The dreaded Anterior Cruciate Ligament (ACL) injury of the knee is one of the worst sporting injuries to occur with the rehabilitation period being up to 12 months after surgery.
The injury can occur from a simple twisting/cutting movement, a hyperextension movement of the knee (ie the knee straightens too far backwards), or occasionally when another player lands on the knee and twists it or extends it too much.
The athlete commonly feels a great deal of pain and often hears a loud ‘pop’ sound. The player normally falls to the ground as the knee gives way underneath them. Often the injury is associated with damage to the cartilages (meniscus) and/or ligaments of the knee. The ACL is a very important ligament that holds the knee together during twisting and direction changes. Hence surgical reconstruction of the ligament is required if the player wishes to return to sport.
The main surgical decisions are whether to use one of the hamstring tendons or part of the patella tendon to reconstruct the ligament. Over the last few years, the LARS procedure has been trialed which some sportspeople returning to sport in around 3 months. This procedure is only in its infancy and not always successful but is an option for some people, especially older athletes who can’t afford long stints out of the game.
The rehabilitation period is usually between 9 and 12 months where the athlete has to regain movement, strength, balance, power, agility and most of all, confidence in the knee. A long rehabilitation period is also required to allow the reconstructed ligament to fully heal so it can cope with the load that is placed on it as the athlete twists and turns when returning to sport.
Many hours of dedicated rehab and exercises with a skilled sports physio are required to gradually load the new ligament and train the athlete in sport specific strength, fitness and agility skills to maximise the chance of a successful return to sport.
In older sporting people (over 40), who do not plan to return to sport involving quick direction changes, they may opt to not reconstruct the ligament. There is an option to see how well the knee settles after the injury. With regular strength and balance exercises, you should still be able to walk, jog, bike ride and swim with minimal pain or symptoms following an ACL injury. Reconstruction should be considered if there will be good compliance with the rehabilitation programme, frequent giving way and pain in the knee and future plans to participate in activities involving twisting and sharp direction changes.
Unfortunately, the chance of developing arthritis in the knee after an ACL injury is pretty much 100%, so the knee is likely to give some problems down the track regardless on whether you have a reconstruction or not. The reconstruction may slow down the degree of arthritis and speed at which it develops however. A good rehabilitation programme is paramount to try and return the knee to near normal function to maintain the health of the knee for as long as possible.
The physiotherapist at the Adelaide Crows Sports Medicine Clinic can help diagnose the injury and organise the appropriate path of treatment to get you back doing what you want to as soon as possible.