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“You have a torn ACL.” These are some of the most dreaded words for any athlete to hear after they have sustained a knee injury. We hear about Anterior Cruciate Ligament (ACL) ACL tears all the time- from professional sports to recreational youth activities. But just how common are they? Can we do anything to prevent them?

What is exactly is an ACL tear and how do they occur?

The ACL is a ligament within the knee that connects your femur (thigh bone) to your tibia (shin bone) and helps stabilize your knee joint by preventing excessive anterior (forward) tibial translation on the femur. The ACL also helps limit excessive internal rotational forces at the knee joint and prevents hyperextension. An ACL injury can occur in one of two ways: contact and non-contact. A contact injury would occur via direct blow to the knee, likely from colliding from another player such as in football. Non-contact injuries are more common for ACL injuries. These typically occur via the following mechanisms

  • Poor landing mechanics from a jump
  • Excessive hyperextension of the knee
  • Excessive internal rotation of the knee (knee dropping inward towards other leg) while pivoting and changing directions quickly while the foot is planted
  • Poor mechanics with sudden deceleration

Just how common are they?

Statistically speaking, there are more than 200,000 cases of ACL tears each year in the United States. ACL injuries account for more than 50% of all knee injuries. It is believed that 60-70% of ACL tears are non-contact in nature, meaning there was no collision with another player or object. Although it continues to be evaluated and analyzed, it has been stated that females are more prone to ACL injuries than males.

How can we prevent them?

The following are components of a well-rounded ACL prevention program:

  1. Dynamic warm up and cool down: This prepares your nervous system and muscles for the demands of your sport/activity.
  2. Plyometrics and Agility: Plyometrics should have a heavy emphasis on proper landing mechanics, specifically with increasing hip and knee flexion to absorb forces properly.
  3. Proprioception and balance training: emphasis should be on dynamic balance.
  4. Lower body strengthening: hamstrings, calves, quadriceps, and gluteals
    1. The hamstring muscles and ACL work together to prevent your tibia (shin bone) from moving forward in an excessive manner. Therefore, as the strength and muscular control of your hamstrings improve, the better equipped you are to prevent an ACL injury.
    2. Improve gluteal strength and hip motor control. Your outer hip muscles, specifically your gluteus medius muscle is critical for preventing your knee from collapsing inward into a knee valgum position.
  5. Core strengthening: Often overlooked, core strength is crucial for improving stability during activity and exercise.
  6. Flexibility: Limited hip and ankle mobility can cause poor movement patterns that can lead to increased load on the knee joint and ligaments.

So, you have a tear, now what?

It has been established that approximately 50% of patients do not return to the same level of competition following an ACL reconstruction. Nearly 1/3 of young athletes with a previous ACL reconstruction will sustain a second ACL injury within 2 years of returning to activity. There are numerous factors that can contribute re-injury risk, one of which is returning to sport too soon. Recent research indicates that athletes who return to sport before 9 months following ACL reconstruction have a 7-fold increase in risk of re-injury, compared to those who waited > 9 months for full return to competition level.

Now all of those stats may be disheartening, but they are just numbers. The reality is, if you are motivated to put the work in to your physical therapy and are patient with the timeline, you can return to the same level of competition without fear. Did you know that Tom Brady tore his ACL in 2008? Yet, that has not slowed him down from continuing to break records and add more Super Bowl rings to his collection.

How can Active Recovery Physical Therapy help YOU?

Active Recovery is here to help address your current limitations and promote a safe return to your prior level of activity. We can provide you with a whole body movement analysis in order to customize a treatment plan to minimize your risk of injury, as well as continue to rehabilitate previous injuries. If you have had a recent ACL reconstruction, we are here to help guide you back to your activity level as quickly but as safely as possible. We strive on ensuring high quality movement patterns in order to restore full function, as well as improve your performance abilities!

References:

  1. Beischer, S., Gustavsson, L., Senorski, E. H., Karlsson, J., Thomeé, C., Samuelsson, K., & Thomeé, R. (2020). Young Athletes Who Return to Sport Before 9 Months After Anterior Cruciate Ligament Reconstruction Have a Rate of New Injury 7 Times That of Those Who Delay Return. Journal of Orthopaedic & Sports Physical Therapy, 50(2), 83–90. doi: 10.2519/jospt.2020.9071
  2. Gans, I., Retzky, J. S., Jones, L. C., & Tanaka, M. J. (2018). Epidemiology of Recurrent Anterior Cruciate Ligament Injuries in National Collegiate Athletic Association Sports: The Injury Surveillance Program, 2004-2014. Orthopaedic Journal of Sports Medicine, 6(6), 232596711877782. doi: 10.1177/2325967118777823
  3. Joseph, A. M., Collins, C. L., Henke, N. M., Yard, E. E., Fields, S. K., & Comstock, R. D. (2013). A Multisport Epidemiologic Comparison of Anterior Cruciate Ligament Injuries in High School Athletics. Journal of Athletic Training, 48(6), 810–817. doi: 10.4085/1062-6050-48.6.03
by Lauryn Helmers

Lauryn is a physcial therapist at Active Recovery Physical Therapy with a primary focus of Orthopedic and Sports related injury.