Why are Anterior Cruciate Ligament Injuries so common?

ACL Injuries

 

First of all, lets explain what it is and how it happens. 

Your Anterior Cruciate Ligament is one of 4 important ligaments in your knee which helps to provide stability to your knee joint. It connects your femur (thigh bone) to your tibia (shin bone)  and it’s the main job is to control and stabilise the knee during twisting and rotating actions. ACL injuries are therefore common in many sports that involve jumping and landing, twisting, and rotation including GAA, soccer, rugby and skiing. 

Your ACL is not essential for day to day activities such as walking, driving and working (depending on your line of work).

 

Signs of an ACL rupture

How the injury happened is crucial to diagnosing an ACL injury. It commonly occurs when the foot is planted on the ground with a rotation force going through the knee. The ACL is designed to withstand a certain level of force but when this threshold is met the ligament can rupture joint (when this happens it is called “The point of no return”).   People often report extreme pain, the sound of a large ‘pop’ and almost immediate swelling. They generally grab their knee straight away (you’ve probably seen someone do it in a match on TV – they generally know they’ve had a major injury and look devastated!). Bruising occurs within the first 24hrs. Unfortunately, it is not uncommon for people to damage their medial collateral ligament (MCL) and at times cartilage within the knee too. 

Management of ACL rupture – Conservative vs Surgical

Thanks to modern day technology ACL ruptures are quickly and efficiently diagnosed through MRI’s and ultrasound imaging. Once a diagnosis has been made they must decide how the injury will be managed. ACL ruptures can be managed conservatively or surgically. Conservative management of an ACL rupture can be extremely successful. As previously mentioned, the ACL is not usually needed for day to day activity – this means that some people, depending on their level of activity, can be almost unaffected by the injury. Conservative management (generally a rehab programme under the guidance of a Chartered Physiotherapist) is decided upon depending on the age, activity levels and opinion of both the orthopaedic team and the individual. Surgical management is more commonly opted for in the younger population as a fully repaired ACL is essential for return to sport. The ligament is replaced by a graft taken from any of the following; patellar tendon, hamstring tendon or iliotibial band.   

The Road to Recovery 

We often hear in the media about soccer players returning to sport within 6-9 months of an ACL reconstruction. However, research shows that return to sport before 9 months post ACL reconstruction increases the risk of re-rupture. In fact, it can take anything from 12-18 months to rehabilitate and to return to sport. Rehab generally follows a strict protocol, which varies depending on which type of graft is use. It starts quite light, and will quickly progress over the weeks in difficulty and intensity. Initial stages of rehab are about regaining full range of movement of the knee and also regaining as much strength as possible. Generally, after a few weeks, swimming and stationary cycling can be commenced. Running starts to appear into rehab once good control and strength around the knee has returned. It will start with a straight line running and progress on to multi-directional work which may include some jumping and landing drills also. This is all very gradually introduced and the knee is monitored throughout. The final few months of rehab can be very tough mentally in that the knee can feel ready, but returning to full level sport needs to still be very gradual.  

Prevention 

Once rehabilitation has been completed and they are back to the sport then we need to focus on prevention of another injury – or indeed prevention of a re-rupture, which is unfortunately quite common. Unfortunately, there is a very high re-rupture rate after ACL repair. Prevention of re-rupture is done by maintaining high levels of strength, control, and stability in the knee. FIFA devised an ACL injury prevention programme called the FIFA11+ that strives to keep players fit and strong with the aim of reducing the risk of ACL rupture and re-rupture. So why are ACL injuries so common?They unfortunately come as a risk of playing a field sport and all of the demands that go with it.  Females are at a much higher risk of injuring their ACL – from 2-10 times, depending on what research you read. Why is this? They have wider hips generally, which makes the knee more likely to roll in past “the point of no return”. They also have slightly different anatomy within their knee joint which could account for it. Males also generally are stronger in their leg muscles, which gives protection to the knee and ACL. So it does come with the territory, but the stronger the leg is, and the better technically an athlete is trained in their running and playing style, the less likely they are to have this injury.

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