Monday, September 29, 2014
Theo Walcott: ACL injury, surgery and prognosis

Theo Walcott: ACL injury, surgery and prognosis

80 minutes into the North London Derby, Arsenal hold a comfortable 2-0 lead and Theo chases back to nick the ball off Danny Rose. He stretches his left leg in front of the hapless spud to win the ball but immediately crumples to the ground in pain.

He lies there immobile while Bacary Sagna signals to the medical team. As a physio these are always the injuries that worry you most at pitch side. In most cases if a player is comfortable enough to roll around on the floor they often haven’t done much lasting damage. If however they won’t move at all alarm bells start ringing.

Despite Theo putting a brave face on things the Arsenal medical team were clearly worried and arranged a scan for Monday morning which confirmed one of the worst injuries in football – an anterior cruciate ligament (ACL) tear.

The ACL is a ligament deep within the centre of the knee. It helps prevent excess movement between the tibia and femur. It’s vulnerable to injury when there is a twisting force on the knee. Classically the upper leg moves inward with the lower leg fixed in place with the foot on the ground. Reviewing Theo’s injury in slow mo it appears this happens as he reaches for the ball – video here.

wpid-Photo-7-Jan-2014-16281

Note in the second picture that Theo’s foot remains pointed towards the ball while his upper leg rapidly changes direction. It’s always hard to be 100% sure of the exact mechanism of an injury but this appears most likely. It’s possible the injury occurs milliseconds later than this as the knee flexes more and there is further movement of the upper leg. However at that stage Theo’s heel has lifted from the floor allowing more movement of the lower leg to compensate.

Unlike other structures in the body the ACL won’t simply heal on its own. The broken parts of the ligament are no longer in contact with each other. Away from elite sports around 50% of people who suffer an ACL tear will have surgery and many can recover well with adequate rehab. However in elite sports the vast majority will opt to reconstruct the ligament and allow full return to sport.

wpid-Photo-7-Jan-2014-171523The surgery involves replacing the ligament, usually with a section taken from the patient’s hamstring or patella tendon. This is screwed in place within the knee. During rehab this graft needs to be protected and as a result there is a fairly restrictive protocol for rehab which will differ depending on the surgeon. Rehab after surgery is often done in stages based on time (to allow graft healing) and improvement in range of movement, muscle strength and function.

For the first 1-2 weeks weight-bearing may be restricted and sometimes a brace is used. Those with a good memory mighty recall footage of Robert Pires on crutches, hobbling around in a brace after his ACL surgery. From around 2 weeks onward patients are usually weaned off braces and crutches. Rehab starts at day 1, with very gentle exercises to maintain muscle function and reduce swelling.

These are gradually progressed at each stage with the aim being to restore full range of movement in the knee and strengthen all the muscles which support and stabilise the joint. Typically rehab will focus on quads, hamstring, glutes and calf muscles and will include balance and control work as well resistance training. At approximately 3 months post op, when the graft has had adequate time to heal, rehab is usually progressed to include impact, progressive strength work, plyometrics and sport specific rehab.

Return to sport usually takes 6-9 months post op and prognosis is based on a host of factors. ACL injuries often result in damage to other structures in the knee such as the meniscus or medial collateral ligament which can affect outcome. Player’s response to rehab varies a great deal and secondary injuries or relapses can be an issue. In addition the psychological impact of long term injury shouldn’t be underestimated and fear of re-injury can be a barrier in return to sport.

The best case scenario for Theo would be a return to full training in the summer, potentially in mid-July. I suspect he’ll have limited involvement in pre-season but may start to feature in the squad in the early stages of next season.

On a personal level for Theo this must be a huge blow. In recent seasons he’s developed into a real danger man for Arsenal. Although his performances this season have been restricted by injury he’s had an big impact since his return and this season we’ve won 78% of the games he’s featured in compared to just 54% of the games he hasn’t (source Sky Sports News). To be developing well as a player in a team top of the league and then face 6 months out must be devastating.

We wish him a speedy and successful recovery, his first aim of rehab should be to be strong enough in May to help us lift a few trophies!

