You may have seen on social media recently a few professional sports people sustaining ACL injuries. Every season across various sports there are always ACL injuries which get a lot of press, but do you know what these are and how to deal with one if you are a sportsperson?
What does the ACL do?
ACL is short for anterior cruciate ligament, and it is a key ligament in your knee. A ligament is like a rope that connects our bones together. The ACL is the most important ligament in the knee for stability and is one of four key ligaments.
As you can see from the diagram the ACL runs diagonally inside your knee.
It is the most commonly injured ligament within the knee however it can be one of the most devastating sports injuries due to the length of time it takes to recover from.
ACL injuries are far more common in non-contact sports. The most common mechanism for injuring your ACL is high speed twisting or hyperextension (straightening). This normally results from changing direction quickly, landing awkwardly or stopping suddenly.
There are 3 grades of ACL injuries, which can happen across all our ligaments
- Grade 1 (Sprain). Relatively minor trauma where some fibres are stretched
- Grade 2 (Partial tear). Trauma is more severe, and some fibres are torn
- Grade 3 (Complete tear). Most severe amount of trauma where the fibres are ruptured.
What are the symptoms?
- Acute mechanism of injury where you can feel or hear a pop deep in the knee
- Immediate pain and you normally cannot continue playing
- The knee will swell up quickly
- You can feel some sensations of instability and your knee may give way without warning
- Limited movement in the knee
How do I know if I have injured my ACL?
As physiotherapists we are trained to piece together the puzzle that is your injury! We will perform testing alongside listening to the story about your injury which will give us a good idea about the injury sustained. We would then recommend an MRI scan to assess the extent of damage and confirm your diagnosis.
SO, I’ve ruptured my ACL. What next?
It is important to get an opinion from an Orthopaedic Surgeon, who specialises in knee injuries. They will be able to advise you on what the best option is. Surgery is not always needed for all ACL injuries. Factors such as age, activity level and the severity of the injury dictates this. However, most young people with an ACL injury will need surgery, particularly if you are aiming to return to high level sport.
The surgical procedure involves removing the remains of the damaged ACL and replacing it with a graft. This is normally a tendon from either your hamstring or knee.
Where does Physiotherapy come in?
- Rehab starts straight away after surgery. We have extensive amount of data and research that the sooner our rehabilitation starts the better the outcome.
- This may feel difficult due to the pain and swelling post-surgery, but your future self will thank you!
- At first, the focus is on reducing swelling and getting the knee moving again and working to improve your muscle strength and function.
- As time goes on and the pain and swelling improve, physio will continue to push on your rehab working on strength, balance and movement.
- We will guide you back to running, jumping and competitive sport. This can take 12-18 months after surgery.
Why does ACL recovery take so long?
- The knee joint is the largest in the body and works in co-ordination with lots of other muscles and joints. The ACL is a huge component and crucial to stabilising your knee. Within a few months post-surgery, you may feel little to no pain and generally have good function however, that does not mean the knee is ready to go back to sport. This is the part of injuring your ACL that takes a long time. ACL rehabilitation requires extensive and thorough work to develop your strength, power and stability.
Key take home messages-
- An ACL injury can feel very isolating and frustrating. It is important to build your team around you and have a good support network. This should include’ an orthopaedic doctor, an experienced physiotherapist, coach, team-mates, friends and family!
- Take your time with making your decision regarding surgery. Again, discussing with those in your support network to allow you to make a decision that you are happy with
- Work hard on your rehabilitation. Again, this can be a lengthy and frustrating process. Break up your rehab into smaller achievable goals.
- You need specific rehab. There should always be sport-specific training and thorough testing before returning to sport
How can I reduce the likelihood of this happening?
Ensuring you are completing exercises alongside your sport training and matches is important. A physiotherapist can help guide you with this and screen you for any injuries. There are many injury-reduction programs to choose from, including the FIFA 11+ program, the Netball KNEE program and the ACTIVATE World Rugby program.
