ACL injuries are the most common major knee injury that occurs in football. These injuries generally require surgery to allow the patient to return to sport. Without ACL reconstruction, most patients have knee instability and are unable to participate in football activities. ACL surgery is done by using a tissue graft, usually taken from the patient’s knee to reconstruct and make a new ACL. The recovery time until return to play is usually in the range of nine months but can be longer or shorter. Interestingly, ACL injuries and football players often occur without contact, only with changing of directions suddenly.
In football, motions such as cutting and pivoting can put a great amount of force on the knee. As a result the positioning of the ACL makes it responsible for maintaining the integrity of the knee against that force. Injuries often occur when a player plants their foot on the ground and attempt to rotate their body in relation to that planted foot, placing their weight on it. Due to these motions, a twisting force across the knee joint that the ACL must absorb is created. When the ACL cannot cope with this force, it ruptures.
When it comes to diagnosing an injury to the ACL, an MRI as well as a physical examination proves to be a great combination. Due to its high accuracy of detecting the extent of an injury, physicians rely on the MRI to see the framework of the injury quickly. Also, to see how well the ACL works, a physician would need to examine it through specific tests such as the Lachman test and the pivot shift test. These physical examinations require patients to relax the joint being tested, which can be difficult to do with a sore knee fresh from a recent injury.
ACL surgery is performed by using a graft either taken from the patellar tendon, the hamstring tendons or the quadriceps tendon. The other option is to use donor tissue (or transplanted tissue) which is typically not used for primary ACL reconstruction and contact athletes because there is a higher rate of retear. However, there are cases where allograft maybe appropriate such as in multi ligament reconstruction because too many Graft’s are required to harvest them all from the patient.
Small meniscal tears can sometimes be treated without surgery if they do not limit the patient’s activity. If the tear is large and/or displaced, it will often require surgery to be removed a torn fragment or to suture the tissue back together to allow it to heal. The latter is preferred because excision of large amounts of meniscal tissue may increase the risk of arthritis later in life. However, repair sometimes requires removal of the tissue if Healing is not satisfactory. Usually, the final decision to repair or remove the meniscus is made at the time of surgery.
Sometimes, ACL injuries are accompanied by associated knee injuries including other ligaments or meniscus or cartilage. These associated injuries can affect treatment and recovery time as well as ability to return to sport and long-term prognosis. With current surgical techniques, many athletes are able to return to football despite severe knee injuries.
Many of these injuries that occur without contact can be prevented with exercises, in particular, those that focus on balance, strength, and plyometrics such as planks, Nordic hamstrings, and squats. Just as an athlete must have an awareness of their limbs’ relative locations and the strength to re-orient their limbs into a safe position, they must be able to do so quickly, if they aim to avoid injury.
Dr. Robert Marx is an orthopedic surgeon at Hospital for Special Surgery. He does arthroscopic and open procedures for knee and shoulder problems as well as knee and shoulder joint replacement surgery. Dr. Marx also performs complex and revision surgical cases.