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Whether playing sport professionally or participating at a casual level, athletes involved in a highly demanding or high intensity sport are at risk of an anterior cruciate ligament rupture. Sports that require sudden turns, twisting motions or excessive pressure on the knees carry a particularly high level of risk. Direct collisions such as during tackles can also cause the injury, as well as landing incorrectly while jumping. Even a sudden change of speed has been known to cause this type of injury. It is particularly common for players within football, basketball, rugby and hockey.
An anterior cruciate ligament rupture is referred to as a sprain, but a total tear of the ligament can also be included under this definition. Partial tears are, in fact, rare in comparison to full tears. It may be necessary for the athlete to have surgery as well as physiotherapy and strength training to recover the full use and function of the ligament and knee. An ACL injury can vary in severity, however, and the risk can be minimised by staying supple and observing good form while exercising.
For many athletes, an anterior cruciate ligament rupture is also accompanied by additional damage to the areas surrounding the knee. The meniscus, nearby ligaments and articular cartilage can also be damaged at the same time as sustaining an ACL injury. The knee is likely to require treatment as a whole structure, as well as individual components. Some form of ACL injury is very common, but they vary in grades of severity.
A Grade 1 Sprain might mean that the ligament has been stretched but not so much that the knee joint can no longer remain stable. The damage sustained has been relatively mild.
Grade 2 Sprains might be a partial tear of the ligament, meaning that the ligament itself has been stretched to such a degree that it is left loose. The integrity of the knee is at risk here, and may not be held stable.
A Grade 3 Sprain refers to a complete tear of the ligament. This means that the ligament has been split into two separate pieces and the knee joint is left completely unstable.
Many athletes have reported hearing a “popping” sound when suffering an ACL knee injury. An anterior cruciate ligament rupture or total tear in particular is likely to result in this. Severe swelling is common afterwards, as is the knee “giving way” beneath the athlete. There can be mild to severe discomfort, tenderness in the surrounding area and the loss of the full range of motion. Sufferers need to be particularly vigilant against returning straight to activity, as the knee joint can be left very unstable. Continuing to play after an ACL knee injury can result in further damage to the surrounding cartilage and a much longer recovery time.
For athletes and performers of sports that require a broad range of abrupt and twisting movements, ACL knee injuries are very common. Pivoting, sidestepping and landing from a jump are all common causes. A number of studies have shown that female athletes may be at higher risk of an anterior cruciate ligament rupture, although there remains a high rate of incidence amongst male football players. Scholars have suggested a variety of possible reasons for this, ranging from differences in strength training, the effects of the hormone oestrogen on the properties of ligaments, and the differences in pelvis and leg alignment. Whether for male or female athletes, however, the American Orthopedic Society for Sports Medicine recently concluded that approximately 150,000 sports injuries a year in the United States are an ACL knee injury. The United Kingdom reports proportionally similar findings.What are the consequences of an ACL injury?
The function of the knee can be severely inhibited by an ACL injury. Movement can be limited due to discomfort and swelling, but can also be additionally inhibited by a lack of stability. As the majority of ACL injuries are total tears, the knee can be left unstable as a result. Continuing to play can result in further damage of the surrounding knee structure and tissues. Torn anterior cruciate ligaments will not heal without surgical intervention. However, surgical treatment is not always recommended to more elderly sufferers or those who intend to take on a less active lifestyle. For younger athletes, however, or those who wish to return to a demanding level of sport or physical activity, surgical intervention is almost always necessary. Recovery times can vary, but it may be as much as six months before an athlete can return to full function and fitness.
An MRI (magnetic resonance imaging) scan may first be required to assess the severity of the anterior cruciate ligament rupture, but it is also common for doctors to diagnose this through touch and the assessment of the knee’s range of motion.
Keyhole surgery under general anesthetic is then the most likely type of surgical treatment. Tears in the ACL are not usually repaired by sewing the two sections of torn ligament back together, as this has been shown to be ineffective in the long term. As a result, reparation is usually through a substitute graft of the tendon. These can most commonly be taken from a patellar tendon autograft, a quadriceps tendon autograft, or a hamstring tendon autograft. It is also common for ACL reconstruction not to be done immediately after the injury unless it is treatment for a combined ligament injury. This is so that the inflammation that is commonly experienced has a chance to go down and for some range of motion to return before surgical intervention. Surgery performed too early on an ACL can greatly increase the patient’s risk of a scar forming in the joint, known as arthrofibrosis. This can risk losing the motion of the knee joint.
Surgery is only one aspect of treatment, however, and extensive rehabilitation should be undertaken. This will include keeping the motion of the knee supple and effective, and strength training in surrounding areas. Physical therapy will first aid returning movement and range of motion to the affected joint. After successful completion of this, a strengthening programme will be undertaken to ensure that the new ligament is adequately protected and supported. By ensuring that the ligament is able to cope with increasing levels of pressure and strength, the therapist and patient can be confident about a return to activity. The final stage of the rehabilitation is likely to be tailor made to ensure a successful return to the patient’s own sporting discipline and lifestyle. A knee brace may also be worn to protect and support the knee. Crutches are also likely to be necessary to prevent weight from being put on fragile areas of the leg after surgery. Patience during the recovery weeks and months is essential if further strain, scarring, and stiffness are to be avoided. Many patients risk the success of their treatment through becoming impatient, and this can result in a far longer recovery time.
The prevention of knee injuries can be difficult due to the unpredictable nature of sport, but there are some helpful guiding principles. An effective warm up and cool down routine can ensure that athletes’ muscles and tendons are prepared for oncoming strain. This can also help prevent the build up of lactic acid that can inhibit the required range of motion. Many athletes also find that training in suppleness as well as strength improves their performance and reduces the risk of injury. Pilates and yoga have proved particularly popular forms of effective but low impact exercises. Finally, observing good physical form during exercise both in the gym and during play can help avoid placing joints and ligaments under unnecessary strain. If the worst does happen and an anterior cruciate ligament rupture is sustained, athletes should be encouraged that a full recovery is possible with discipline, patience, and effective strength training.