Anterior Cruciate Ligament (ACL) Tear: Symptoms, Treatment & Recovery

The anterior cruciate (an-TEER-ier  KROO-she-et) ligament (ACL) is one of four main ligaments in the knee. Ligaments are tissues that hold the different bones together. The ACL is in the middle of the knee between the shinbone (tibia) and the thighbone (femur). The ACL supports the knee when a person is pivoting, jumping and making quick turns.

There is another area of tissue in the knee called the meniscus (men-IS-cus). The meniscus is the rubbery cartilage disc between the shin (tibia) and thighbone (femur). It acts as a “shock absorber” in the joint. When the ACL tears, there may often be an injury to the meniscus.

Common Causes of Injury

The most common cause of an ACL tear is a non-contact pivoting injury. Most often these injuries occur in sports, such as basketball, soccer, and football.

Symptoms

• knee pain
• a pop you can hear or feel at time of injury
• swelling
• feeling like the knee will give out (will still be able to walk)

Diagnosis

After an injury, your knee may be very swollen. If the doctor thinks there may be an injury to the ACL, they may suggest you wait a few days before scheduling an appointment. This lets the swelling go down. It will make the exam easier and less painful.

If the doctor examines the knee and feels unsteadiness or abnormal movement, there may be damage to the ACL. In some cases, your doctor may need x-rays to check for injury to the bone.

The ACL and meniscus are made of soft tissue. A tear in soft tissue will not show up on an x-ray, so the doctor may order an MRI (magnetic resonance imaging) test. This test allows the doctor to see if there is a tear in the ACL or injury to the meniscus.

Initial Treatment

• RICE: Rest, Ice, Compression, Elevation
• Knee brace
• Crutches
• Pain relievers, such as Motrin® or Tylenol®. Motrin helps reduce pain and swelling. Tylenol may also help with discomfort. Motrin can often be taken every six hours and Tylenol can be taken every four hours. These medicines can be alternated every three hours as needed for pain control.

Surgery

When the ACL tears, the ends cannot be sewn back together. The ligament needs to be rebuilt to allow you to function in sports or activities that are more physical. Surgery to rebuild the ACL is called arthroscopic (ar-thro-SKAH-pic) ACL reconstruction. The doctor rebuilds the torn ligament using part of your hamstring or other tissue. It is usually an outpatient surgery. Younger children who have the surgery may stay overnight to help manage their pain and swelling after surgery. An older child can go home after surgery if pain is well controlled and if they can use crutches or a walker safely.

After Surgery

• Brace and Crutches
  • After surgery, the health care provider or nurse will teach you how to use crutches and wear a hinged knee brace. It is very important that you use the brace and crutches as instructed.
• Ice
  • You will also be taught how to use the Polar Ice device. Use the machine regularly for the first 24 to 48 hours after surgery to help decrease swelling. After 48 hours, you may begin using it for 30 minutes at a time, 3 to 4 times every day until the swelling lessens.
• Pain Medicine
  • You will get a prescription for pain medicine. The doctor may recommend Motrin for pain relief as well. Motrin will help with swelling and will help you stop using the prescription pain medicine faster.
• Exercises
  • You will have exercises to do. The muscles at the site of surgery will be weak, but it is important for you to do these exercises. They help build up the strength of the leg muscles. This helps with healing. ACL exercises are below.
• Physical Therapy
  • At the first appointment after surgery, you will get a prescription for physical therapy. You should start physical therapy as soon as possible after the first follow-up appointment (usually one week after surgery). The exercises at home and in physical therapy will help you recover quicker. They will help reduce swelling and improve the range of motion. 

Follow-up

Your first follow-up appointment will be about one week after surgery. At this time, the incisions will be checked; and any dressings will be removed. You can talk to your care team about your pain level. You will get a prescription for physical therapy.

When to Call the Doctor

Call the Orthopedic clinic at 614-722-5175 any time with questions or if you have:

• pain that gets worse
• a new rash
• fever higher than 101 degrees F by mouth
• chills
• nausea or vomiting
• drainage of any kind from the incision
• more redness and warmth at the incision

Expectations for Recovery

In most cases, it will take 6 to 9 months of recovery until you can return to normal sports or activities. Your doctor and physical therapist will work with you to increase the strength and motion of the knee.

Your doctor has a specific set of rules for activities following an ACL reconstruction surgery, and the physical therapist will follow this timeline. It is important for you to not do activities until the doctor or physical therapist says it is okay. This will allow the ACL to fully heal.

Please see ACL Protocol Exercises below.

ACL Protocol Exercises

You have had surgery to repair one or more ligaments ACL (anterior cruciate ligament) or meniscus in the knee. Do these exercises until you follow up with your health care provider’s office or physical therapist. 

If any of these exercises are hard to do, call your physical therapist.

• Quadricep Set:

  • Lie on your back with your knee brace unlocked. With your leg straight, push the back of your surgical knee into the mat. Tighten the front muscle of your thigh. Repeat with your other leg (Picture 1).
  • Do these motions 10 times. Hold each for 5 to 10 seconds.
  • This exercise should be done at least 3 times per day, up to 1 time each hour.

