An anterior cruciate ligament (ACL) tear has long been viewed as one of football's most devastating injuries, often bringing with it surgery and close to a year on the sidelines.
But a series of footballers returning within weeks of suffering ACL ruptures has put the spotlight on an alternative pathway — one that challenges the assumption that reconstruction is always required.
Several players outside the professional ranks have made remarkably quick comebacks after ACL injuries, returning to the field in as little as seven weeks.
Their recoveries do not suggest every ACL tear can — or should — be managed without surgery. But they do raise a compelling question: is reconstruction always the only pathway back to football?
Christian Woodford, a strength and conditioning coach with more than 20 years of experience and an honours degree in exercise neuroscience, has spent years exploring that alternative pathway.
Woodford has spent years using intensive strength and conditioning programs to rehabilitate selected athletes without ACL reconstruction, suggesting conservative management and intense strength training can allow a player to return within two months.
Ovens and Murray star Matt Hedin, Southern Football League duo Phillip Ilic and Dale Alanis are all living proof that not all ACL injuries require surgery. And they're not the only ones.
"I would say, and this is serious. Probably going on, I'd say 30 to 35 now, and I'd say the rate has probably been 80 per cent that haven't done it again, 80-70 per cent, which is f****** pretty good considering," Woodford told Zero Hanger.
"With the conservative management, sometimes the knee flares up, so it gets a bit angry, and that's where you have to stay on top of the icing. You have to stay on top of the strength work. You have to really double down on your recovery."
Woodford's first client on the pathway was Hedin in 2018, a case that opened his eyes to what might be possible without reconstruction.
"I think six or seven weeks before playing in the finals, but they were going to go to the Grand Final. I ended up getting him back to the Grand Final. They ended up losing it, but he ended up playing really well, and that was my first athlete doing it," Woodford said.
"And that's when I first started switching on to the fact that, hold on a second, this guy's just had an ACL rupture, and (after) seven weeks of a concentrated loading of strength work, of power work in the gym and on the field speed work as well, and he just came back. But not he's just come back, but he's performed. But not only that, he's got no pain. He feels better without an ACL.
"So what I kind of found was there's a certain percentage of the population (this alternative pathway can suit), and it depends on how much structural damage the knee gets. So when I say that, I mean the structures stabilising the knee: lateral collateral ligament, medial collateral ligament, ACL piece. What damage is there?
"There's a high percentage that can come back to sport without ACL surgery, and then they're generally the ones that have a lower amount of structural damage, mainly just the ACL, and maybe a little bit of damage on the lateral, the medial, and maybe a little bit of meniscus."
Woodford honed his approach while working in the American college system before bringing those learnings back to Australia.
"My job is to develop structural stability and strength through quads, hamstrings, and glutes in isolation, but also functional multi-joint movement," Woodford said.
"Let's get loading through your lower body. Let's get strong through your posterior chain. Let's do all the dynamic movements. You jump, sprint, you change direction. Let's develop the capacity, and let's develop your ability slowly to be confident that you can come back and perform at a high level."
At AFL level, however, examples of players following a similar pathway remain exceedingly rare.
Geelong star Gryan Miers has emerged as an extraordinary trailblazer, playing on with a partial or incomplete tear rather than undergoing immediate reconstruction.
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Miers remains a rare example in the AFL, missing only a handful of matches after suffering the injury before returning to the field.
His case, alongside the rapid recoveries occurring further down the football pyramid, raises an intriguing possibility: perhaps an ACL rupture does not always mean the end of a season — or an automatic trip to the operating theatre.
Woodford never suggested all ACL injuries should be treated as such, but should be part of the consideration.
Stay on ZeroHanger.com for the individual stories from Ovens and Murray League footballer Matt Hedin and Southern Football Netball League duo Phillip Ilic and Dale Alanis.