Tom is an Arsenal fan, physiotherapist and creator of RunningPhysio. Follow him on Twitter via @tomgoom.

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81 comments

  1. I’ve torn mine twice. In spite of having a kidney stone, the first ACL tear was the worst pain in my life, as I tore part of meniscus on that one. “Now, I’m not a doctor”, but based on Theo’s reaction during and after the injury, I am guessing he did not tear his meniscus, at least not very badly. So I would think he’ll have a relatively straightforward recovery. And I wish him all the best.

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    • Here’s something about ACL injury: Roberto Baggio had an ACL injury 4 1/2 months before WC 2002 and made a record-breaking 77-day return to play post-ACL in the ’02 WC.

      So let’s be optimist and hope for a miracle.

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      • Correction: He did not play in the WC, but was actually available to play. Here’s the link to the telegraph article: http://fw.to/c0B2HvS

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      • Let’s hope he forgets all about the WC, so many players have fucked themselves by trying to come back too soon (Lee Sharpe, Rossi after his first one I think too) – just get well Feo, we’ll be waiting buddy

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  2. Shame, just an abolsute shame. I can’t imagine what he’s going through right now. This lad has been working too hard for the WC and he has missed it yet again! He must be in a terrible state right now, let alone the pain.
    Get Well Soon Theo! You’ll come back stronger we know it you warrior! There’s always next time :)

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    • mastaofthegoonaverse

      Course its a shame and he will work hard and recover. I was left penniless and couldn’t walk for nearly a year,

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  3. Will theo retain his pace? Will he have the same explosive burst? Or will he lose a step?

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    • The most important thing is that he has a swift and full recovery. How he deploys his talents once he is back to fitness is of lesser significance right now..

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    • The graft is generally more stable and strong than the original ligament. In addition, ACLs really have the function of preventing excess rotation of the joint, so things like cutting, shuffling side to side, and changing direction are really what you need the repair for. the ACL is not as relevant as it pertains to straight line speed.

      given a top of the line rehab, there is no reason why his pace should be diminished any appreciable amount. He might lose a half step, but he should still continue to be the fastest man on the field.

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  4. Currently recovering from ACL reconstruction

    Really impressed you put this post up about the ACL, great work arseblog!

    I will say though, the rehab program you mention is quite old fashioned. A brace for the knee is rarely used and modern practice has the knee weight-bearing and utilised on the day of surgery. I remember the day after surgery I was doing mini squats. Everyone is different though.Theo’s a warrior, so I’m sure he’ll get through it!

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    • I had my ACL done and my experience was not of mini squats the day after surgery, it was ice-man, a contraption that sent ice-chilled water through a pad around my knee. I was operated on by the same surgeon that did a football player I knew at University, so I assume he was pretty good.

      I guess it depends on whether they take the patellar tendon, hamstring, or one from a dead person. I had the patellar tendon graft and there was certainly no weight bearing straight away.

      Anyway, It took me a little over 12 month before I could play football again, but I did not have a professional physiotherapy team managing my recovery.

      I also did my ACL snowboarding but did not know, I ran around for ~10 years without an ACL before it loosened up playing football, the doctor recommended reconstruction if I wanted to continue playing, so I did it. Four days before surgery I climbed a 14,000 ft mountain, then I could not run for 6 months…

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      • 10 years without an acl… I’m genuinely curious, are you using hyperbole or being serious?

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        • Serious, read the article that Blogs linked in his post yesterday, there is a guy who makes it as a pro basketball player without both ACLs, my own doctor said there was a famous American football player who played without an ACL. I did a lot of mountain biking around that time and I guess it strengthened the knee, even after I felt the knee give playing football my doctor said it was stable, but offered an MRI anyway. There was no ACL, it had ruptured so long ago there was no trace of the ligament anymore.

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        • Your knee may pop out once in a while, but it isn’t that bad. Anyway…if you have knee ligament problems I suggest you fix them right away, ’cause in a few years time it will become a pain in the arse.