• Ankle Pump:

  • Keep your knee straight and bend your toes upward until you feel a stretch behind the knee. Then point your toes downward. Repeat with the other foot (Picture 2).
  • Do these motions 10 times. Hold each for 5 seconds. This exercise should be done 3 times per day.

• Extension Hangs:
  

  • Lie on your back with the brace unlocked. Place a towel roll under your surgical ankle. Let gravity pull your knee straight (Picture 4).
  • Start with 5 minutes and work up to 10 to 15 minutes. Do this at least 3 times each day.

• Heel Slides:
  

  • If brace is set 0 to 90 degrees, sit in dining chair as shown below. The brace should be on and unlocked. Bend the surgical knee. Slide your foot on a cloth or paper towel backward to about 90 degrees (Picture 5).
  • Do this motion 30 times. Hold for 10 seconds. Do these 3 times a day.
  • If brace is set 0 to 30 degrees, lie down as pictured below. Lie down with non-surgical knee bent and brace on and unlocked. Gently bend surgical knee to about 30 degrees. Slide your heel on the surface toward your body (Picture 6).
  • Do this motion 30 times. Hold for 10 seconds. Do these 3 times a day.

Anterior Cruciate Ligament (ACL) Tear (PDF)

HH-I-341 ©2021, Nationwide Children ’s Hospital

Anterior Cruciate Ligament (ACL) Tears (for Teens)

What Is the Anterior Cruciate Ligament?

The anterior cruciate ligament (ACL) is one of the ligaments in the knee joint. A ligament is a tough, flexible band of tissue that holds bones and
cartilagetogether.

The ACL connects the bottom of the thighbone (femur) to the top of the shinbone (tibia). The ACL helps keep the knee stable.

What Is an ACL Tear?

The anterior cruciate (pronounced: KROO-she-ate) ligament can tear if an injury stretches it too much. The tear might be partial (through a part of the ACL) or complete (all the way through the ACL).

What Are the Signs & Symptoms of an ACL Tear?

Most people who tear their ACL feel pain and a “pop” in their knee when the injury happens. Their knee usually gets swollen soon after the injury. After the swelling goes down, someone with an ACL tear usually can walk. But the knee may feel unstable and can “give way” and make the person stumble or fall.

What Causes an ACL Tear?

Most ACL tears happen during athletic activity. For example when someone:

• changes direction or twists the knee while running
• jumps and lands in a way that twists the knee

The ACL also can tear if the knee is hit forcefully from the side.

Who Gets ACL Tears?

ACL tears happen most often during sports that have turning, cutting, and pivoting movements like skiing, soccer, football, basketball, and tennis. Girls tear their ACL more often than guys do.

How Is an Anterior Cruciate Ligament Tear Diagnosed?

To diagnose a torn ACL, health care providers ask about the injury and do a physical exam. During the exam, the health care provider presses on the knee and legs and moves them in certain ways. These tests can show if the ACL is torn.

Health care providers also might order imaging tests like:

• X-rays to check for injuries to the bones
• an MRI to check the extent of an ACL tear and to see if the knee has other injuries

How Is an ACL Tear Treated?

Right after the injury, an ACL tear is treated with:

• RICE: Rest, Ice, Compression (with an elastic bandage), and Elevation (raising the knee)
• over-the-counter pain medicine such as acetaminophen (Tylenol or store brand) or ibuprofen (Advil, Motrin, or store brand)

Most partial tears can be treated with bracing and physical therapy (PT). A person might need to use crutches as the tear heals.

Some complete ACL tears need surgery. The need for surgery depends on many things, including:

• the type of the activities (or sports) the person wants to do
• if the person is an athlete
• age
• other injuries to the knee
• if the knee “gives way” or feels unstable

What Happens During Surgery for a Torn ACL?

ACL reconstruction surgery uses a graft (piece of tissue) to reconstruct (rebuild) the ACL. The graft can be a tendon, from the patient’s own body (called an autograft) or from someone else who donated the tendon (called an allograft). 

ACL repair surgery is usually done arthroscopically. This type of surgery is done using a tiny camera (called an arthroscope) and small instruments that are inserted through small incisions (cuts).

Recovery from ACL surgery can take 6–12 months. If you have an ACL repair, you may use crutches and a leg brace after surgery. Some people might need a knee brace after that.

Physical therapy is important to help the knee heal. PT helps to:

• improve range of motion and flexibility
• regain strength in the knee, thigh, and shin muscles
• reduce pain and swelling
• improve balance

How Can I Prevent Another ACL Tear?

If you had an ACL tear, there’s a higher chance it might happen again. Training programs may help you avoid another ACL tear. These focus on neuromuscular training (NMT). NMT teaches movement patterns that lower the risk of injury, especially while jumping, landing, and changing direction. NMT programs include stretching, plyometrics (jump training), and balance training.

Ask your care team if an NMT program, like PEP training, is right for you.

What Should I Do?

Recovering from an ACL tear takes time. It’s normal to feel angry, frustrated, or down, especially if you can’t play a sport you love.

