How did Zlatan Ibrahimovic play six months with a ruptured ACL in his left knee?

Dr. Raj, DPT explains

Footballing legend and AC Milan star Zlatan Ibrahimovic revealed through IG that he played the final six months of the season with a ruptured ACL in his left knee. Lets start with how that’s even possible.

How’s it possible?

Nearly all elite athletes who rupture an ACL will have surgery – which Zlatan has undergone – but some are better able to cope without one. This key distinction between “copers” and “non-copers” is the level of instability in the knee following the ACL rupture.

Comparison examples

I couldn’t come up with other football-specific examples but two others are quarterback Phillip Rivers of the NFL’s San Diego Chargers who played in a playoff game six days after an ACL rupture and meniscus damage and even more incredibly, NCAA 3-time college champion wrestler Spencer Lee of Iowa college who tore his right ACL in the 2019 final and then in 2021, he ruptured his left ACL during the season, never had it repaired, and went on to win his 3rd title. The functional & stability demands in wrestling are incredibly high – much higher than football. It’s an incredible story and accomplishment.

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In-season management

Zlatan mentioned numerous by-products of his decision over the course of the six months. He barely trained with the team to load manage, more than 20 injections, had fluid (swelling) drained weekly, took painkillers daily, and had problems sleeping due to the pain. He also had a meniscus tear which may have occurred at the time of the initial injury or due to ongoing instability in the knee.

Long-term consequences

The key long-term consequence is an increase for osteoarthritis in the knee and generalized pain and dysfunction. Ongoing commitment to strength and fitness – beyond just his rehab and career – will be key for Zlatan to limit that risk and symptoms.

Competitor mentality

Zlatan’s competitive spirit and drive is top of the top and this is yet another example of what elite athletes will put themselves through for team and sport. Only time will tell if it’s worth it or not – would love to hear his answer in 10-15 years – but for now, he can take pride in what he sacrificed for the team and being part of AC Milan’s first Serie A title in 11 years.

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Dr. Rajpal Brar, DPT, (@3cbperformance) is a physiotherapist, movement expert, strength and conditioning/fitness coach, sports scientist and mindfulness coach. He runs the LA and online based physiotherapy and athletic performance clinic 3CB Performance and you can subscribe to his Youtube channel (which posts a variety of sports injury, performance, and fitness related content).

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