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Monday, October 5, 2009
Updated: October 8, 4:30 PM ET
Cutting it close

By Alyssa Roenigk
ESPN The Magazine

This article appears in the October 19 Body Issue of ESPN The Magazine.

From learning that Coach has gambling debts to surviving an atomic wedgie, sports overflows with rites of passage. But none fires the smithy of the soul quite like an ACL tear. The path to ligament enlightenment may begin with a bang (see: Brady, Tom) or -- as with motocross star Blake "Bilko" Williams -- the whimper of a (right) knee twinge. But either way, nothing in sports says "I've arrived" better than an ACL surgery scar.

Ironically, when not making orthopedic surgeons rich, the anterior cruciate ligament keeps a low profile, crossing in the center of the knee, attaching shin to thigh and stabilizing the joint. This workmanlike hunk of tissue can endure 500 pounds of pressure. But like Manny Ramírez, sometimes it just quits, a misfortune that befalls 100,000 folks (including more than 100 pro athletes) each year. Most such injuries occur when the leg pivots awkwardly or when the knee is hammered. For Bilko, alas, the ACL cried ˇNo más! as he dismounted his bike after his winning X Games run. Oh, the indignity.

BLAKE "BILKO" WILLIAMS | AGE: 24 | SPORT: FMX | BORN: Baxter, Victoria, Australia | BASE: Murietta, Calif. | CLAIM: 2009 X Games gold | COMPLAINT: Torn right anterior cruciate ligament ... again

Time was, a torn ACL was more or less a career ender (see: Collins, Doug). But modern jocks often return within months of having shredded the humble band. Thank arthroscopic surgery and platelet-rich plasma therapy, in which the patient's own blood is used to speed healing. It can be pricey -- upwards of $10,000 until universal health care kicks in -- but worth every dime.

Here's how Bilko's knife play went: At 11 a.m. on Sept. 2, he limps into Newport Center Surgical in Newport Beach, Calif. Soon after, surgeon Warren Kramer uninstalls the ruined cadaver ligament used to fix Bilko's knee after a blowout 10 months earlier. Next, Kramer pulls two hamstring tendons (pictured) through a small incision below Bilko's knee. A nurse strips the tendons of muscle and marinates them with the platelet-rich plasma. Finally, Kramer anchors the pieces with screws to Bilko's tibia and femur. Bilko leaves the clinic on crutches at 4 p.m., knowing he's just four months from putting his new best friend in harm's way again.

Alyssa Roenigk is a senior writer at ESPN The Magazine.