While you heal, try to find other ways to stay involved in sports, such as keeping score or being a team manager. Or, if you want to develop new talents besides playing sports, this is a good time to explore a new hobby like playing the guitar, painting, or drawing.

To get the best treatment possible:

• Go to all follow-up visits and physical therapy appointments as directed.
• Follow the care team’s instructions for at-home exercises.

20 iconic torn crosses in NBA history – Blogg on the floor – Blogs

Another knee injury shook the NBA world – Rajon Rondo tore his anterior cruciate ligament. He is not the first and, unfortunately, he is not the last to tear up the “crosses”. It is believed that at the present time there are more such injuries than before; but thanks to modern medicine, cruciate ligament rupture no longer means the end of a career, as it was in the 80s, and the athlete returns to the floor in 6-8 months. In fact, there have been various examples in history.

The history of problems with “crosses” can only be traced back to the early 80s, and we have very accurate data on injuries since the 1990s. In the old days, almost all injuries of the knee, and even more so of the ligaments of the knee, were considered in a single vein. “When I played, we never heard of such a thing. Meniscus tear – yes, but there was never any talk of cruciate ligaments, ”said Elgin Baylor, who broke his kneecap and ended his career due to an Achilles injury, but did not encounter injuries of the “crosses”. Perhaps in the past there were indeed fewer torn knee ligaments, and it is believed that not only increased loads, but also high-top sneakers that support the ankle, may be to blame for this. Kareem Abdul-Jabbar stated that he does not wear such sneakers for this very reason. “You usually recover from a sprained ankle. I would not want the load to be transferred to the knee.”

Below are 20 of the most famous examples of NBA players tearing crosses. Let’s start with those who managed to return.

Bob Lanier

Perhaps the first recorded case of torn crosses was an injury to Bob Lanier, which the center received in college, shortly before the 1970 draft. Despite this, Detroit selected him 1st overall. While signing with the Pistons, Lanier was still wearing a cast on his leg. Bob spent the first five seasons without injury, and although he then had to undergo 7 more different operations on his knee (don’t forget that these were the 70s), Lanier had a brilliant career, getting into the Basketball Hall of Fame as a result.

Since the Crosses: 14 seasons (959 games), 7 All-Star Games.

Walter Davis

There’s another reason why Phoenix fans hate the Lakers: it was on LAL’s home court during a 1984 preseason game that Walter Davis tore his cruciate ligaments in his knee. The parquet of the legendary “Forum” was slippery that evening, and an unsuccessful fall put the driven swingman out of action for a long time: a complete rupture of the posterior cruciate ligament, a partial rupture of the anterior cruciate and internal lateral. However, Davis returned at the end of the 84/85 season, and at 1987, he designed his last, sixth appearance at the NBA All-Star Game. Davis did not even lose in scoring after the injury, and in 1986/87 he set a personal record for minutes played in a season.

After the Crosses: 7 seasons (504 games), 1 All-Star Game.

Bernard King

King became the first player in NBA history to go to an All-Star Game with an ACL replacement. Of course, the injury took a toll on his career: Bernard led the NBA in scoring when a horrific injury forced him to re-pair. Now technology has reached a new level, and the ligament for such purposes is borrowed from other parts of the body, and then, at 1985, King had to open the joint and stretch the tendon to make a new ligament. Because of such a complex operation, Bernard missed two years. The Knicks weakened, Ewing came to them from the draft, and the history of the NBA in New York spun in the other direction. Injuries made themselves felt in the future, and one can only wonder how history would have turned out for King and the NBA without that unfortunate story, but the fact remains – on a newly built on the technologies of the Stone Age, King scored 28.4 points on average, when he was already 34 years old.

Post-Cross: 4.5 seasons (334 games), 1 All-Star Game.

Danny Manning

Like King, Manning was unable to reach his full potential due to health problems. But if Bernard became the first All-Star on one knee, Manning became the first star to have ligament replacements in both knees. “First, strength returns, and only then confidence,” Manning himself claimed immediately after his return. A couple of years after these statements, he was already playing in the All-Star Game.

Post-Cross: 12.5 seasons (859 games), 2 All-Star Games.

Ron Harper

A year after Manning’s injury in 1989, his teammate Ron Harper tore the crosses. Just as King consoled Manning and promised that he could play at a high level, Danny helped Ron with advice: “I told him to be patient. It was impossible to understand exactly what he was going through, but I could guess. Surprisingly, it was thanks to the injury that Harper became what we remember him now – after all, he turned from a flying super-athlete-sniper into a team player focused on the game of passing. This is exactly what Phil Jackson needed from him to successfully three-pit and later return the cups to LA.

After the “crosses”: 10.5 seasons (753 games), 5 champion rings.

Mark Price

Mark Price spent the best part of his career on a “foreign” cruciate ligament. His recovery was so successful – he returned a month and a half ahead of schedule – that Price’s example is often simply forgotten when torn “crosses” are remembered. Mark’s health problems began much later and for completely different reasons: a broken hand in 1994, a loose left heel at 1995.

