, can then be used as a replacement. Tissue from a cadaver can also be used, but has a higher failure rate.
Will the 42-year-old Rivera play again? He could, ElAttrache said. But if the recovery isn't 100 percent, the physician said Rivera doesn't seem like the kind of athlete who would tolerate being less effective.