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        • Some American Football players go to play college (American) football without realizing that they don’t have an ACL or some other ligament. Then they get drafted for a major team, and they have to retire because of it.

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        • Same goes for me, I tore my ACL when I was 10 and had it fixed when I was 20. My doctor also said that there are a lot of kids running around without even knowing they had no ACL.

          It actually hurts when I see the picture of Theo’s tackle, poor lad! I really hope he takes his time for the recovery and doesn’t rush back.

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    • The article does explain why Diaby is always injured though. He’s had so many cruciates taken out of his hammy that he has no hammy laft

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  5. I feel for Theo, just about when he was hitting his stride and best form. Very tough to replace the clever movements and the obvious speed. Get well Theo, and trust your mates will go get them trophies for you.

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    • It’s sadly been a bit of a trend with Theo. I can think of his getting injured at least three times at a point when you had this strong feeling that he was about to take flight.

      It’s crazy, he used to be this kid with a lot of pace but limited technical quality and now you can tell that he’s become a much more clever player with ever-improving technical skill and finishing that is, at least on occasion, reminiscent of Henry. Wenger has such a magical touch for moulding elite warriors out of rough drafts.

      I believe in Theo, setbacks or not. I believe that he can be the top goalscorer in the Premier League. His passing in the final third is excellent as well. His hold-up play has become more and more reliable, and his understanding with Sagna (ANOTHER reason to extend Bac’s contract, please) is borderline telepathic now.

      Also, I find that an Arsenal side with Theo is always much more exciting than without him. Not having a go at the rest of the squad, I love every player on it. But the way that he terrorizes defenses is, for me, on par with Suarez and Aguero.

      I won’t say get well soon but I will say, please get fully fit. I wish you a complete and permanent recovery above all else. Remember the struggles that Ramsey and Rosicky went through, and look at them now. Even Diaby can be used as a role model for his mental strength when he’s had more reasons than everyone else to give up. You’ll be back, and you will fully realize your potential.

      Then you will go on and win the Golden Boot as Arsenal win every cup and competition in sight.

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  6. Sometimes life can really be bullshit. Very sorry for the kid.

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  7. Adding onto the great piece above, I think the best case scenario for Theo would be to come onto the pitch on crutches in late May, celebrate a first Premier League win together with his (football) friends…

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  8. Truly gutted. And to think those sp*ds cunts kept yelling “LET HIM DIE”……welp, an injury is never a good thing but the timing couldn’t have been better for us. Lets hope le prof (and everybody else involved) learned from what happened to eduardo and the effect it had on our season and sign somebody. But not a desperation signing simply bc we’re not desperate. Top of the league, knock out in CL, cruisin thru the FA cup, all the cards are in our hands….lets act on it!! COYG!

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    • I like when they do shit like that, reminds how superior we are to them in every way. Maybe’s its different when you’re from a smaller country (I be Irish I do) but if Robbie Keane was down and I was in the Arsenal end, I would be just as concerned as if it were an Irish game. Don’t understand at all but has to be different for English seeing as most of the players are. Ramble ramble ramble…..

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  9. Very interesting article, thank you.

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  10. I have a brother who plays basketball and the same thing happened to him, 6 months ago. he had the surgery and it took well over a month before he had to ditch Crutches and walk freely. Its been five months since it happened and still he hasn’t got back to trainning let alone running. He complains of twitching in his knees and general weakness in that area and doubts remain if he will ever gain enough strength to play the game again. but i hope he recovers since its the through bball that he got his University scholarship.

    With proper surgery and rehabilitation: (which i believe is better at Arsenal than we have here!) i hope Theo recovers and comes back stronger. it will take alot of hardwork and determination no doubt and i just pray theo has that. Get well soon theo. we need you.

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    • See the link on the main blog today, some interesting stuff about ACLs and basketball players.

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    • I had this same surgery in my left knee…. It took me one day to ditch pain killers and 10 days to start hobbling around and ditch crutches… 30 days to start full rehab with balance training ….. Stretching and a little bit of motion. 4 months I was running again… Haven’t re injured it since. Theo’s body structure is virtually exactly like mine was at the time, he can be back for the start of next season, he shouldnt try to be more ambitious, it could ruin his entire career if he re injures it at the world cup.