Post-crosses: 6.5 seasons (427 games), 3 All-Star Games, 3 All-Stars at the end of the year.

Tim Hardaway

Before the start of the 1993/94 season, Golden State could be considered a contender for the highest places, because the team, among other things, joined the first pick of the draft – Chris Webber. Unfortunately, three major players were injured before the start of the season – Mullin, Marciulionis and Hardaway. At the same time, the last two both broke the “crosses” and dropped out for a whole year. Hardaway, after rehabilitation, began the second half of his career – less fast, but more successful, marked by the retired number in Miami.

Post-crosses: 8.5 seasons (559 games), 2 All-Star Games, 3 caps at the end of the year.

Baron Davis

Baron suffered a ligament injury in his freshman year of university while playing in the NCAA playoffs, then recovered by the start of the next season, played it even better than the previous one and decided to enter the NBA draft, where he went under 3- m number. And now, a few years later, he is already a full-fledged star-beard of the NBA, and there is no question of any loss of athleticism: the young body withstood a serious injury.

Post-crosses: 12.5 seasons (835 games), 2 All-Star Games, 1 cap at the end of the year.

Jamal Crawford

Jamal suffered an ACL tear in the most honorable way for a Bulls player (which he was then, in July 2001), while sparring against Michael Jordan. “After the operation, you start recovery, you become more and more confident over time. And now the last stage is psychological: will I be able to play again as before? The injured leg by that time is even stronger than the healthy one, but you don’t believe in it – you are scared, you doubt it.

After the “crosses”: 11.5 seasons (856+ games), the title of the best replacement in the NBA.

Kendrick Perkins

In recent years, a number of big men have suffered torn knee ligaments and successfully returned to the court: Nene, Al Jefferson, David West. The most famous injury was the case of Kendrick Perkins, because it happened at the most important moment – in the NBA Finals. Many Celtics fans still believe that Perk’s crosses in Game 6 of the Finals were the turning point of the series: Boston led 3-2 in meetings and lost the remaining games without their center. Perkins has since been traded to the Thunder, and while his stats have gone down and his performance has been criticized, it’s clearly not because of his injured leg. They have already learned how to sew up “crosses” in basketball.

After the “crosses”: 2.5 seasons (139+ games), participation in the final.

* * *

Alas, history also knows the opposite examples, although now they are becoming less. The same Danny Manning (twice) and Baron Davis again tore their cruciate ligaments, and it ended not as happily as the first time. Here are a few unfortunate players whose careers have been ruined by cross injuries.

Billy Cunningham

First player to officially retire from the sport due to crosses. Game against the Knicks on December 1975 years was his last. While trying to outrun Butch Baird on the fast break, Billy felt intense pain: “I thought my knee came off.” The spectators of that match still remember the scream that escaped Cunningham’s chest. Billy tried to come back, but that was still the era when torn crosses meant the end of a career: a few preseason games in which it became clear that the joint did not hold without a ligament, and the Hall of Famer went to coaching.

After the “crosses”: coaching career, championship 1983 years old.

Doug Collins

In the season Cunningham suffered an unfortunate injury, current Sixers coach Doug Collins was on the same team with him. His playing career is one of the saddest in terms of injuries. The No. 1 pick in 1973 suffered a serious leg injury in his rookie season, then suffered a cracked leg in 1979, and recovered only to have his crosses fail a year later. Doug Collins was the first to understand what happened to Derrick Rose at the end of Game 3 of last year’s Bulls-Sixers series: the fall happened in front of the Philadelphia bench, and Collins himself perfectly remembers what a torn knee ligaments looks like.

Post-Cross: coaching career, early Bulls success for Jordan.

Terry Cummings

In the 1990s, they didn’t finish their career because of crosses, but they didn’t always recover to the end either. During streetball in the offseason, San Antonio forward Terry Cummings, a two-time All-Star with Milwaukee, suffered a torn ACL. As a result, in the 1992/93 regular season, Cummings played fewer meetings (8) than in the playoffs of the same year (10). And despite the fact that in the end Terry played to 1999 years old, his statistics immediately fell by half: from 17 + 8 two seasons before the injury to 8 + 5 after. About 22 + 9 times the Bucks is out of the question.

After the Crosses: 6.5 seasons (415 games).

Doc Rivers

The 1995 San Antonio team was nicknamed the “ACL team” (anterior cruciate ligament) because four players from that roster had anterior knee ligament surgery. In addition to Cummings, as well as Jack Haley and Sean Elliott, Doc Rivers also received an injury earlier. So in Boston, there is someone to tell Rondo what awaits him in terms of rehabilitation. The main thing is not to talk about playing success: Rivers played only 2 seasons of 15 minutes on average. Do not forget that by the time of the injury, Rivers was already 32 – Rondo, Rose, Rubio are noticeably younger.

After the Crosses: 2 seasons (141 games).

Sean Livingston

The injury and subsequent career of Sean Livingston are usually frightened every time someone breaks crosses on the basketball court. There is no need to be afraid of repeating that story – Livingston tore three of the four knee ligaments at that moment: both “crosses”, one lateral ligament, as well as a meniscus – in addition, he dislocated everything that could be dislocated in the knee. This is much more serious than a single anterior ligament tear. The fact that after that Livingston still finds some strength to return is already a miracle.

