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Back to basketball: how I avoided ACL surgery

An obsession… with sport and medicine

From the moment I started playing basketball, I was obsessed with the sport. I spent days, months and years learning basketball and sweating it out on the basketball court. Sometimes I imagined myself as Jeremy Lin on the Madison Square Garden court!

After leaving high school, I came to Fudan University Shanghai Medical College (China), where I majored in clinical medicine and played for the college basketball team as a captain. Seeing so many sports injuries on the basketball court made me rethink the relationship between sports and medicine. I realized I wanted to learn more and chose sports and exercise medicine as a career.

In 2019, I started my postgraduate studies in Sports and Exercise Medicine at Huashan Hospital (China) affiliated with Fudan University. I am now in the third year of my PhD and am researching skeletal muscle injuries and rotator cuff tears under the supervision of my mentors.

A new beginning… and an abrupt end!

In September 2019, during my first basketball game as a new graduate student, I felt in good physical condition and performed well in the first half. However, due to a lighting failure in the gymnasium, half time was extended by almost an hour! At the start of the second half, I did a crossover, with the knee slightly bent. Suddenly I felt my knee joint being ‘moved’ and then ‘reset’ in an instant. That moment felt like an in-game buzzer beater – the ball was thrown from my fingertips, time seemed to stand still, and I heard my heart pounding. Then, with a muffled ‘bang’ from the twisting knee joint, I fell to the ground.

The injury: from the doctor to the patient

On the evening of the injury, the pain was not intense. I immediately iced the knee, wore a knee brace, and propped up the injured leg with a pillow to reduce swelling before going to bed. The day after the injury, the pain was intense. My injured knee was extremely exudative and I was unable to bend or straighten it. I wore a knee brace and used crutches to avoid putting pressure on my injured knee.

Based on my professional knowledge, I thought the anterior cruciate ligament (ACL) could be torn; but I still hoped for the best result. My teacher and mentor, Dr. Jiwu Chen, performed a physical examination for me and confirmed that the stability of my injured knee was good (with negative tests for Lachman, anterior drawer and pivot-shift). However, an MRI taken on day 6 after the injury indicated that my ACL was torn, although luckily the meniscus was intact. Dr. Chen (a sports medicine expert) gave me some practical suggestions, including wearing a knee brace right away and using crutches to avoid any secondary injuries (Figure 1).

Figure 1

The smile after the MRI re-examination. Photo of me (right) and Dr. Jiwu Chen (left) under the “with both a caring mind and heart” plaque.

This injury instantly changed my role from doctor to patient. My life after this injury has not been easy, with limitations such as numbness in my hands from holding crutches, difficulty taking a shower or going to the bathroom.

Decision time: early ACL reconstruction or conservative management?

I have read a lot about acute ACL injuries and learned that current treatment options are still controversial. I have come across articles reporting that results did not differ between early ACL rehabilitation and reconstruction, versus delayed optional ACL rehabilitation and reconstruction.1–3 Given my busy school schedule and my good joint stability, I decided to follow the path of conservative treatment.

Early rehabilitation is especially important in conservative treatment, and Dr. Jiwu Chen and the sports medicine team at Huashan Hospital customized a detailed rehabilitation protocol for me. This focused on controlling pain/inflammation, improving range of motion (ROM), strength, and ultimately returning to play.

Thirty-three days after my injury, I was able to return to the basketball court practicing shooting with a heavy knee pad. A new MRI looked encouraging. Compared to the deformed and broken fibers in the sixth day MRI, the MRI demonstrated that the ACL intensity signal was much improved with fibers in continuity at thirty-five days post-injury. Probably, the ACL was only partially torn and residual continuous fibers could not be shown due to edema in the acute inflammation phase. 6 weeks) in the diagnosis of ACL injuries, with a particular tendency to overestimate the severity of the injury.5

Through gradual, supervised rehabilitation, I was able to transition to 90° cutting maneuvers at 66 days, return to training at 150 days, and full basketball at 200 days post-injury. A year after the injury, I gradually regained peak performance and helped my team win the Fudan University Men’s Basketball Cup championship. Now my knee is working fine and the ACL looks normal on the MRI. But I still have occasional mild knee pain and some level of “psychological blockage”.

Learn as a patient and doctor

In the past 3 years, two of my teammates have also suffered ACL tears. Due to my good results, they also chose a conservative treatment. Unfortunately, both failed and underwent ACL reconstruction surgery. One of them did not follow the doctor’s instructions and returned to sport prematurely; the other was overweight and had a ruptured ACL with a torn meniscus. Our different scenarios and results gave me food for thought.

In my opinion as a patient and as a doctor, a positive result depends on three elements:

  1. Good clinical stability of the joint and MRI findings of a partial ACL tear with no other damage (i.e. meniscal tear).

  2. Early intervention by a vocational rehabilitation team.

  3. The good compliance of the patient with the doctor.

My case also raises questions about the timing of ACL reconstruction. The accuracy of MRI in distinguishing a complete from a partial ACL tear when performed soon after an acute injury remains to be tested. Many doctors may recommend that surgery be done as soon as possible after a clear diagnosis of a complete ACL tear by MRI. However, my case suggests that with standard conservative treatment, supervised rehabilitation, and MRI confirmation, some patients can successfully return to sport. This issue deserves more attention for future research.

I realize that my good outcome may be related to a partial ACL tear, no other damage, and early rehabilitation. The full effect of my conservative treatment still needs to be tested over time to see if any problems arise in the future. But for now, this doctor is no longer patient and returns to basketball!

Ethics statements

Patient consent to publication

Thanks

I would especially like to thank my professor and mentor, Prof. Jiwu Chen (Department of Sports Medicine, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China) and Prof. Shiyi Chen (Department of Sports Medicine, Huashan Hospital , Fudan University, Shanghai, China) who helped me write this article. The sports medicine team (Department of Sports Medicine, Huashan Hospital, Fudan University) for their medical advice and patience and my physiotherapist Longbing Wang (Tichuang Sports Center, Shanghai, China) for all the rehabilitation hours spent together. Finally, the support of my family, my friends, the Shanghai Medical College basketball team and the Huashan Hospital basketball team.