The Crucial Link

The Sunday Age

Sunday March 9, 2008

Emma Quayle

As a young Sydney player banks his career on a synthetic knee reconstruction, Emma Quayle looks at a few cases where the technique hasn't worked so well.

ROD MacPherson did not hesitate. By the time the anterior cruciate ligament in his right knee crumbled during a reserves final in 1986, the Footscray player already had decided he would not be a Bulldog the next year.

He was 22, and had played only eight senior games that year. He had been asked to join the newly formed Brisbane Bears, and wanted to take his second chance. So when MacPherson's surgeon said he could replace his ruined ACL with an artificial fibre called dacron and be ready to play by round one the next season, he decided to do it.

"My career was at the crossroads," MacPherson said. "I just wanted to keep playing footy."

More than 20 years before French surgeon J.P. Labouro controversially reconstructed Nick Malceski's right knee using a synthetic ligament that may have him back in the Sydney side within three months, four Footscray players decided they wanted to come back quickly, too. It was an easy decision that had consequences, and led to much more wrenching calls.

First, defender Michael Egan had his ligament replaced with gortex fibre. The technique was one the club's surgeon, David Young, had seen and studied while overseas. Doug Hawkins had the same thing done after his knee fell apart in a 1986 game against Collingwood.

More than 18 months after Zeno Tzatzaris landed badly in a game against Geelong in 1985, he had a dacron graft in his injured knee. The dacron fibre was an upgrade on gortex; after rupturing his ACL, the defender had strengthened his leg and played for a while without one, until his knee got too sore.

On the same day he had his surgery, MacPherson had his knee repaired as well. He can still remember Egan turning up at the hospital, too, to have his knee - which had felt a little loose - tightened up. "He wandered in and wandered out like when you have a fan belt replaced on your car," MacPherson said. "It gave me some confidence."

Egan's graft ultimately lasted less than six months and, of the four players, only Hawkins had success with the technique. He took a full 12 months off after he fell in the first 10 minutes of his fateful match; he had done so much other damage to his knee (two cartilages and his medial ligament were wrecked, as well as his ACL) that he couldn't have rushed back even had he wanted to.

When he did play again, his knee felt incredibly tight. It still does; to this day, he can't flick it to touch his backside. His knee is now held together by scar tissue - the graft almost certainly would have disintegrated by now - but he never again ruptured it, and credits his long break. "I look at the other guys who did it, and the only difference was the time I took," he said. "That's the only thing I can see."

Tzatzaris was like MacPherson. He agreed to the surgery the second it was suggested because he wanted to keep playing football. He wore a leg brace for six weeks after his surgery and found that people actually were more anxious about how to rehabilitate the injury than the surgery itself because while the operation had been done before, coming back from it hadn't.

Still, he was able to run almost as soon as the brace came off, and after a full pre-season, played in round one of the next season, 1987, and his graft lasted three years, although he took seven months off in between to have his left knee reconstructed with a hamstring graft.

When his artificial graft went in a 1989 reserves game, it was a strange sensation. There was no pain, and no bleeding. Tzatzaris wasn't even sure he'd ruptured it; it just felt a bit weird. He played out the game, and the year, and did the pre-season for 1990 minus an ACL again.

Early in 1990, Tzatzaris got a simple knock to the side of the knee that caused more, different trouble, and then had it reconstructed again, with a hamstring graft this time. His knee has not held him back too much: Tzatzaris is a personal trainer who runs up to 20 kilometres each week. But he has had 14 operations on his right knee - the last time, he was kneeling down working on his taxes when some bone spurs came loose - while on his left knee, he's had only the one reconstruction, "plus one or two little arthroscopes".

If he had his time over, he would not have had an artificial graft. Not because his right knee went so wrong, but because his left knee worked, and he twisted so awkwardly in that reserves match he's sure his ACL would have snapped no matter what it was made of.

"But then I ask the question: had I had it operated on there and then, would I have suffered the same damage to it in 1990?" Tzatzaris said.

"It was such a simple knock."