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  11. Tore mine a few years back doing the exact same thing. Knocked the ball out to the sideline with the outside of my foot. Heel came down and stayed planted in the turf. Knee bent in a manner it’s not meant to do. Snap. As far as him smiling on the way off the field, it hurts like hell then no pain at all. I jogged on mine at halftime and announced I would be playing the second half only for my goalkeeper to threaten tackling me for being stupid. Turns out he was right. Hope Theo will have a full and quick recovery and won’t be as fat and slow as I am now!

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  12. I heard his pace wont drop. hopefully he will come back stronger to help us defend our title next season!

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  13. Six months is a pretty optimistic timetable, but then again, everybody’s different. When I snapped my ACL and had the subsequent surgery I was off crutches in just six days, but it was nine months before I could run regularly. The knee’s never been the same. But … I didn’t have Arsenal’s army of physios and doctors guiding my rehab, and I didn’t have Theo’s drive and willpower, and my career didn’t depend on my working my butt off to get back into shape.

    Pires came back even better than before after his surgery, and that was back in the day when the doctors had to do a horseshoe cut and lift up the patella to put the new ligament in. Today, the surgery is arthroscopic and requires only a one inch incision at the top of the tibia plus three tiny holes around the top of the knee that you couldn’t fit a coffee stir stick into. I’m sure when Theo comes back, whether it’s in six months or nine months, that he’ll be as good as ever.

    And to help him in his comeback, he’ll have a league winner’s medal on his mantelpiece to look at over the summer, to go along with the FA Cup winners medal and the Champions League medal the team will win for him while he’s out. They’ll be his incentive to get healthy and win another treble in 2014-15.

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  14. Really want to be positive, and I still think we can have an excellent season, but in all truth I doubt we can win the league without him.

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    • If you want to be positive, just don’t say it! :-) Sometimes it’s a good idea to keep your doubts to yourself…

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  15. I hope the club are looking for the best knee surgeon, wherever he or she may be in the world.

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  16. The other ACL – Alex chamberlain.

    should help ease Theos Absence….

    Get well and back soon.

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    • I don’t think the Ox tore his ACL. I think he tore his PCL. However, this is just based on his mechanism of injury and his lack of surgery (which wouldn’t be considered if he had torn his ACL)

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  17. Blogs, can you remember how long it took Dreamy Bob to recover?

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  18. As fans we feel the pain and the agony of seeing a chunk of a wonderful player’s career go down the drain through sheer bad luck or misfortune.
    Imagine what the man who discovers these players and wants the best for the club and the one man who wants to win trophies with Arsenal more than us all feels!

    Everything about the Theo injury has made me so sad lately. Get well soon, Theo! We know you will make it and come back stronger.

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  19. The surgeon will be Andy Williams. Good man, good surgeon.

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  20. I liked that you put Pires injury in there. Remember he had a great season when he got injured, had a really good comeback season and then he was better than ever in the next one. That’s some good inspiration for Walcott, I think he’ll make it back good as ever.

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  21. It’s interesting articles like this that keep me coming back to this site time and again, every day. Stellar stuff, keep it up

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  22. Ping pong 4 Frimpong

    I know this isn’t very relevant but Novak Djokovic must not have any ACLs. He bends his knees like that all the time. Moving back on topic, get well soon Theo!

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  23. That was a very interesting article and I thank you for publishing it.
    I feel bad for Theo re his second miss at the World Cup. He’s currently the most inform Englishman in the league so he could well have shone but for me it’s not the end of his world.
    England have absolutely no chance of getting out of the group at the World Cup and it could all be finished after 180 minutes so keeping him away from the slaughtering the players will get while they’re over and on their return might not be a bad thing.
    He’ll be 29, probably at the peak of his power when the next World Cup comes around. Plus the serial failures of English football will have finally moved on, perhaps even that fat, bald toss pot. There’s a chance that he could well even see some kind if success at the Euros with them all gone.
    He’ll live to fight another day and I’m sure that day.
    Sorry for the long post.

