THE 2024 Grand Final provided a full circle moment for world-renowned rehabilitation specialist Enda King, who watched with satisfaction as the first AFL star he worked with retired as a premiership player. 

Joe Daniher travelled to Dublin as an Essendon player to seek treatment from King more than five years ago as he battled groin injuries, moving to Brisbane shortly after where King followed his career from afar as he played 96 games in four seasons.    

King has since grown in prominence as more and more AFL players venture overseas to seek his advice and treatment at Aspetar, the expansive orthopaedic and sports medicine hospital in Qatar. 

He has helped AFL stars including Jeremy McGovern, Jordan De Goey, Elliot Yeo and Adam Cerra through injury concerns, and worked with many international athletes as they recover from the dreaded ACL injury.  

With more ACL injuries happening across elite sport, experts like King are working hard to find new and better ways to help athletes recover and return to their professions and ideally avoid re-injury. 

They can see a future where virtual reality is utilised more in rehabilitation, surgery methods are highly tailored based on things like age, muscle mass, size and gender, and genetics plays a role in preventing the injury before it happens. 

"There's quite a strong family and genetic history with ACL injuries, and you'll often see it in a run of brothers or sisters or where Dad or Mum has had the injury," King told AFL.com.au. 

"So identifying those athletes at risk through gene testing will evolve.

"Then the ability to analyse human movement in its natural environment, so on the footy field while playing and training, will do a much better job at identifying athletes that are [at risk] and being able to target them. 

"I think inevitably that's the way it's going to go, with the use of machine learning and AI to combine their injury history, biomechanical testing, GPS numbers and put all that in a single system and start getting better at identifying who's at risk of any injury, and in particular a knee injury.

"Collecting data has never been a problem for us. It's collecting all the important data and then being able to have systems that can analyse it properly that has been the gap." 

Finding ways to prevent ACL injuries from happening is something that King thinks about daily, and it shapes as one of the main areas for innovation in the next 10 years, particularly the prevention of re-injury in elite athletes. 

Leading surgeon Julian Feller, who is credited with saving the careers of some of the AFL's biggest stars, believes a return to an old technique can continue to play a role in prevention. 

The surgeon of choice for most Victorian clubs, Feller was using a technique in the 1990s where a lateral extra-articular tenodesis (LEAT) procedure was added to the ACL reconstruction at the same time. 

The method started to grow in prominence again around 10 years ago and is now used on a majority of AFL players, making the initial stages of rehabilitation harder but reducing the risk of re-injury, particularly when paired with a hamstring graft. 

A study in Canada is investigating success rates when a LEAT procedure is combined with a quadricep graft and a patella tendon graft, which Feller said could influence how knee reconstructions are performed in the future. 

"We're in this sort of flux with how often we need to do a LEAT and is a hamstring tendon with a LEAT a good enough option, or should we be looking at other graft types?" Feller told AFL.com.au. 

"There's lots of questions which certainly in three years we will know a lot more about, and then it may even be that you can try and tailor what you do to the individual patient with good evidence behind you. 

"You can pick all sorts of examples, but I think we'll probably be able to tailor the surgery to the individual a bit better, and also in terms of how quickly we want them to come back if there's contract pressures and that sort of thing."

Having foreseen the trend towards faster recoveries a decade ago, Feller can see advancements in virtual reality helping players in the future and allowing them to gain confidence in their movement during different stages of rehabilitation.  

He believes synthetic grafts will be eliminated and donor grafts will be used sparingly, with hamstring, quadricep and patella tendon grafts to be used more strategically as part of a "better algorithm" that designs the right surgery for individuals. 

Brisbane forward Lincoln McCarthy is the ideal example of a player whose surgery and rehabilitation can be tailored for a quicker return as he pushes to be available for Brisbane's finals campaign this season following an ACL injury in March. 

The 30-year-old would match the efforts of Carlton veteran Sam Docherty in 2024 if he can do that, helping build the case for AFL players to chase quicker recoveries in the right circumstances. 

"He's obviously out of contract at the end of the season and there's a drive to try and be involved with a finals campaign, so straight away it was about, 'What are all the different options here?'" McCarthy's manager Tim Lawrence told AFL.com.au. 

"If he can get back and play, that would be amazing. But it is more about being there and making sure the team has some depth and coverage in case something goes wrong. 

"So that meant speeding it up and not going the traditional way, because we know that's 10-12 months. So how do we do this quickly?

"There's no magic wand or thing that we hadn't heard of, it's just being aggressive and pushing as quick as we can. 

"We'll probably have a fair idea by June or July whether it's going to work or not, but he's really committed to it."

In McCarthy's favour is his recent experience recovering from an ACL injury in 2024, with the former Geelong forward understanding where the opportunities are to accelerate and hit key milestones.   

It's an area where King is experienced in helping athletes make every week count, with the rehabilitation specialist believing the key to fast-tracked recoveries was to work on all aspects of the rehab at the same time. 

"If you want to get back early, it's not enough to only focus on one aspect of your performance, you really need all of the various components to be coming back and working on concurrently," he said. 

"So conditioning is improving all the time, body composition is being monitored, sport specific skill has been worked on early and progressed through, and then landing, strength, and other qualities are all coming along.

"My philosophy with the athlete is we want you physically ready whenever you get the nod to proceed. 

"So for example we have done loads of running mechanics drills before we go for our first run, and we've done loads of change of direction and cutting long before we go on the field. 

"We're a step ahead preparing for what's next so that when you do get the nod to proceed, your body is physically ready and you are mentally ready to take that step successfully."

While King and Feller can see opportunities for innovation with elite athletes who suffer ACL injuries over the next 10 years, the key battleground could well be at the junior level. 

Daniel Kadlec is a researcher at Edith Cowan University in Perth who specialises in ACL injury prevention, also spending seven years working in women's football with WAFLW club Claremont. 

Kadlec said he had seen a gradual reduction in ACL injuries in women's football as players enter the sport with more training and physical preparation as junior athletes, potentially pointing to a solution over the next decade. 

"There's a huge difference in how much girls and boys are getting prepared and how much time and resources they have to be as fit and strong and fast as possible when they get drafted," Kadlec told AFL.com.au. 

"That's probably one of the biggest challenges, just to have this foundational work done over years and years. 

"The best case is that it has already started when it comes to high school level and they have professional staff and training throughout the pathway. 

"Acknowledging funding though and putting the right people into the right places when athletes are starting the whole journey [is important]." 

Kadlec said he had come across too many ACLs working in women's football, but the downward trend was pleasing, with the AFL's most recent injury report at the end of last year also showing that incidence rate in AFLW matches had decreased. 

When training injuries were included, the overall incidence rate in the AFLW had not risen over the past four years. 

While there is a temptation to search for ways to fast-track recovery in the future and get athletes back to their sport, Kadlec hoped there would also be room for firmer guidelines on when players can return to action. 

"That comes with research and establishing not more but better criteria that are very specific to athletes or to sports when it comes to when can I put them back into training and into competition?" Kadlec said. 

"Once the athlete crosses the white line, there's always going to be risk associated. So prevention is still very hard and even if you do everything right, things can still happen that are out of control. 

"What we can cover is making them as strong as possible, as fit as possible, as fast as possible. They are the biggest rocks that impact them when it comes to being robust and as resilient as possible."