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UFC 154: GSP vs. ACL

Special to FOX Sports Dr. Jonathan Gelber, M.D.
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Georges St-Pierre will return to the octagon, where he will face interim welterweight champion Carlos Condit at UFC 154 on Saturday in Montreal.

GSP has been out of action for 11 months after undergoing surgery to reconstruct a ruptured ACL. From a medical perspective, GSP’s knee may end up being the first flicker in the aura of one of the greatest champions of all time. Not only is his knee not the same as before the injury, but the surgery itself may limit his strength and agility against one of the UFC’s best strikers.

First, it’s important to know what the ACL actually does. The ACL, or anterior cruciate ligament, is one of two ligaments that crisscross in the middle of your knee. The ACL acts to prevent the knee from becoming unstable and buckling during sudden changes in direction such as cutting or twisting.

GSP underwent ACL reconstruction with a patellar tendon autograft (autograft means using your own tissue). The patellar tendon is where your quadriceps muscle runs over the top of your patella (kneecap) and attaches to your tibia (shin bone). The tendon is taken along with some bone from the patella and tibia on either end. This graft is thought to have the easiest chance of it healing since it has bone on the ends. In very simple terms, an ACL surgery is like stringing a rope between two cans and then tightening the rope so the cans stay close to each other.

Unfortunately, a common side effect of patellar tendon harvesting is pain over the kneecap, especially when you kneel down, which is something grapplers do all the time. The other issue with patellar tendon grafts is that there may be some resultant weakness of the quadriceps, which are the muscles that straighten your leg, so theoretically this could weaken the "snap" of GSP’s kick. Furthermore, even without taking part of the patellar tendon for the graft, the quadriceps muscles begin to weaken after ACL ruptures – so getting them back to 100 percent strength is vitally important for GSP. They act as important stabilizers of the knee, because when they contract, they help keep the knee aligned, especially with sudden changes of direction or level changes.

Prior to his injury, GSP was training with Jon Chaimberg, a well-respected strength and conditioning coach. This certainly put him in a good position for rehab, as he had a good base to begin with. After his surgery, GSP underwent formal physical therapy with certified physical therapists. Beyond that, GSP has surrounded himself with nutritionists and massage therapists, as well as well-known manager/coach Firas Zahabi. He has a good team behind him.

GSP has done everything right by the book to recover from his surgery. However, an injured knee is never the same as an uninjured knee. Surgeons do their best to bring people back, but sometimes it takes up to one year to get back to playing sports and two years before an athlete feels normal, even for elite professionals.

THEY'RE KNOCKOUTS

It's hard not to fall hard for the UFC Octagon Girls.

Many people will look at Adrian Peterson’s rapid recovery and think all professional athletes will return to their prior level of play after only nine  months. What Peterson is doing for the Minnesota Vikings is actually considered impressive, even by NFL team doctors who do the surgeries on these guys. Up until Petersen, the list of NFL running backs that came back and performed poorly was ever growing: Jamal Lewis, Edgerrin James, Deuce McAllister and Ronnie Brown to name just a few; not to mention that one study showed that a third of NFL players that rupture their ACL don't even come back.

What does help predict how well someone comes back is their baseline skill level (higher NFL draft picks come back better) and age at the time of surgery. GSP tore his at age 30, and Petersen tore his at 26. Sometimes those few years matter in professional sports. Other studies have shown that even NFL players only get up to 80 percent of their original quadriceps strength back one year after ACL surgery.

So the question remains if GSP is returning too soon. His graft is likely strong, but the real question is if his mobility will be the same. He may not be able to move suddenly from side-to-side as quickly as he did 1 year ago. In addition, his quadriceps strength may be just a fraction less, which is all it takes for someone to lose at an elite level. Furthermore, GSP is one year older and hasn’t been in the groove of competition as he was during his dominant reign.

TRISTAR GYM

Take a look inside the gym that GSP calls home.

Carlos Condit might be able to exploit this by keeping the fight standing. Condit has won a majority of his fights by knockout, and striking is certainly one of his strengths. During stand-up, GSP may not to be able to move laterally as efficiently, which will directly be related to his knee stability. In addition, if he does want to take the fight to the ground, shooting in will also stress his surgically repaired knee. High kicks or superman punches may not be in GSP’s repertoire as they once were.

On the other hand, GSP has shown he can certainly neutralize opponents on the ground. So should he find a way to get Condit, down, it may be all he needs to see a win by submission or decision.

There is no question that GSP will enter the Octagon in great physical shape and with a great team behind him. But with many of these factors against him, he may never be able to return to his pre-injury level.

However, GSP didn’t become one of the most successful UFC champions of all time without finding a way to win. Even a slightly less-than-perfect GSP is still championship material.

Want more injury analysis? Check out Fight Medicine on Twitter @FightMedicine or visit FightMedicine.net.

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