After crosses: 4. 5 seasons (209+ games).

Leon Pou

Another sad example from the recent past is Leon Pou. Together with Rondo, Perkins, and Tony Allen, these are already four people from the Celtics championship team who survived a cruciate ligament tear. Now Leon plays in Puerto Rico. In his case, injury proneness and slow recovery played a big role in Pou’s career never bouncing back.

After the “crosses”: 1.5 seasons (50 games).

Michael Redd

Redd’s case is special. By the age of 31, his ligaments were so loose that they simply could not stand it, and when they were sewn up, there was a second rupture. And even after this, the efforts of the Phoenix doctors, who once raised Danny Manning to his feet after the third (!) rupture of the ligaments, allowed Redd to finish last season as part of the NBA team. So far, he is a free agent and hopes for a new contract in the NBA, but the knee is already very bad.

After the “crosses”: 1. 5 seasons (61 games).

* * *

In the last couple of seasons, stars of the first magnitude are out of action due to “crosses”, and therefore a lot of attention is riveted to this problem. Three point guards, whose last names begin with “P”, were especially affected. Luke Ridnaur should think about knee brace.

Ricky Rubio

Last March, two things became clear: Kyrie Irving would win nearly 100% of the votes for Rookie of the Year and Spain would come second in the Olympics. Both of these events could have happened without Rubio’s injury, but with her, the likelihood of their occurrence became very high. After the operation, the Spanish point guard missed more than six months, but returned by the time that was predicted. While he is not 100% ready and admits that his knee still hurts, but with each new game he gradually returns to his form. The only worry is that he plays on a team that has had players out of action every week lately.

Derrick Rose

April 28 can be celebrated as Broken Crucifix Day because on that day in 2012, two players suffered from such an injury at once – Derrick Rose and Eman Shumpert. And if Shumpert has already returned, then Rose is yet to come. Chicago, without Rose, went from being a contender to being eliminated in the first round of the playoffs. So far the news is about the end of February or later. Helps him to recover Baron Davis, who survived the break of the “crosses” in his youth, and also last year. He knows this better than any other NBA player, and since young Davis’ and Rose’s playing styles are similar, Baron must help Derrick adapt his game after injury. And then Rose will come back the same way Davis came back from his injury 15 years ago.

Rajon Rondo

Yesterday a regiment of “crosses” arrived. More precisely, even earlier: doctors discovered that Rajon Rondo was playing out the previous match with Atlanta (which, by the way, recently lost Lou Williams due to the same misfortune) already on a torn knee. The rupture of the “crosses” sometimes goes unnoticed, it seems that the knee is only dislocated. An ordinary person can generally live with a knee ligament injury and not notice much discomfort, but not athletes. However, now after such an injury, almost every basketball player returns, especially the young one. Sean Elliott once played without a front link from the age of 14 and has achieved a lot in the NBA. Another CAC player, the current one – DeJuan Blair – does not have an anterior cruciate ligament at on both knees, which caused him to fall in the draft before the second round – nevertheless, he still does not have serious problems with his knees. And Rondo, and Rose, and Rubio, and Eric Maynor, Ricky Rubio, Eman Shumpert, Brandon Rush will be all right.

Good health to all players and fewer injuries in the future.

All cruciate ligament injuries in the NBA

Cross injuries are a nightmare. In the Premier League, they are torn more and more often, 30% get relapses, and there are a million reasons (even boots) – Underexpert opinion – Blogs

Editor’s note: co-author of the text – Artem Ryzhenko, clinical resident in sports medicine and rehabilitation, runs a telegram channel about injuries in football.

You should immediately start with the main thing. A torn cruciate ligament is worse than most injuries. As a rule, football players understand everything in the first seconds, even without a medical diagnosis, and often leave the field in tears. Below – dotted line lists the reasons why everyone is so afraid of crosses.

• 70% of such injuries are accidental, crosses are torn suddenly and out of the blue. It’s one thing to get injured in a hard joint for the ball (when you go to the fight, you psychologically prepare for everything), and another thing is when you just put your foot unsuccessfully on landing.

• Long and difficult rehabilitation. To recover from such an injury, you need at least six months, and the first months of almost every exercise are accompanied by severe pain and require great effort.

• You may not play at the same level after an injury. It’s one thing to recover and quite another to get back in better shape. Such situations harden someone, and break someone.

• Frequent relapses. Nearly a third of all players who tore crosses experienced re-injury to crosses or tore them on the other leg.

Sports doctor Zurab Ordzhonikidze combined all these theses into one succinct sentence: “A cross injury for a football player is like a myocardial infarction for an ordinary person.”

New stories appear almost every week, one of the most recent examples is Depay, who had a delightful autumn part of the season, but by the end of the year broke his crosses and will now miss the Euro. And the match of the 19th round of Serie A “Roma” – “Juventus” is generally a real drama. With a difference of 19 minutes, two young football players of both clubs flew out with crosses – Roman midfielder Nicolo Zaniolo (20 years old) and Turin defender Merih Demiral (21 years old). Now they have an operation and six months of rehabilitation ahead of them instead of fighting for a place at the base.

