Everything you need to know about the ACL!
September 11, 2020
What is an ACL?
‘ACL’ stands for anterior cruciate ligament. It is a ligament in your knee joint, which joins your femur to your tibia. It runs on a slight angle, from the back of your femur (thigh bone), to the front of your tibia (shin bone). The angle of the ACL is related to its function, which is to help stabilise the knee by resisting the tibia from gliding forwards and helping with rotational stability. ACL injuries are common in sports which demand change of direction, as well as contact sports. ACL injuries are known for their lengthy recovery, often requiring surgery to repair or replace the ligament and return to sport timelines are often at least 9-12 months recovery post-surgery.
I’ve torn my ACL, do I need surgery?
It is a misconception that all ACL injuries need surgery. Conservative management can be very effective but it depends on a couple of things:
- If there is any other damage within the knee joint (meniscus (cartilage), other ligament damage, fracture to the bones in the knee)
- The type of sport (if any) that you want to return to – if your knee is stable, and strong and there is minimal damage to other structures, if you wish to return to a sport which doesn’t demand a lot of change of direction or contact, you may be able to rehab your knee and return to sport without surgery. Nowadays, there is also growing evidence to support return to multidirectional sports without a surgically repaired ACL
Both options (conservative management and surgery) should be considered and a decision made based on each individual’s situation. It is important to remember that, if you choose to have surgery, the surgery is only half of the solution – without proper rehabilitation there is a high risk of ACL re-rupture. Therefore, if you are planning to have the surgery, you must be willing to commit to rehab. It can seem like a long recovery period and may seem daunting, but it is also a period of time to work on your strength and control, to not only improve your knee stability, but in a lot of cases it can improve your overall performance, as we often haven’t had the time (or felt the need) to work on these things in the past.
When can I run after my ACL surgery?
Rehabilitation following ACL surgery should be tailored to the individual, rather than based on set time frames. It is common to begin running at around 3 months after surgery BUT prior to returning to running your physio will use a number of “performance criteria” to compare to your other knee to determine if you are ready to start running, this will often include:
- Range of movement testing
- Strength testing
- Assessment of swelling
- Assessment of quality of movement with a single leg squat and a single leg hop
Once your physio has decided that you are ready to commence running, you will be given a progressive return to running program – starting very slowly with jog/walk intervals and building up the duration/distance over time. You will then progress to building up speed and incorporating change of direction running.
Why are ACL injuries so common in the AFLW?
Stats show that within the AFL, women are 9 times more likely to injure their ACL than men. There are a number of potential reasons for this. It has only been in recent years that women have been able to play AFL professionally. This led to an influx of players who came from other sporting codes, which require different movement patterns. AFL involves a lot of cutting, jumping and landing and women coming from other sports may not be used to the 360-degree nature of football. Most male AFL players have grown up playing football, and have therefore had much longer to learn the movement patterns required to jump, land and change direction. Most ACL injuries occur when a player lands on one leg while trying to change direction and the knee collapses inwards. Correcting the player’s landing technique can help prevent this from occurring. Generally, women’s sport does not have the same funding as men’s – this may mean that amateur clubs don’t have access to strength and conditioning coaches and physios who can put in place prevention programs and conduct screening of players to determine those at risk of injury and therefore they are less likely to engage in preventative measures to reduce their risk.
There is some evidence to suggest that hormones can also have an impact on the increased likelihood of ACL injuries in women, although it is not clear exactly why this is. It appears that post-ovulation, when progesterone levels are high, the likelihood of ACL injury is increased. In addition, women generally have a wider pelvis, which changes the angle of the femur (known as the Q angle). This makes women more prone to having their knee collapse inwards and as discussed earlier, this is a very common mechanism of injury for ACL rupture.
Now that AFLW is professional, this may lead to a few positive changes which could result in less ACL injuries:
- More young girls growing up playing football, learning the correct movement patterns
- More funding for women’s sport, allowing for prevention programs to be put in place by S&C coaches and physios
- Greater awareness of the risk of ACL injury in women among the general population and in amateur clubs, which could lead to coaches incorporating preventative exercises in warm-ups and training (such as those in the FIFA-11 or the KNEE program)
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