ACL knee ligament injuries
A common injury athletes fear is ACL knee ligament injuries. Why is this though? You may hear announcers talk about an athlete’s rehab journey after they have returned. You may even hear them talk about how bad it will be if it was the ACL that was injured on the play. So why is it that this particular injury is feared more than others?
Purpose of the ACL knee ligament
Like all ligaments, the ACL’s job is to maintain efficient movement within the knee. The ACL helps stabilize the knee and prevents the shin from sliding forward. It does this by attaching from the posterior aspect of the thigh bone (femur) to the anterior portion of the shin bone (tibia). The ACL does not work alone though. There are several other ligaments that surround the knee to help stabilize it. These include the MCL, PCL, and LCL. Along with the combination of ligaments, the muscles surrounding the knee also help the knee move and stabilize.
Mechanism of Injury
For the most part, we will see ACL injuries from athletes involved in contact sports, or sports with a quick change in directions. Depending on the severity, the injury can be classified under grade 1, 2, or 3. Grade 1 injuries can be described as mild, painful with minimal stretching/tearing of ligament fibers. The next is Grade 2 injuries can be described as moderate. It can be painful with up to 50% of ligament fibers torn. And finally, Grade 3 injuries can be described as severe. It may or may not be painful, and complete rupture of the ligament fibers.
Although grade 1 and 2 injuries are not as severe, we can still see recovery times lasting up to 12 weeks. But how do you tell the difference between the grade of injury? While a proper assessment by a health professional can determine this. Athletes will have an idea of when a grade 3 injury has occurred as there will be a popping sound.
Now to discuss the injury we all fear as athletes. Grade 3 ACL injury. Grade 3 injuries differ to the grade 1 and 2 injury for recovery as the ligament has been ruptured. This means that most athletes will opt for surgery. ACL reconstruction is a surgery performed to replace the ruptured ligament with a hamstring tendon or patella tendon. So we have a replacement ligament, but why does it take so long for athletes to return to sport? The tendon is not built the same way a ligament is but can adapt to do the job. This takes time for the adaption to take place. The recovery for this can last around 9 months for a full return to sport (sometimes longer).
Following surgery the new ligament will be limited in the movement it is allowed to prevent re-rupture. During this time we may lose muscle mass, and strength in the operated leg. Along with the surgeon’s protocol for exercises, it is important to work with a physiotherapist. A physiotherapist can safely manage exercises, and progress exercises to provide optimal recovery. As we start to feel better, less pain, and stronger we may think we are ready for a return to sport. However, returning too early can increase our risk of re-rupture.
From this understanding, it is important to work with surgeons, doctors, coaches, and physiotherapists to help design a return to sport plan.