High school junior Lillian Marx has loved competitive diving since she was 9 years old. She even does “dry land conditioning” on her trampoline to train in her spare time. Unfortunately, last spring, she sustained an injury during one such training session.
“I planted wrong and heard a pop,” said Marx. “It was pretty scary.”
After a trip to the ER, Marx’s mother booked her an appointment with Zahab Ahsan, MD, a sports medicine orthopaedic surgeon with Endeavor Health. Dr. Ahsan ordered an MRI scan and confirmed that Marx had torn her ACL and medial meniscus.
“The anterior cruciate ligament (ACL) is the main structure that gives the knee stability, particularly for activities like jumping or pivoting,” explained Dr. Ahsan. “A torn ACL is one of the most common knee injuries we see in athletes.”
Most patients need an ACL reconstruction as opposed to a repair via surgery. “The ACL is like a rope between the tibia to the femur — the two main bones of the knee,” explained Dr. Ahsan. “When it tears, it's almost like the rope shreds, so it's not something we can stitch back together.”
In order to reconstruct an ACL, surgeons take another form of tendon or soft tissue to essentially make a new ACL. This tendon or soft tissue can either come from the injured person’s own body or a cadaver — the latter having a higher rate of reinjury.
“Typically, using your own tendon or tissue is better because it heals more quickly and reliably,” said Dr. Ahsan. Taking a graft from the patient’s body is called an autograft.
Before surgery, the first phase of treatment is something Dr. Ahsan calls “prehab” — rehab prior to surgery. Over the course of two to six weeks, prehab allows the patient to improve their knee’s range of motion and muscle function to help set up a faster recovery after surgery.
In May 2023, Dr. Ahsan performed what’s called a patellar tendon autograft on Marx by taking tissue from the central one-third of the tendon that connects her kneecap to her tibia to reconstruct her ACL. This is considered the gold standard for ACL reconstruction in athletes and amazingly, it only takes about an hour of surgical time.
ACL injuries are commonly accompanied by a tear in the meniscus, cartilage that serves as a shock absorber and secondary stabilizer of the knee. As was the case with Marx, the torn meniscus can typically be stitched back together.
Dr. Ahsan said the timeline for recovery after ACL reconstruction is impacted by the patient’s specific injury, how motivated they are, and how strong they were going into the procedure.
“Lillian’s goal was diving, which is unique,” he explained. “Diving impacts the knee differently from sports like soccer or basketball where we commonly see more ACL injuries.”
Patients typically need to do physical therapy for 8 to 12 months before they can return to a pre-injury level of performance. However, the high school diving season started in August — just a few months after Marx’s injury.
“I told Lillian and her family that I thought we could defy the standard timeline and get her back to her sport sooner,” he said. Sure enough, just two weeks after the diving season began, Marx was diving competitively again.
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