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  24. All I can say is Theo should be encouraged recent ACL comebacks in American sports. and ACL tear is not the kiss of death it might have once been. I know it must suck of Theo to miss the rest the season and the World Cup but he should be able to make a full recovery.

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  25. Alex injured his PCL, not ACL.

    While they both interlap each other in an X like formation, they provide stability to different knee torsions.

    I’m not sure if Alex had full reconstruction or not.

    Side note – whatever happened to the ability to reply to specific posts on mobile (iPhone)? We lost that a few months back and I was hoping it would return.

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  26. Get well soon Feo!

    How about Jackson Martinez of Porto as a signing?

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  27. Nice to see a change from all the abuse he got a couple of years ago.

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  28. Haha ad at the top of the page ” Injured? Want to know how much your claim is worth?” Blogs, this is possibly the best product placement I’ve seen on all of the web! Not sure if Theo is a reader so you may need to send him a link! Think he could get a few quid out of those pricks down the road? (If they haven’t thrown it all away already!)

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  29. Everyone is different alright. Depends on the surgeon and doctor/physio too.

    I was on crutches for 10 weeks after mine cos I messed it up pretty bad. I bet Rose will be hearing that ‘pop’ in his nightmares for weeks to come.

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  30. I feel sorry for Walcott missing the world cup again but…

    Frankly this latest media induced nonsense about us missing Walcott more than England should stop.

    Firstly mcNulty starts bleating on about it and now the gimps on ESPN (who don’t have an original thought between them) are on to it. If it wasn’t Burley or that unknown Venenzuelan bloke espousing claptrap, it’s now some chum named Taylor Tweedman who is repeating mcNulty verbatim.

    1) We will be covered in the wide role which Walcott brings back to the team. We have played without Walcott all season until recently. We have Podolski back and soon Ox. Gnabry weighed in with an assist recently (almost two with the late chancefor Ozil…and as I recall a couple for Walcott too). Whilst we have been playing without wide player options through the entire first half of the campaign, we now have that option back and in strength regardless of Walcott.

    2) Where we may miss Walcott is his goal scoring. However, we should also remember that we have just been through the majority of the campaign without him and have still kept top spot. Ramsey is missing but may soon be back. Meanwhile the goal scoring front (which should be separate from the wide role above), can be covered by others. Podolski is a good finisher and nothing stays static. Santi may take up the slack with his thirst for goals barely satiated after the recent derby. Quoting Walcott’s statistics for finishing does not mean others will not improve and if this season is anything to go by (even Betnder weighed in with a goal) it does not exclude the possibility of others coming into a rich vein of goal scoring form in Walcott’s absence.

    3) McNulty (does he watch footy?) makes the same infantile mistake of pronouncing our death before the transfer window is even shut. He gave us little hope of finishing 5th before the transfer window was closed in the summer. We are into the January window and seems to me if we add one more offensive player (a striker who can play wide or vice versa), we will more than cover for both a potential Giroud loss as well as Walcott’s absence. Whilst it is a tight window, it does not mean there isn’t quality available to make up the potential shortfall of Walcott.

    4) Walcott’s loss is not as significant as say (touch wood) we lose Giroud or Metersecker.

    There is ample firepower in the squad for the moment over the next couple of games to do the business.

    but Wenger must be on the look out (As I am sure he is) to cover Giroud principally and potentially make up for Walcott’s strike rate.

    Someone like Michu could easily come in for 10m an offer us the back up we need up top and at the same time a bit of (EXTRA) option out wide. he is not cup tied and is already familiar with the league.

    A Pato loan can also do the trick in bringing a different set of quality up top to Giroud (and the soon to return Bedntner). He is quick and can also play wide, is 24 and is not cup tied with plenty of CL experience.

