Club Statement: Clay Smith

[Sedat]

So there is no risk of further damage by playing on an already ruptured ACL?

There's no risk in further tearing an already torn ACL - once it is torn it needs to be replaced (ie: reconstructed) with a hamstring tendon, patella tendon, or a synthetic fibre (in the case of LARS). There is, however, a risk in the possibility of cartilage damage occurring as a result of instability within the joint - thankfully this didn't happen to Clay.

There are 4 ligaments in your knee - the anterior cruciate ligament is basically your twisting and turning ligament, and is the only one that cannot repair itself (hence when it is torn it needs to be replaced/reconstructed). If your quad and VMO (the ball muscle just above the knee joint) are particularly strong, then this can have a cushioning effect on the knee joint even in the event of damage to your ACL. However, if there is any quick turn or change of direction when there is weight bearing on the knee in question, you will collapse.

[AndrewP6]

I'm no doctor, but the idea of them okaying a player to go back out after they know he's torn an ACL doesn't sit well with me, regardless of his desire to want to continue.

[LostDoggy]

I read that medical report and found it concerning. Gutsy by the guy but it sounds like a risky situation no matter how much they are saying it wasn't.

He ruptured the graft, so he had no ACL, but going back on the park was very little risk of doing more damage? Not sure that seems realistic, if the ACL is gone then the range of movement required for AFL football would be severely compromised and the possibility for other ligament and meniscus damage surely heightened.

I mentioned when he was first picked that I was concerned it was too early, I think this was a problem, he shouldn't have come back to AFL until mid season and probably wouldn't have if not for Libba and Wallis injuries. I was told the graft is known to be fully settled at 12 months.
I love the club and love the guy and I'm no medico, I have had one myself but there is probably much I don't understand.

[jazzadogs]

Well done to the club for clearing that up. I was certainly disappointed when he came back on, as the tests for ACL tears only have a sensitivity (ability to pick up injury) of about 60-70%, meaning there would have been a 30% chance they were incorrectly saying it was fine. Admittedly this also means there is a chance that they initially got a false positive, but that's unlikely based on the results of the scans.

If the diagnosis was a complete rupture of his ACL, then it cannot be made worse. He would have been undergoing a complete ligament reconstruction, with the full 12 month rehab pathway, regardless of going back onto the field. I agree with the club that his return to the field could not have made the injury and treatment any worse.

All the best to Clay.

[The Bulldogs Bite]

I wonder why we haven't went down the LARS path?

If the traditional reco didn't work the first two times, why would it work a third?

[lemmon]

I wonder why we haven't went down the LARS path?

If the traditional reco didn't work the first two times, why would it work a third?

Age must have something to do with it, he is still only 21 with a lot of time left. It may have been a different decision if this had all occurred at 27 years of age. In saying that, didn't Troy Menzel have LARS after two recos? Seems to have been relatively successful there.

[Cyberdoggie]

Not particularly. What can happen with a rupture is that the swelling acts like a splint to the knee itself and the knee actually feels quite stable (some may remember Lenny Hayes playing out a full game with a ruptured ACL). There is some possible risk of cartilage and meniscus damage but generally Clay would have been in a hell of a lot more pain and wouldn't of been able to run at all if this was the case.

Ok so he apparently ruptures it the first time, is able to walk ok, gets told the news decides to have another crack at because it feels ok.
If he is moving ok then you assume there isn't much swelling?... I would of thought if it started to swell up he wouldn't be able to run like he did.

Then if he has already ruptured it, why did he go down with so much pain and require a stretcher the second time it occurred?
That doesn't make sense to me.

Unless things have changed recently the only test they can do at that point is to basically pull on his lower leg to feel for the clunk sound if the ACL is still there, but that is not 100% sure, it would tell them yes this is a worry or it seems ok.
I still don't understand why they sent him back out there, not only could it of made things worse for Clay, it definitely effected the team seeing him go down twice, the second causing a long delay and a big send off on the golf buggy. This would of certainly entered the minds of the players as a distraction. They had the whole half time break to be thinking about Clay instead of the game because that seemed under control, then it was taken from underneath them.

[Remi Moses]

Been handled poorly .
Clay shouldn't have come back on regardless how annoyed or angry he was.
I think he was in a state of shock, and let's just wish all the best for him

[FrediKanoute]

A guy I knew ruptured his and it wasn't found till about 6 months down the track by which time he'd already completed the majority of a soccer season, no idea if there was any further damage done though

I had my left knee diagnosed with a ruptured ACL in Jan 15. I told he Doc he was wrong because there is no way I have ruptured an ACL. He suggested it may be an old injury.......25 year old injury one I had damaged playing at University, but at the time the diagnosis from about 3 docs, a surgeon and my physio was lateral and meniscal damage, the ACL was fine.

