10 Things to know about an ACL injury
1. Anatomy of the Anterior Cruciate Ligament (ACL)
Things to know about an ACL injury
The ACL is one of the major stabilising ligaments of the knee. The ligament runs in the centre of the knee from the femur (thigh bone) to the tibia (shin bone).
2. Symptoms of an ACL Injury
An ACL injury may be characterised by the following symptoms:
A “popping” sound at the time of the injury
Pain especially in the first few minutes after an injury
Knee swelling within a couple of hours
The feeling of giving way or lack of confidence in the knee
3. ACL injury in females vs males
Female athletes are more likely to experience ACL injury than male athletes.However in Australia, more ACL reconstructions are performed on males (this can be explained by participatory bias of males in high risk sports).
4. Sports with high risk of ACL injury
ACL injuries occur in all sports, however some sports are considered higher risk than others. This is because ACL injuries are often caused by sudden direct blows to the knee (such as in a tackle) or sudden twisting movements with the foot in contact with the ground.
High risk: Contact football (NRL, AFL), snow sports.
Medium risk: Basketball, non contact football, netball, volleyball, martial arts.
Low risk: Tennis, swimming, running, cricket, golf.
5. ACL injury management
The 'optimal' treatment of a torn ACL is not known. Age, degree of instability in function, associated knee injuries and desire to return to certain sports are all taken into account when making a decision. As it stands, there are three options:
Surgery followed by exercise rehabilitation
Exercise rehabilitation alone
Exercise rehabilitation with delayed surgery
The research at a glance:
The only high quality treatment randomized controlled trial of the ruptured ACL, the KANON trial, found no difference in functional outcomes at 2 and 5 years following randomisation to early reconstruction plus exercise therapy versus exercise therapy with optional delayed ACL reconstruction.
6. Not JUST the ACL...
50% of ACL injuries are accompanied by damage to other ligaments or cartilage in the knee. Generally , surgery is recommended when dealing with a combination of injuries to the knee.
7. Rehabilitation for ACL injuries
Significant long term rehabilitation and strengthening is required, regardless of whether surgical or conservative management is chosen. Rehabilitation should continue for 9-12 months and include progression through phases:
Phase 1 – 0-2 weeks Recovery from surgery.
Phase 2 – 2-12 weeks Intermediate post op phase.
Phase 3 – 3-6 months Jogging, Agililty, Landings
Phase 4 – 6-12 months Return to sport
Phase 5 Prevention of re-injury
8. Statistics on returning to sport
Re-injury rates following an ACL injury are between 6% and 25%, thus a decision for return to sport must be made with clearance from the orthopaedic surgeon and the physio.
81% of individuals with an ACL injury will return to any kind of sport
65% only will return to their pre injury level
55% merely will return to competitive sport
The research at a glance:
A recent study set out to explore an objective return to sport/discharge criteria. They examined 158 professional male athletes in Qatar and followed up with them 6 months after return to their sport. The discharge criteria examined were Quads strength deficit, Single Hop limb symmetry, Triple hop limb symmetry, running agility T test. It found that, not meeting all 6 variables examined by the study places you at a 4x greater risk of ACL graft rupture.
9. Preventing ACL injuries
As the majority of ACL injuries occur in non-contact situations it seems likely that the appropriate prevention efforts are warranted. Studies show that preventative training programmes can reduce ACL and other traumatic injuries by 50%.Preventative training programmes only take 10-15 minutes to complete and are recommended to be done 2-3 times per week. They included stretching, strength training , jump training and improvements in balance and technique. Two commonly used preventative programs are "The Fifa 11+ Program" and the "PEP Program".
10. Long term effects of an ACL injury
50% of athletes diagnosed with an ACL injury will develop osteoarthritis within 10 to 20 years of injury.If you have experienced an ACL injury and would like to discuss your options give the clinic a call on (02) 8313 9217 and come in for an assessment.
References:
Likelihood of ACL graft rupture: not meeting six clinical discharge criteria before return to sport is associated with a four times greater risk of rupture. Kyrtsis et al 2016
Delaying ACL reconstruction and treating with exercise therapay alone may alter prognostic factors for 5-year outcome: an exploratory analysis of the KANON trial. FIlbay et al
Brukner and Kahn Clinical Sports Medicine
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