This blog provides weekly reflections by Instant Sports Injury Assessment (ISIA) Founder, Dr. Wolohan concerning the importance and advancement of sports medicine, and real-time updates on the evolution of ISIA.
Anterior cruciate ligament injuries are one of the most common athletic injuries that occur involving the knee. These injuries can occur in many ways but often take place in cut-and-pivot, jump-and-land, stop-and-start sports, such as basketball, soccer, volleyball, and football. The mechanism of injury is often a rotational injury on a fixed foot as might occur when one is cutting or pivoting or ultimately a hyperextension injury where the knee straightens past full extension, or they also can occur when one lands from a jump in an uncoordinated or unbalanced fashion. ACL injuries are most often associated with the athlete feeling a pop within the knee, pain, and then subsequently swelling within an hour or two. Athletes can often still walk with an ACL injury but notice pain, swelling, and have difficulty continuing to participate in their sport.
Many things predispose to anterior cruciate ligament injuries, including body habitus, knee alignment, relative strength between the quadriceps on the front of the leg and the hamstring on the back of the leg, estrogen cycle in women, and on some occasions fatigue. Anterior cruciate ligament injuries are often associated with other injuries to the knee, including medial collateral ligament injuries and meniscal tears or pathology.
There are preventative strategies used to help reduce the incidents of anterior cruciate ligament injuries, and these include specific proprioceptive and muscle strengthening programs.
Once an athlete has a torn ACL, it is difficult for them to go back to cut-and-pivot, jump-and-land, change-direction sports, as the knee is unstable and will easily be reinjured with these activities. For sedentary folks who are older and do not wish to pursue cut-and-pivot sports, anterior cruciate ligament injuries can be managed nonoperatively. For young and active athletic men and women with a goal and a desire to return to a high level of sporting activity, anterior cruciate ligament reconstruction surgery is most typically recommended.
The surgery involves rebuilding the anterior cruciate ligament that was torn. Methodologies for doing this include burrowing a piece of the patellar tendon, hamstring tendon, or on some occasions an allograft or donor tendon to rebuild the anterior cruciate ligament. Allograft or cadaveric donor tendons are felt to have a somewhat higher failure rate and, thus, are less advantageous in young, highly competitive athletes. Anterior cruciate ligament surgery can be done as an outpatient. The patient can return home the same day and can immediately put all of their weight on their limb. Crutches are usually necessary for about 2 weeks.
The patient is allowed to swim and ride on an exercise bike in approximately 4 weeks, jog in approximately 4 months, and return to full athletic play in the neighborhood of 6-8 months depending on the athlete, their recovery, and the sport with which they hope to return to.
Anterior cruciate ligament reconstructive surgery does have an excellent track record for helping the athlete return to play. Some athletes do have difficulties with the knee after ACL reconstructive surgery that can preclude or prevent them from returning to a highly competitive activity level.
The likelihood of returning to a high level of athletic performance without ACL reconstruction is extremely low.
In conclusion, anterior cruciate ligament injuries are common injuries in athletics. They do present the athlete with a special challenge. Most athletes with ACL injuries can return to competitive high performance level of play with anterior cruciate ligament reconstruction surgery.
Please call or contact us or ask your orthopedic physician if you have any questions with regard to anterior cruciate ligament injury.