Shogun and ACL Injuries in MMA

Hi, everyone.

I am a doctor and MMA fan. I have been watching MMA since it was called NHB and we had to pass videotapes around our jiu-jitsu class to watch the fights!

I am starting a new MMA medicine blog/website ( and would like to start some discussions where fans, fighters, doctors, or cutmen can write stories, interviews, or just share their experiences.

My goal is to spread real information from qualified professionals and not misinformation that is out there.

Here is an excerpt from my recent article on ACL injuries:

With Mauricio "Shogun" Rua’s upcoming fight against Brandon Vera, the shadow of Shogun’s multiple ACL surgeries still looms over him. It’s unclear exactly how many surgeries Shogun has had, but it seems that he has had at least 2 surgeries to repair a torn ACL. Since ACL tears are a common surgical injury and the surgical outcomes could affect your MMA or combat sport, it seems like a good place to start this website off.

The ACL, or anterior cruciate ligament, is one of two ligaments that crisscross in the middle of your knee. The knee is basically composed of the femur (thigh-bone) on the top, and tibia (shin-bone) on the bottom, with the patella (knee-cap) in the front. The ACL acts to prevent the tibia from moving forward away from the femur and is most important for sudden movements like cutting or twisting.

Unfortunately, if you injure your ACL it can’t heal or grow back on its own. And if you plan on continuing in sports, you will need it "reconstructed" – which means replacing it with a new ACL graft created by a surgeon. The main categories that most people don’t understand but can have significant outcomes on their surgery are: 1) Graft Choice 2) Surgical Technique 3) Rehab.

What graft you and your surgeon choose can have different potential outcomes depending on the type of graft selected. This is something that has been and will continue to be debated by surgeons. Traditionally, most surgeons would take a tendon from your patellar tendon, which is where your quadriceps runs over the top of your patella (knee-cap) and attached to your tibia (shin-bone). You can feel it if you bend your knee and feel just below your patella. When this graft is used, a piece of bone is taken out of the patella and another piece is taken from your tibia with a strand of patellar tendon in-between. This graft is thought to have the easiest chance of it healing where the ACL used to be since it has bone on the end and bone tends to heal better to bone than tissue heals to bone. Unfortunately, a common side effect is pain over your kneecap, especially when you kneel down, which is something grapplers do all the time. The other issue is that there may be some quadriceps weakness, which are the muscles that straighten your leg, so theoretically this could weaken the "snap" of your kick.

Another option is to use part of your hamstrings, which are the muscles behind your knee and help to bend it. This avoids all the pain from the front of knee, but as you might guess, it can weaken the strength of bending your knee. Unless you are using the back of your knee to choke someone out, I am not sure how this would really affect your MMA game. In addition, it doesnt’t have bone on the ends of the graft so it may not heal as well to the femur or tibia.

The third option is to use an allograft, or a cadaver ligament. Different ligaments can be used depending on what the surgeon prefers. This method avoids all the pain of harvesting the graft from your own body (which is the most painful part of the surgery) and can make your rehab easier. The down-side is that there is a risk of disease transmission, but I think that in today’s age this is something like one-in-a-million (don’t quote me on the specific numbers). Another down-side is that since it’s not your own tissue, it may not integrate as well as your own tissue and thus may have a slightly higher chance of failing. This may not be the best choice for a younger, elite athlete.

The next thing that may affect your outcome is the surgical technique.....

You can read the rest of the article, comment, and follow me at

In regard to Shogun’s upcoming fight against Vera. Shogun has had not only one ACL surgery, but also a second one which makes the chance of it failing even greater. In addition, he likely will never reach the same level of strength he had before his surgeries. Back in Pride, Shogun was known for his devastating kicking power. Unfortunately, we will never have the Shogun from Pride fighting in the UFC, but so far the Shogun we have seen has done pretty well. Even recently, ESPN’s Sport Science measured his kicks at an amazing 2749 pounds of force! Brandon Vera, however, is known for his striking ability, and ACL surgery can limit your ability to move laterally out of the way of oncoming kicks. As these guys get older, they can't rely on strength and speed anymore and must use their technique, which usually means more of a ground game. On his feet, Shogun’s clock is ticking thanks to his injuries and surgeries. For Shogun’s sake, let’s hope his knees outlast his UFC career.
I hope to start some quality discussions where fans, fighters, and doctors can come together to make the sport safer and people can make better decisions with better knowledge. Get involved at to make this sport even better! @FightMedicine

\The FanPosts are solely the subjective opinions of Bloody Elbow readers and do not necessarily reflect the views of Bloody Elbow editors or staff.

Log In Sign Up

Log In Sign Up

Forgot password?

We'll email you a reset link.

If you signed up using a 3rd party account like Facebook or Twitter, please login with it instead.

Forgot password?

Try another email?

Almost done,

By becoming a registered user, you are also agreeing to our Terms and confirming that you have read our Privacy Policy.

Join Bloody Elbow

You must be a member of Bloody Elbow to participate.

We have our own Community Guidelines at Bloody Elbow. You should read them.

Join Bloody Elbow

You must be a member of Bloody Elbow to participate.

We have our own Community Guidelines at Bloody Elbow. You should read them.




Choose an available username to complete sign up.

In order to provide our users with a better overall experience, we ask for more information from Facebook when using it to login so that we can learn more about our audience and provide you with the best possible experience. We do not store specific user data and the sharing of it is not required to login with Facebook.