In an interview with MMAJunkie.com Radio on May 10, Gegard Mousasi acknowledged that he recently had surgery to repair a torn ACL. Even worse, he confirmed that the he tore the same ACL that was previously repaired in March 2012. He entered his UFC on Fuel TV 9 fight in April against Ilir Latifi knowing that his knee was injured.
In the interview, Gegard indicated that he used the same surgeon that did his previous ACL reconstruction, and that the failure of the first surgery "wasn't about the surgery. It was just, maybe training too early or something like that that caused the problems... the surgeon didn't do anything wrong." He anticipates returning to action the end of this year, or possibly January 2014 depending on when the UFC has a fight for him.
When asked if his rehab from this ACL surgery will be different from last one, Gegard replied "We're moving a little bit more faster forward with this one. Its healing also much faster than last time because they did less damage to my knee, so the recovery is going also faster this time."
From a rehab and recovery standpoint, there is a lot to sort through in the new information that Mousasi divulged. First in my mind is the failure of the first ACL surgery. Mousasi indicated that the most recent surgery "did less damage" to the knee than the first. I therefore presume that the first surgery used the traditional patella tendon graft to replace the ACL, where an incision is made over the patella tendon below the knee cap to harvest part of the tendon as well as a bone plug at each end of the tendon. (This is called a bone-patellar tendon-bone, or BPTB graft.) This is the "gold standard" for ACL construction, and the fact that this surgery failed is not good.
If the first surgery used the BPTB graft, his surgeon had to resort to a back-up source of ACL graft for the second surgery, such as cadaver allograft or hamstring tendon graft. While these do not involve the extra incision as in the BPTB graft (thus "less damage" to the knee), they come with their own unique challenges for recovery, especially in an elite athlete. The cadaver allograft takes longer to incorporate (or "take") within the knee. The allograft has an increased potential to rupture again, especially in a young, elite athlete. (Ask Dominick Cruz about this one.) In my opinion, the hamstring tendon graft would be preferable in a second ACL repair, as it uses one's own tissue to replace the ACL. However, the hamstring tendon graft takes longer to heal as well (compared to BPTB grafts), as there are no bone plugs at the ends of the hamstring tendon graft. Soft tissue-to-bone healing takes longer than bone-to-bone healing.
For the ultimate health and stability of Gegard's knee, I hope he had the hamstring tendon graft. He stated that his recovery is moving "a little bit faster" than the last time. However, it is very early in his recovery at this point, and "moving faster" probably means that he is no longer on crutches, he may be performing low level quadriceps exercise, etc. Ultimately, I feel that his rehab may take longer than expected, simply because he probably had one of the alternative ACL replacements in his second surgery. I would not expect him back in the Octagon until January 2014. (His own time frame in the MMAJunkie.com Radio interview was November - January.) As with all injured fighters at this elite level, there are the two variables that are not typical of the average patient that has this surgery- an incredible level of dedication to returning to a high level of competition and a dedicated rehab team that he probably has access to every day. This level of dedicated rehab can safely return a fighter to competition sooner than expected. Let's hope that is the case for Mousasi.