You may hear a ‘pop’ and experience severe pain at the time of your injury. Often your knee will swell up immediately or very shortly after the injury, also. You might not want to/be able to move your knee or walk on the injured leg due to the pain. Later, when you attempt to walk, you may feel that your knee ‘gives way’ and it may remain painful despite resuming day-to-day activities.
Should you, or someone you know experience these symptoms, it is highly recommended that you seek medical attention as soon as possible to rule out an ACL injury, or to see how severe the injury is and to receive the correct treatment.
Current Men's Olympic and World Record Holder in the 300m and 400m sprint, South African Wayde van Niekerk, sustained a knee injury in a game of touch rugby that tore his ACL and meniscus
Credit @Reuters and athleticsweekly.com
SO WHAT IS AN ACL INJURY?
It is a sprain or tear of the anterior cruciate [KROO-shee-yate] ligament (ACL) in the knee.
The ACL acts as a tether running crosswise between the femur (the thigh bone) and tibia (the largest bone below the knee) to which it is attached. The ACL’s primary function in the knee is to provide stability. It does so by preventing the tibia from sliding forward on the femur during walking/running. It secondarily acts to limits sideways knee movement, knee extension, and rotation.
As an orthopaedic surgeon, I see the majority of torn ACLs occurring in sportspeople who sustained a non-contact injury during play. They usually report a sudden change in direction, a sudden stop, turning while their foot was fixed/planted or landing from a jump when the injury occurred.
There is a risk of sustaining an ACL injury associated with just about every sport can put you can think of: cricket, soccer, netball, rugby, hockey, basketball, tennis, roller skating, gymnastics, javelin - you name it!
An ACL injury can also be sustained through contact trauma - directly to the knee. This occurs, for example, in high-speed car accidents and falls from a significant height. The knee is commonly hyperextended (bent too far backwards) during the event. Usually contact trauma injuries occur simultaneously with other serious injuries to the knee (fractures, multiple ligament tears, meniscal tears, etc.).
A milder ACL injury or sprain may have none of these symptoms, and can usually be treated by rest and physiotherapy. Physiotherapy is important to help regain range of movevment in the knee as well as help recover knee strength.
However,in patients with functional instability, surgery is the treatment of choice during which I reconstruct the torn / ruptured ligament. After surgery, I always recommend additional physio therapy and strength training.
Mick Fanning, Australia's three-time world champion, tears his ACL on a tube in the Eastern Cape during a frontside turn (video)
Credit @PaulDanielsVideo and Surftotal.com
WHAT ARE THE OTHER INJURIES THAT CAN HAPPEN WHEN I TEAR MY ACL?
Almost half of people who tear their ACL will have torn their meniscus[highlight this to a future link].
Contact injuries often produce a ‘terrible triad’ injury at the knee, which means that the ACL and Medial Collateral Ligament (MCL) is torn. The medial meniscus may be damaged at the same time or it may be damged at a later stage due to the instability caused by the torn ligaments.
Additionally, fractures of the femur and/or tibia may occur, multiple ligaments may also be torn.
UMaine women’s basketball player, Blanca Millan suffered a torn ACL
Credit @Andy Molloy/Kennebec Journal and .pressherald.com
HOW WILL MY DOCTOR BE ABLE TO DIAGNOSE WHETHER I HAVE AN ACL TEAR OR NOT?
There are three dynamic, clinical tests that can be done to assess integrity of your ACL. The ‘anterior drawer test’, the more reliable ‘Lachman test’ (both are positive when the tibia pulls further forward than nornal) and the ‘pivot shift test’. The latter rotates and displaces the tibia on the femur to test instability.
If I suspect you have a torn ACL, an X-ray and/or MRI will assist in ruling out any associated injuries, it will aid in confirming your clinical diagnosis and guide your further care.
HOW DO I PREVENT AN ACL TEAR, AND WHO IS AT INCREASED RISK FOR A TEAR?
Because the risk of suffering a ruptured ACL in women is approximately four times higher than that in men, women in sports that put them at risk (see below), should incorporate a Neuromuscular Training (NMT) programme in their regular training programme.
NMT’s are evidence-based programmes that replace the traditional warmup. Used in all sports that increase player risk (sports that require jumping, decelerating rapidly or making sudden changes in direction), NMT programmes incorporate excercises that strengthen one’s core, hamstrings and hip muscles.
An example of an evidence-based NMT programme I have previously succesfully implemented into my roller derby in-season pre-training and pre-game workup is that of the PEP (Prevent Injury, Enhance Performance) Programme. [link: https://health.usf.edu/medicine/orthopaedic/smart/pep ].
Individuals who have had previous ACL reconstruction surgery also have a 15 times higher risk of rerupture. Compliance to post operative rehabilitation, and a good NMT training programme in-season is imperative to prevent risk of rerupture.
Baylor guard Kristy Wallace tore her ACL during the first half of an NCAA college basketball game against West Virginia,
Credit @ AP Photo/Tony Gutierrez and apnews.com
WHAT WILL MY FUTURE IN SPORTS LOOK LIKE AFTER SURGERY?
You can expect to return to your pre-injury level of training and play safely 9 months or more from the date of your surgery. A significant knee injury such as a torn ACL need not always be a devastating injury, but it may be a career limiting one if the athlete intended to progress their sport to higher levels of play.
Long term complications include chronic knee pain, instability and osteoarthritis.
Dr Anne Maina
Specialist Orthopaedic surgeon
MBBCh (Wits), FC Orth (SA), MMed Ortho (Wits)
Comments