Cross injuries are even more common than you think and cost clubs a lot of money

Anterior cruciate ligament tears account for 20. 5% of knee injuries and 3% of all injuries in football.

In 2017, the BBC conducted a study and found that the number of knee ligament injuries in the Premier League is increasing every year.

In each of the studied years, knee ligament injuries were among the three most common injuries, second only to musculotendinous ones. In the same 2017, the website SportingIntelligence.com and the insurance company JLT found out that cruciate ligament injuries are not only a blow to the athlete’s career, but also to the club’s budget. In the 2016/17 season alone, the Premier League spent £177m on the salaries of players undergoing rehabilitation.

“Over the past six seasons, the cost of cruciate ligament injuries has steadily risen as players become more expensive. It annoys the clubs, but they can’t change the situation,” explained JLT sports director Duncan Fraser.

It turns out that an injury to the cruciate ligaments is a problem not only for a player, but also for his club, and for sports in general. Players cost more and more and get injured more often. Is there nothing that can be done about it? To do this, you need to understand the root of the problem.

What are these ligaments responsible for? Why is their breakup so painful?

Figure shows right knee, front view, joint capsule and patella removed for convenience.

Pathology cannot be analyzed without knowledge of the norm. Therefore, a small anatomy course – the anterior cruciate ligament starts from the inner surface of the external condyle (bone protrusion) of the femur, crosses the knee joint and attaches to the anterior part of the anterior intercondylar fossa of the tibia. And now in Russian: this ligament stabilizes the knee joint and prevents the lower leg from moving forward excessively.

The posterior one starts from the lateral surface of the inner condyle of the thigh, crosses the knee joint and attaches to the posterior intercondylar fossa of the tibia. And again in Russian: it stabilizes the knee joint and keeps the lower leg from moving backward. An important detail is that the posterior ligament is much thicker, which is why its injuries are much rarer in sports (for 1 injury to the posterior ligament, there are about 20 ruptures of the anterior ligament).

Collateral ligaments (outer and inner) keep the lower leg from moving in and out, respectively. Often their rupture is combined with an injury to the cruciate ligaments.

In addition, the thigh muscles also stabilize the knee. The main role here is played by the four-headed.

It has 4 heads (so powerful it’s more like 4 separate muscles with a common point of attachment) and they can generate enough traction to stabilize the knee even with a torn or missing ACL, but more on that later.

How does cruciate ligament rupture occur?

The mechanisms of their damage can be divided into 2 groups:

1. Contact: impacts, collisions and so on. In the case of a contact injury, everything is quite simple – it is a direct blow to the lower leg or a fall on it. At this moment, the body moves in one direction, the lower leg in the other. If the force is strong enough, then the ligament does not withstand and breaks.

There is a rupture of the ligament in which direction the movement of the lower leg occurs – the anterior forward, the posterior – backward. This is how about 30% of these injuries occur.

2. Non-contact: falls, sudden changes in direction, braking, landings. This is about 70% of cruciate ligament injuries. With a fixed shin, the femur rotates inward, or the shin and foot tuck and rotate outward.

It is much easier to show it on video:

In both cases it is accompanied by:

• click, crunch or something similar;

• severe pain at the time of injury and when walking;

• a feeling of instability in the knee: when you try to lean on the injured leg, it tucks.

What scares me the most is how serious an injury you can get out of the blue. In addition, since everything in our body is interconnected (especially the joints), the force that can tear a ligament rarely falls strictly on one cruciate and therefore an isolated injury to only one ligament is a rare occurrence. Much more often, along with the crosses, the menisci and lateral ligaments are torn, as was the case, for example, with Djordjevic – this is called the “unlucky” Turner triad (Soviet surgeon and orthopedist).

It is called unlucky for two reasons: firstly, due to the proximity of the medial meniscus, the medial lateral ligament (they are even fused to each other) and the anterior cruciate ligament, their simultaneous rupture is quite common when the anterior cross is torn. And secondly, such an injury requires a longer recovery, since there is a pronounced instability of the knee joint, practically nothing keeps it from pathological movements inward and forward.

Ibra is a perfect example of non-contact breaking of crosses. Because of him, Zlatan left Europe and lost his former greatness. Three years ago, 34-year-old Zlatan just hit the ground running, and in his first English season he scored 28 goals in 46 matches. Manchester United were preparing to extend his contract. But one evening spoiled everything – April 20, 2017. United took on Anderlecht in the UEFA Champions League quarter-finals. Closer to the final whistle, Zlatan fought for a high ball in the penalty area, landed badly and went to the hospital with a torn right knee cross.

