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Olympic Recovery

The ACL evolution
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IT WAS ALL preordained. The fall, the knee, the finish—everything that happened to Abbey D'Agostino at the 2016 Olympics was meant to be. She knows that now. And she's thankful for it. "I'm coming to find that the best things are not what we expect," says the 25-year-old Boston native.

On the afternoon of Aug. 16, D'Agostino lined up in Rio for the first round of the 5,000 meters. Three weeks earlier, she had suffered not quite a fracture but rather a stress reaction on both sides of her pelvis. Since that limited her pre-Olympic training, D'Agostino was simply hoping to qualify for the final. "At 3,000 meters in I was feeling it was realistic," she says.

Then, running in a pack, D'Agostino and Nikki Hamblin of New Zealand became entangled. Hamblin fell forward, and D'Agostino tripped, landing on her right side.

She popped up and, instinctively, she says, helped Hamblin to her feet. After a few strides D'Agostino's right knee buckled. "That feeling was disturbing," she says. Another short stride—it buckled again, and she went down. This time Hamblin helped D'Agostino up. With almost a mile left both runners went on to complete the race. "I had to finish," she says. "It wasn't a question. It was a statement."

After the race D'Agostino hugged Hamblin, who offered her a sip of water. As D'Agostino was carted off in a wheelchair, she and Hamblin held hands briefly. Afterward the pair were hailed as torchbearers of the Olympic spirit, their moment destined to be included in celebratory montages for decades. The Olympic Channel dubbed it The Most Beautiful Moment of Rio 2016. "We did about 12 interviews the next day," D'Agostino says. "But I was so thankful that we could spend time together. I saw the video, and I was so awestruck, how beautiful it was."

Less inspiring were the scans of D'Agostino's knee. She had completely torn her right ACL and meniscus, and strained her MCL. She had surgery in September and shortly after embarked on rehab, starting with half rotations on a bike. A month after the operation she moved on to an elliptical machine. One month later she could do a full rotation on a bike and jog in the pool. By January she was running outdoors. She resumed regular training in March and by May started to think she had a shot to compete at the U.S. championships in June, but a strained right hamstring put that notion to rest.

"Being more realistic, it'll probably be 18 months before I feel completely normal," she says. Today she's focusing on the bike or swimming in the morning and using an elliptical bicycle in the afternoon. "Just a lot of good music, podcasts and cross training," she says.

D'Agostino, who is a devout Catholic, views her injury as a blessing. She and Hamblin have stayed in touch, and the two reunited at the Laureus Awards in Monaco in February. (D'Agostino captioned an Instagram post of the two, "Reunions sure are sweet.") She's used her time off and increased profile to give speeches at youth camps and to lobby Congress for the Personal Health Investment Today Act, which would allow pretax dollars to go toward fitness activities. "I'm really thankful that I was part of something that gives me a platform for discussing what matters," she says. "I'm being active and choosing to learn and not to become bitter, but better."

The rigors of rehab and her public engagements haven't dimmed her Olympic dream. Says D'Agostino, "I was thinking about 2020 a week after the injury happened."

EDGE

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Treatment As Usual

L.A. orthopedist Bert Mandelbaum lays out the typical recovery from ACL repair, as guided by a physical therapist and assuming no setbacks.

Presurgery

• Reduce swelling with ice

• Strengthen surrounding tissue

Week 1 [Post-Op]

• Remove stitches

• Start biking, 10 minutes daily

• Begin physical therapy

Week 2

• Stop using crutches

• Start swimming

Weeks 3--12

• Gradually increase biking, swimming and strength exercises

Week 12

• Start box drill—patients shuffle in four directions

• Start jogging

Week 16

• Test neuromuscular skills of acceleration, jumping and shuffling

• Observe running on treadmill, fixing habits that might lead to reinjury

Week 24

• A second neuromuscular test; if passed, the patient is cleared for noncontact drills and training

Week 26

• The patient can return to full activity, including contact. Minutes to increase gradually

For more athlete training profiles and tips, go to SI.com/edge

EDGE

Repair and Replace

An ACL tear is no longer the giant-slayer it was 50 years ago. Gale Sayers was driven from football by an ACL tear in 1968; in December 2011 running back Adrian Peterson tore his ACL and returned to the field nine months later. How has knee care changed? Bert Mandelbaum, an orthopedic surgeon in L.A. and the team physician for the U.S. men's soccer team, identified three key developments.

1. Scoped Out

The development of arthroscopic surgery in the mid-1980s marked a shift for orthopedists. The technology allowed them to diagnose and treat knee injuries without the trauma and complications of major surgery. "If you had an ACL tear before the 1980s," Mandelbaum says, "you'd have an operative procedure, then be put in a cast and spend the next six-to-nine months trying to get your chicken leg back to functioning."

2. From Rehab to Rehab and Prehab

"Athletes pushed us to get better," says Mandelbaum. Patients wanted to return quickly and not lose effectiveness. This led to an emphasis on presurgery conditioning and strengthening and to new protocols for postsurgery care, including stimulation, passive motion machines and building strength through nonimpact activities—biking and swimming.

3. Bio Science

Recent developments in care include infusions of platelet-rich plasma (PRP)—to further regenerative capacity—and improving ligament grafts by using stem cells. What's next? It may be a while, but 3-D printing of tissue grafts made from stem cells, customized for age and function, is coming. "That's going to be our future," says Mandelbaum.

Posterior Cruciate

Medial Collateral

Anterior Cruciate

Lateral Collateral