Most athletes have at least heard of tearing their ACL (anterior cruciate ligament in the knee) and for someone who knows it well or has had one, the word ACL can often make them shutter. About 70% of ACL injuries happen without contact during sports and are instead the result of excessive over (hyper) extension, rotation or a deceleration “sudden” stop common in pivoting sports like soccer and basketball. Approximately 1 in 3500 people will sustain an ACL injury each year. Women sustain ACL injuries as rates between 2.4 to 9.5 higher than males. It is unsure exactly why this happens but many theories have been proposed regarding anatomical differences, and training/neuromotor control errors. Many studies have shown ACL tears are related to certain periods of the menstrual cycle for women (follicular phase or preovulatory phase).
So that is nice to know, but if you have already injured your ACL, you want to know “where do I go from here?” Not everyone that tears their ACL needs surgery (only about one third of ACL tear patients do). There are very specific criteria often used to determine if surgery is the best course of action which need to be discussed with a qualified medical professional. Another third of individuals will be able to handle their injury just fine and return to normal activities without surgery. Another 1/3 will likely return to recreational activities with a functional brace and an appropriate strengthening program.
Common pre-screening criteria exist to determine if a person is a potential coper (able to return to function without the need for surgery). These criteria include the patient/person having no other injuries except an isolated ACL tear, having normal knee motion, no swelling, and a normal walking pattern. The patient should also have a least 70% quadriceps strength as compared to the uninvolved side, and should be able to hop straight up and down on the single injured limb without pain. If these criteria are met, the person can then go through further screening to see if they can cope with their injury without surgery. Some of these criteria include various hopping tests, functional screening questionnaires, quadriceps maximal strength tests, and the patient should not report any knee buckling. If these criteria are passed, a person may not need surgery. This is also dependent on a person’s job, recreational habits, and at what level of activity a person would like to get back to. This should be discussed with and assessed by a qualified medical personal.
If a person’s activity demands and/or the person does not pass either the pre screen or screening criteria, then an ACL reconstruction may be indicated. Most current research does not favor one graft (the new reconstructed ACL) over another for long term function of the knee but often is dependent on other factors that should be discussed with the orthopedic surgeon. For those of you who have selected to have an ACL reconstruction, be aware that it will take at least 6-9 months on average to return to sport (if possible) and this is following an appropriate rehabilitation process.
The best course of action is prevention and minimizing risk by ensuring you have proper jumping, landing, and cutting mechanics and ensuring you have proper strength in your legs (especially the hamstring, hips and quads). You can learn more of these exercises by tuning into our blog each week and attending the CPMC fitness class “Total Body Fitness” which focuses on these muscles as well as other muscle groups important for body health.
NOTE: These exercises may not be appropriate for someone right after ACL reconstruction.
JOSPT April 2010