The most likely option at this age is to finish playing football. But Ibra was determined to return and even went for a consultation with the famous sports doctor and professor at the University of Pittsburgh – Freddie Fu. He was delighted with Zlatan’s body and convinced the Swede that he would return to football: “The morphology of his health, his bones and muscles are all as perfect as you can imagine. He is one of the best athletes I have ever worked with, he is in great shape. ”

Ibra took up training with great enthusiasm – he often came to Manchester United’s base even at night. Zlatan returned after 9 months, and in absolutely his own style: in the first match he hit with scissors, and after the game he called himself a lion.

It seems that Zlatan remained a beast, but this is not entirely true: he played only one match at the start of Manchester United, scored one goal and promptly left for MLS, a league with a much lower pace.

“ Zlatan came back different,” Mourinho said after leaving Manchester United. – He lacked speed and sharpness, he lost to our young players . I saw in him doubts and self-doubt, he understood that he was no longer so strong.

Are crosses always torn by accident? Are there any prerequisites?

At risk are football players, American football players, skiers and in general any contact sport. You may ask, what does contact sports have to do with skiing? What is the contact? But have you ever seen skiers fall? The leg goes in one direction, and the body rotates by inertia in the other. Yes, yes, again the same mechanism, because the boot, like a boot, fixes the lower leg.

This is why this type of injury is sometimes referred to as “ski boot injury”.

Another one interesting fact: in women, the risk of cruciate ligament injury is about three times higher than (Just yesterday Ada Hegerberg tore her crosses). This issue has not been fully studied, there are many different theories related to anatomical features, hormonal regulation, the ability to coordinate, but in general it all comes down to a simple one: “a man is stronger, he has more testosterone (the male sex hormone is also responsible for strength). muscles and ligaments), which means stronger ligaments and muscles.

The suddenness of this injury is frightening, but several risk factors can still be identified – when the likelihood of breaking the crosses increases.

• When the thigh muscles are not strong enough. Strong muscles can in many cases save you from injury, but still do not guarantee this.

• When the thigh muscles are damaged. Tired, weak muscles, untreated injuries – all this increases the risk of damage to the ligaments.

• When coordination is not at the top level. The ability to control your body (especially when jumping) can help avoid one of the mechanisms of injury, but again: in football, you usually do not allow free jumping and landing in the fight for a high ball. It really needs mastery of the body.

• When playing on artificial turf. Wet synthetic fields turn into a real ice rink. It’s easy to get lost here.

• When the spikes are not picking up well. The role of spikes in football is obvious – it is a stable good grip on the lawn. If you use too short ones – the leg can go, turn up – a vivid example of a non-contact mechanism. But too much grip can also interfere – not only will such shoes slow down, but also increase the risk of tripping due to the fact that the foot literally hit the ground. The RFU even has special recommendations for the selection of shoes.

There is a high chance of re-injury if the crosses are torn. Giuseppe Rossi was a Serie A star and almost moved to Barca, but two relapses killed his career

A few years ago, the Stockholm Sports Injury Research Center, with the support of the Westmanland Regional Hospital, studied the impact of a cruciate ligament injury on the future career of football players.

The numbers are so-so: among those who returned to football, almost a third (30.3%) were again faced with an injury to the crosses. 9.7% – received repeated damage to the anterior cruciate ligament, 20.6% – torn the anterior cruciate ligament on a healthy leg. A striking example is Giuseppe Rossi.

In the mid-2000s, the Italian striker was considered a United supertalent: Ferguson called him a future Old Trafford legend, Ronaldo admitted that he was a little jealous.

But it didn’t work out at Manchester United – after a couple of loan spells, Rossi moved to Villarreal, where he finally began to open up: in the amazing 2010/11 season, he scored 18 goals. Rossi was only 23 at the time and the Premier League was back on the horizon with Manchester United retaining the right to buy Giuseppe for £10m and Liverpool looking for a striker.

But everything changed in October 2011. Then Rossi left the field in a match with Real Madrid because of strange sensations in his knee. As a result, Villarreal flew 3-0, and an MRI showed Rossi had a cruciate ligament rupture.

Six months later, the striker was ready to return, but there was a relapse during training. And that meant at least another 10 months without football. As a result, Giuseppe missed 557 days, during which he managed to fly past Euro 2012 and change from Villarreal to Fiorentina. Rossi finally returned only at the start of the 2013/14 season: amazingly, even after a year and a half without football, he remained a goal-scoring striker.

By January 2014, Giuseppe had already become a superstar in Serie A – 16 goals in 17 matches (among them a hat-trick for Juventus), admiration for Vincenzo Montella (the Fiorentina coach called Rossi a “true genius”) and interest ” Bayern and Barca. The fairy tale ended in the January match against Livorno: defender Ricardo Rinaudo went into a hard joint and Rossi tore the crosses again. On the same knee.

This time the miracle didn’t happen – a year and a half later Giuseppe came back slow, traveled around the middle peasants in Spain and Italy, almost didn’t score and really didn’t come out at the start.

The impact of the second broken crosses on Rossi’s game is perfectly illustrated by the statistics:

In April 2017, in a match against Eibar, Rossi landed badly and tore the crosses for the third time – in fact, this injury ended his career. Now Giuseppe is 33, he does not have a contract, and only the title of the best scorer in the history of Villarreal reminds of his fighting youth.