    Not saying Wenger will go for either but just want to make the point not to get too carried away with Walcott’s loss and be sucked into the media’s doom and gloom. This team is resilient and has more options returning to the bench sooner than later.

    if anything Walcott’s blow is a bigger loss for England unless you believe the clap trap that Townsend (himself injured) is a good replacement or Llalana.

    Ox and Gnabry will shoulder the load for pace and Podolski, Santi can start adding to the score sheet( or indeed Jack). Ramsey will return to the squad and if we add another offensive player (assuming Giroud continues) we have plenty of firepower.

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    • Bottom line, don’t get suckered into any media induced knee jerk doom and gloom. It’s plain bollocks.

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    • Hope English readers will pardon me, but I think what the media are trying to say here is that the Arsenal will be missing Theo more simply because England is fucked-up anyway.

      But with Per you are spot on, for some reason it seems that Kos+Verm partnership is cursed and cannot work (perhaps Sagna with either of Kos or Verm could). That leaves us with the transfer market priorities CB, CF, RB in this order, which of course means Arsene will buy AM.

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  31. Interesting piece about the knee.

    Cheers. Enjoyed it.

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  32. One time I shit my pants. I was ashamed and had a hard time making the 35 minute commute to work with out the fear of it happening again. Point is, sometimes the mental block is harder to get over than the physical block. Good luck theo. get well soon. The arse needs you.

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  33. On a totally unrelated issue, other than it was during the TWO NIL win against the filth, which I just watched again. Did anyone else notice that not one of those biased itv wankers, either during commentary, or afterwards mentioned that we played the last fifteen minutes with ten men?

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  34. Lets also take a moment to feel sorry for his weekly wage.

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  35. Best wishes for Theo! Hope everything goes according to plan and that he recovers well and speedy! COYG!

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  36. tilldeathdouspart

    Good luck Theo for a full and speedy recovery.
    We’ll miss you and we’d rather you were with us but we’ll get by.
    Serge looking good.Pod back,Ox back soon.Ramsey to come.Not all bad.
    Talking of Rammers – Jesus of Nazareth had legendary healing powers.
    Isn’t there anything Jesus of Cardiff can do to help?!

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  37. everyones opinions are to similiar on this site cause of the rating system need more indiviual thoughts and views on things.. not just this news story but many others.

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  38. I hope that he does not go the same way as Michael Owen. He never really recovered that yard of pace after those injuries.

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  39. i call this a knee-jerk reaction: your knee behaving like a jerk

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  40. For all the shtick Theo gets from all corners of the soccer punditry spectrum, he has been one of the most consistent performers in an Arsenal shirt for the last few years.

    He is one of the most exciting players in the EPL, Without a doubt, and maybe one of the most exciting players in the world.

    Great write up. Very good article.

    They say that you don’t really know what you have until it’s gone. Well, Fuck That. We miss you Theodore. Get well soon.

    God Speed Gunner.

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  41. @heraldgoon: cheer up mate, Dejuan Blair of the dallas mavericks don’t have any ACL on both his knees. And yet, he continues to play good bball for his team. I’m sure your brother would recover.

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  42. Terrible injury, worst thing you can do because it doesn’t fix itself…

    I tore mine in March 2012. Had the operation in December 2012.

    Last year was a complete write off for me, only started being able to have a casual kick around with mates around November.

    Hoping to play this year though!!

    Wishing Theo all the best, shame but from a selfish Arsenal perspective… it has happened right when Gnabry played amazing, OX looks to be back in training and it is January transfer window.

    For us, it could be worse..

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  43. Wish Theo will recover soon! Hope this won’t affect him at all. Damn!

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    • ThePascalCyganInsideGunnersaurus

      lol I wouldn’t touch this surgeon with Mourinho’s ACL! This man is shamelessly cashing in on Theo’s injury to raise his own profile as a private practitioner ha ha

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  44. Great post. Am I the only Arseblog reader who hasn’t done his cruciate?

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  45. I hope has a quick recovery!
    Even though he is inconsistent in patches we are definitely weaker without him. Hopefully Gnabry and the ox step up.
    I also think Wenger missed a trick by not signing Keisuke Honda on a free transfer!

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