Adam Doueihi - Partial ACL tear
Scans have revealed a high grade partial ACL tear for Adam Doueihi, that he will now seek further specialist evaluation before deciding on a treatment option. Let’s run through what a partial ACL tear means regarding likelihood for surgery and best/worst case scenarios.
Unlike other knee ligaments a partial tear of the ACL does not guarantee surgery can be avoided. Rather than looking solely at the ACL itself and the severity of the tear, the knee joint as a whole is assessed to determine whether it is functional (stable) or not (unstable).
Effectively an ACL can be 60% torn, but the knee joint itself remains functionally stable (doesn’t give way when changing direction, jumping/landing etc). Conversely there can be a 20% partial tear that results in constant episodes of giving way and instability. This instability can bring great risk for further injury to structures in the knee, which can have both short and long terms consequences for the athlete’s health.
If knee stability is maintained, and secondary damage in the knee is minimal (meniscus etc), surgery can often be avoided. Players will undergo an intensive rehab program to reduce swelling, improve range, build the strength back up and improve the dynamic stability in knee joint. If this is successful return to play is often achieved within 2-3 months.
But if knee is considered unstable, surgery will be the option in NRL players. There is growing evidence of ACL ruptures being successfully managed with a strict bracing protocol & avoiding surgery, but this is yet to be attempted officially by an NRL player.
Even for those who choose rehab initially - there is still a chance that surgery could be required. Recent evidence suggests that up to 40% of partial ACL tears treated non-operatively progress to a complete rupture, with that number increasing to 75% if the athlete plays pivoting contact sports.
So while the odds aren’t great, reconstruction surgery isn’t a 100% certainty for Doueihi. He’s actually been through this process before - in the 2021 preseason he suffered a “minor partial tear” of his ACL, which he and the club decided to manage with rehab heading into the season. He lasted until August that year before making the partial tear worse, which after consultation with specialists resulted in his 2nd ACL reconstruction surgery.
Speaking on the Magic Sponge Podcast he indicated the risk of further damage with his knee considered unstable was the main driver behind the surgical decision in late 2021 - he didn’t want to get 10 weeks into rehab then require surgery anyway.
Considering the main factors of Doueihi’s case:
- 2 previous ACL reconstructions to this knee
- High grade partial tear (+ potentially further meniscus damage)
- Obviously showed some functional instability in suffering this latest injury (knee gave way/shifted on landing)
- Still young (24YO)
Most of the signs are pointing to another reconstruction surgery & at least 9 months on the sideline. That won’t be confirmed until further specialist review, so for now Tigers & Doueihi fans (like me) can hold onto slim hope he will be able to avoid surgery & return in 2-3 months.
But even in the likely case surgery is required it won’t be a career ender - it will just be a big challenge for the Tigers and Doueihi to minimise re-injury risk as much as possible before his return.
In memory of Geoff Chisholm (1965-2022)
I agree with this. It's crystal ball stuff and his young age is a big factor in a successful return from rehab.Most of the signs are pointing to another reconstruction surgery & at least 9 months on the sideline.
Thankyou for this comprehensive report mate. Good stuff.
Wests Tigers hooker and captain Api Koroisau has today undergone surgery in Sydney after suffering a fractured jaw in Thursday night’s 28-12 loss to Gold Coast Titans at Cbus Super Stadium.
The injury, which happened while he was making a tackle on Titans prop Tino Fa’asuamaleaui, will see Koroisau miss approximately six weeks.
It’s also a huge blow for the NSW Origin side, which will now be without Koroisau for the remainder of this year’s series.
Luke Brooks is also facing an extended period on the sidelines after suffering a hamstring injury in the second half of the same game.
Brooks also flew back to Sydney on an earlier flight than his teammates on Friday to undergo scans, which revealed a Grade 2 hamstring strain. He is expected to miss between 4-6 weeks.
Wests Tigers next game is against Melbourne Storm at Campbelltown Sports Stadium on Saturday 17th June.
In memory of Geoff Chisholm (1965-2022)
4-6 weeks with a Bula, wakeham, will smith, Simpkin spine. Strap yourselves in ladies and gentlemen, we’re in for one hell of a ride.
4-6 weeks with a Bula, wakeham, will smith, Simpkin spine. Strap yourselves in ladies and gentlemen, we’re in for one hell of a ride.
surely in that time we are blooding TDS from the bench
Laurie at 6? TDS 14 for sure
Laurie at 6? TDS 14 for sure
you thinking ?
7. wakeham
6. Laurie
9. Simpkin
14. TDS
not many points in that spine it's a worry
Laurie at 6? TDS 14 for sure
you thinking ?
7. wakeham
6. Laurie
9. Simpkin
14. TDS
not many points in that spine it's a worry
oh we are in huge trouble no doubt.
1. Bula
6.
7. wakeham
9. simpkin
14. TDS
this is all we have. Laurie has to slot back in somewhere as he is the only real first grader still in KOE. Unless you want to play Laurie and 1, he is our 6. It’s going to be very tough to watch however.
I'm not sure how wise it is to be blooding TDS without an experienced half to look after him.
Debuting TDS into a halves partnership of wakeham and Laurie- isn't setting him up for success
Top 8 2023
Good news: Charlie Stains may be ready to play against Souths up in Tamworth, Round 22