“Honestly, it is very hard for me to remember the nightmare that I experienced again and again. Every injury has a sad story – either I missed the World Cup and the Euro, then the transfer to the top club failed . .. These fucking injuries always interfered.

Rossi has collected a complete collection of failures: two recurrences of crosses and a set of other serious injuries. Giuseppe Rossi is a perfect example of how an ACL tear turns ambition and talent into a void.

Breaking crosses – is it almost always the end of a career?

Of course not. How an athlete handles a cruciate ligament injury depends on many factors, most notably the athlete and their relationship to injury and rehabilitation.

There are several players in history who got this injury and quickly forgot about it.

• Alessandro Del Piero injured his knee ligaments at 24, but returned and even said that the injury made him stronger:

“I used to play mostly instinctively, but after the injury I learned to control my instincts. There is more balance in my game.”

• Lahm tore his crosses shortly after returning to Bayern, but soon forgot about the injury and made over 300 appearances for the Munich side, helping them win the Champions League. It also happened in the national team – in 2014 Lam became the world champion with Germany.

• Although Ronaldo’s career was ruined by injury, the Brazilian is still regarded as one of the greatest strikers in history, having enjoyed several top seasons since his injury (including World Cup gold medals).

• Alan Shearer broke his crosses before his second season at Newcastle but returned to become a club legend with over 300 appearances and 148 goals.

• Ruud van Nistelrooy may never have moved to Manchester United – PSV and Mancun had barely agreed on a transfer when it turned out that the striker had a serious knee injury. The British did not refuse the player and waited for him for almost a year. Not for nothing: the striker broke the record of Shearer and Henry, scoring in 8 league matches in a row, and then improved this result by extending the streak to 10 goalscoring games. Van Nistelrooy won absolutely every English trophy with Manchester United.

Is tearing up crosses always an operation? Is it possible to get by?

It is possible, but in professional sports it is not relevant: to achieve good knee stability, muscle strength in such a situation is not enough.

What happens during the operation? Surgeons remove the stump of the torn ligament so that it does not interfere with movement, take a graft from the patellar ligament (it is long enough and at the same time wide enough to easily cut off part of it), drill holes in the femur and tibia, where the graft is placed, which exactly repeats the course of the “native” ligament.

It all looks like this:

You can do without surgery only if there is a tear and if the knee remains stable. In this case, the athlete pumps the quadriceps muscle, which compensates for this partial tear, further stabilizing the knee.

But in the case of professional athletes, if he flatly refuses to operate, the doctor simply waits for the patient to return with a completely torn ligament. In professional sports, leaving an athlete with a torn ligament is practically a guarantee of a complete rupture in the future.

Rehabilitation after breaking the crosses is sheer pain, you need maximum dedication and great willpower

And then the most difficult stage. He was well described by Roman Zobnin when he injured his ligaments in 2017.

“The most difficult time is the first week after the operation,” the footballer recalled. – I could not sleep and walk normally, I did everything through pain. It was painful. Even the enemy will not wish what I suffered. But with every day of training it becomes significantly better. ”

Since the rehabilitation process is quite complex, it is divided into stages.

• The first weeks after the operation, starting literally on the second day, the main task is to restore the full range of motion, eliminate pain and relieve swelling, mainly these are minimal loads, massage, passive movements (i.e., performed without effort, they are performed by a massage therapist or doctor). This is the most important and difficult stage, since absolutely any exercise associated with the slightest effort provokes severe pain.

• By the end of the first month, the range of motion should be restored and work on strengthening the thigh muscles, coordination begins, gradually adding a bicycle, an elliptical trainer, if possible, exercises in the pool and aquabike. For example, this is what Depay can already do after just a month.

View this post on Instagram

1 month ✅

A post shared by Memphis Depay (@memphisdepay) on Jan 19, 2020 at 12:00pm PST

Then it’s a little easier – the main task of the remaining period of rehabilitation is the restoration of muscle strength, the introduction of more and more complex exercises and a full return to normal training. From 2 months, you can add exercises on the treadmill (low speeds, mostly a step, without a slope), from 3-4 months, running, agility exercises begin, and after 4-5 months, the athlete is already able to endure running loads without pain. By 5-6 months, the footballer is generally able to return to the loads of the general group.

Cruciate ligaments can also be torn during a yard match. Here are ways to protect yourself

It is important to remember that knee ligament injuries are not only a problem for professional football players, but also for ordinary people who went out to play on the next box.

100% protection against such damage will not work, but there are a number of rules that will reduce the chances of getting to know the arthroscope and are quite applicable for amateurs. Keep a few things in mind.

• Warm-up is required. This is a general rule for the prevention of any injury.

• Strong thigh muscles help take pressure off the knee. First of all, this concerns the quadriceps muscle, which, as mentioned above, additionally stabilizes the knee. So matches on the box should be combined with trips to the gym or independent exercises to strengthen leg muscles.

• Proprioception training. And now in Russian. Proprioception is the feeling of the position of your own body parts relative to each other and in space, in other words, the ability to understand what your hand is doing, even if it is behind your back.