My surgeon this year has said, the muscle mass meant that the knee was kept stable, but he noted that I probably would have struggled to play Aussie Rules - which was true was never the same player and gave up after regularly "jarring" the knee. Had no trouble skiing and playing cricket though!

[Cyberdoggie]

Well done to the club for clearing that up. I was certainly disappointed when he came back on, as the tests for ACL tears only have a sensitivity (ability to pick up injury) of about 60-70%, meaning there would have been a 30% chance they were incorrectly saying it was fine. Admittedly this also means there is a chance that they initially got a false positive, but that's unlikely based on the results of the scans.

If the diagnosis was a complete rupture of his ACL, then it cannot be made worse. He would have been undergoing a complete ligament reconstruction, with the full 12 month rehab pathway, regardless of going back onto the field. I agree with the club that his return to the field could not have made the injury and treatment any worse.

I'm confused by this as you mentioned that there could of been a 30% chance of mis-diagnosis, so then if they cannot be 100% sure he has ruptured it, and he seems ok with movement, why send him back out?
The facts are conflicting with each other to the point where it raises questions and doubt. His symptoms weren't like a normal ACL rupture where a player goes down with pain and can barely walk, given his history and the facts above you would err on the side of caution.

I'm very worried they made a bad mistake that could cost this kid his playing career and are in damage control.

[Greystache]

I had my left knee diagnosed with a ruptured ACL in Jan 15. I told he Doc he was wrong because there is no way I have ruptured an ACL. He suggested it may be an old injury.......25 year old injury one I had damaged playing at University, but at the time the diagnosis from about 3 docs, a surgeon and my physio was lateral and meniscal damage, the ACL was fine.

My surgeon this year has said, the muscle mass meant that the knee was kept stable, but he noted that I probably would have struggled to play Aussie Rules - which was true was never the same player and gave up after regularly "jarring" the knee. Had no trouble skiing and playing cricket though!

Cadel Evans won the Tour de France with a ruptured ACL, he wasn't going to get it reconstructed until after he retired.

[jazzadogs]

I'm confused by this as you mentioned that there could of been a 30% chance of mis-diagnosis, so then if they cannot be 100% sure he has ruptured it, and he seems ok with movement, why send him back out?
The facts are conflicting with each other to the point where it raises questions and doubt. His symptoms weren't like a normal ACL rupture where a player goes down with pain and can barely walk, given his history and the facts above you would err on the side of caution.

I'm very worried they made a bad mistake that could cost this kid his playing career and are in damage control.

Basically there are no physical tests which can ON THEIR OWN 100% rule in or out an ACL tear, or any other damage to the knee for that matter. When combined with the clinical history, the fact that I'm sure our doctors have performed the same tests on Clay countless times and know his knee, plus the mechanism of injury, they would have been pretty much 100% sure that it was a complete rupture. I was pretty close to 100% sure and I was sitting down the Footscray end! This is backed up by scans which show a clean rupture...no other injury.

It seems to me that Clay ruptured the ligament, the medical staff correctly diagnosed a ruptured ACL which was still functional in the immediate term, the prognosis of another complete reconstruction was explained to Clay, he completed the functional tests including sudden direction change and returned to the field of his own accord. At the moment he stepped back onto the field, he was still going to be having a complete reco this Tuesday whether he made it through the match or not.

If they had have claimed there was no rupture, then I would have been extremely disappointed. In my professional opinion they acted appropriately.

[chef]

Well said

[Maddog37]

I heard that Clay threatened to body slam each of the medical staff one by one if they didn't let him back on the ground!

[Doc26]

Basically there are no physical tests which can ON THEIR OWN 100% rule in or out an ACL tear, or any other damage to the knee for that matter. When combined with the clinical history, the fact that I'm sure our doctors have performed the same tests on Clay countless times and know his knee, plus the mechanism of injury, they would have been pretty much 100% sure that it was a complete rupture. I was pretty close to 100% sure and I was sitting down the Footscray end! This is backed up by scans which show a clean rupture...no other injury.

It seems to me that Clay ruptured the ligament, the medical staff correctly diagnosed a ruptured ACL which was still functional in the immediate term, the prognosis of another complete reconstruction was explained to Clay, he completed the functional tests including sudden direction change and returned to the field of his own accord. At the moment he stepped back onto the field, he was still going to be having a complete reco this Tuesday whether he made it through the match or not.

If they had have claimed there was no rupture, then I would have been extremely disappointed. In my professional opinion they acted appropriately.

If our medicos confirmed a rupture of the ACL, I fail to accept at that stage why we might risk any severe and permanent damage to Clay's remaining meniscus cartilage and the joint surface cartilage regardless of how small that risk might be.

Not that I see it as relevant but we were up at that stage by 48 points. I just can't see what there was there to be gained other than taking on a level of risk that for mine couldn't be justified.