MacPherson knew absolutely when his graft was not happy. He played the first seven games of 1987 for the Bears, but the next week at training, his knee felt sore. It was infected, badly: by the next night, he was in hospital, where he lost more than 15 kilograms in a week.

Trying to explain to the doctor what was in his knee was one thing; trying to convince him not to remove it was another. No matter how sick he got, MacPherson did not want to give up on that graft. "The doctor kept telling me, 'I'm ripping it out'. And I kept telling him, 'No, you're not ripping it out'," he said.

"His theory was that because it was artificial, my body wasn't recognising it. The antibiotics weren't cutting in, and all that sort of stuff. I was on a drip for seven or eight days up there, and at one stage he said to me, 'I'm going to take it out because if you get an infection in your bones, we'll have to amputate your leg'.

"I think he was just trying to scare me. He was trying to force me into a decision, but it was very scary. I called David Young and he told me to get down to Melbourne straightaway. He took a look at it and agreed that it had to come out. And it was hard for him because it was his baby, that sort of operation."

"He said, 'I don't want to sound dramatic, but your health is more important that this graft, and than football, simple as that'."

MacPherson had his knee "deconstructed", and was always going to have to wait a while to have a new graft put in. Removing a ligament is a complicated procedure, and doing the reconstruction is much more difficult the second time around. He waited longer than that, tried to play again without an ACL, but after a handful more operations and several failed comebacks, aborted the attempt altogether.

He had a hamstring graft done later and played some games for Werribee, but knows he will need a complete knee replacement one day. It is not a pleasant thought - "The less I know about it, the better," MacPherson said - and he hasn't forgotten how frustrated, annoyed and angry he was when it all happened.

The Bears reneged on his contract extension - MacPherson had re-signed the day he went into hospital - and the end of his career also meant the end of his development job with the Queensland league. More than just his knee dissolved, and it was tough. "I was angry and frustrated and all of those things," he said.

"Coming to terms with your league career finishing is never easy to accept. My whole life just crashed down."

To Tzatzaris, Malceski is one of the best young players at Sydney, with several years ahead of him. "I'm really surprised he's gone down that path," he said. "He's such a young bloke."

Hawkins has no problems with artificial grafts - his worked - but hopes the 23-year-old doesn't rush back too quickly. "I think that's a big mistake," he said. "There's no need to. I wish he'd take the whole year off anyway."

To MacPherson, the young defender is one of the 10 best Swans. He can't understand why he would have opted for a quick comeback when he is so important to his side and when he has so many more seasons ahead of him. But he does know what it's like to be told you've wrecked your knee.

"My decision was based on the fact I had to make my second chance work, and work quickly. But he's not in that position," he said. "I can't see why at this stage of his career he'd be taking the risk.

"It's hard. It's hard as a 23-year-old to be told you might miss one whole year of football. But it's harder when you never play again."

KNEE TROUBLE

Players who have ruptured their anterior cruciate ligaments in the pre-season and earlier:

Daniel Giansiracusa (WB) December 7, Whitten Oval (training)

Nathan Grima (North) January 29, Bulleen (training)

Paul Hasleby (Frem) February 17, Subiaco (v West Coast)

Brad Dick (Coll) February 23, Albany (v West Coast)

Nick Malceski (Syd) February 17, Launceston (v Hawthorn)

Mitch Brown (WC) February 23, Albany (v Collingwood)

Kristin Thornton (Syd) February 23, ANZ Stadium, Sydney

Rhett Biglands (Ade) late January, Adelaide (training)

Beau Muston (Haw) March 1, AAMI Stadium

THE PIONEERS OF ARTIFICIAL LIGAMENTS

DOUG HAWKINS Footscray (1978-94) and Fitzroy (1995), 350 games, 227 goals. Best-and-fairest 1985 (Bulldogs)

MICHAEL EGAN Footscray (1978-87), 128 games, 12 goals.

ROD MacPHERSON Footscray (1982-86), Brisbane (1987), 50 games, 27 goals.

ZENO TZATZARIS Footscray (1984-90), 34 games, 0 goals.

© 2008 The Sunday Age

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