What are the signs of an ACL tear. How is an ACL tear diagnosed. What treatment options are available for ACL tears. Who is at risk for tearing their ACL. How long does recovery from ACL surgery take. What can be done to prevent future ACL tears.

Understanding ACL Tears: Anatomy and Mechanism of Injury

The anterior cruciate ligament (ACL) is a crucial component of knee stability. This tough, flexible band of tissue connects the femur (thighbone) to the tibia (shinbone), helping to maintain proper knee alignment and function. An ACL tear occurs when this ligament is stretched beyond its limits, often during athletic activities.

ACL tears can be classified as partial or complete:

• Partial tear: Only a portion of the ligament is damaged
• Complete tear: The ligament is fully severed

Understanding the anatomy and mechanism of ACL tears is essential for proper diagnosis and treatment. How do ACL tears typically occur? Most ACL injuries happen during sports or physical activities that involve sudden changes in direction, jumping, or direct impact to the knee. Common scenarios include:

• Pivoting or cutting movements while running
• Landing awkwardly from a jump
• Sudden deceleration combined with a direction change
• Direct contact or collision to the side of the knee

Recognizing the Signs and Symptoms of an ACL Tear

Identifying an ACL tear promptly is crucial for proper management and treatment. What are the telltale signs of an ACL injury? The most common symptoms include:

• A distinct “popping” sound or sensation at the time of injury
• Rapid swelling of the knee, usually within a few hours
• Severe pain, especially when attempting to bear weight
• Reduced range of motion in the affected knee
• Instability or a feeling of the knee “giving way” during movement

It’s important to note that while many individuals with ACL tears can still walk, the knee may feel unstable and prone to buckling. This instability can lead to falls or further injury if left untreated.

Immediate Steps to Take After a Suspected ACL Injury

If you suspect an ACL tear, taking immediate action can help manage pain and prevent further damage. What should you do right after a potential ACL injury? Follow the RICE protocol:

1. Rest: Avoid putting weight on the affected leg
2. Ice: Apply cold packs to reduce swelling and pain
3. Compression: Use an elastic bandage to minimize swelling
4. Elevation: Keep the leg raised above heart level when possible

Additionally, over-the-counter pain relievers like acetaminophen or ibuprofen can help manage discomfort. However, it’s crucial to seek medical attention for a proper diagnosis and treatment plan.

Diagnosing ACL Tears: Medical Evaluation and Imaging Techniques

Accurate diagnosis of an ACL tear is essential for determining the appropriate treatment course. How do healthcare providers diagnose ACL injuries? The diagnostic process typically involves:

1. Physical examination: The doctor will assess knee stability and range of motion
2. Patient history: Discussion of the injury circumstances and symptoms
3. Imaging studies: X-rays and MRI scans to visualize the extent of the damage

During the physical exam, the healthcare provider may perform specific tests to evaluate ACL integrity:

• Lachman test: Assesses forward movement of the tibia relative to the femur
• Anterior drawer test: Checks for excessive forward movement of the tibia
• Pivot shift test: Evaluates rotational stability of the knee

While X-rays can’t directly show ligament damage, they’re useful for ruling out fractures or other bone-related issues. Magnetic Resonance Imaging (MRI) is the gold standard for definitively diagnosing ACL tears, as it provides detailed images of soft tissues, including ligaments.

Treatment Options for ACL Tears: Conservative vs. Surgical Approaches

The treatment approach for ACL tears depends on various factors, including the severity of the injury, the patient’s age, activity level, and overall health. What are the main treatment options for ACL tears?

Conservative Treatment

For partial tears or in cases where surgery isn’t immediately necessary, non-surgical treatment may be recommended. This approach typically includes:

• Physical therapy to improve strength and stability
• Bracing to provide support during activities
• Lifestyle modifications to avoid high-risk activities
• Pain management techniques

Surgical Treatment

Complete ACL tears, especially in young, active individuals or athletes, often require surgical intervention. The most common surgical procedure is ACL reconstruction. How is ACL reconstruction performed?

• The torn ACL is removed
• A graft (either autograft or allograft) is used to create a new ACL
• The graft is secured in place using screws or other fixation devices
• Arthroscopic techniques are typically used, minimizing incision size and recovery time

The choice between conservative and surgical treatment should be made in consultation with an orthopedic specialist, considering the individual’s specific circumstances and goals.

Recovery and Rehabilitation After ACL Treatment

Regardless of the treatment approach, rehabilitation plays a crucial role in recovering from an ACL tear. What does the recovery process typically involve?

For Conservative Treatment

• Physical therapy focusing on strengthening and stability exercises
• Gradual return to activities as strength and stability improve
• Possible use of knee braces during physical activities

For Surgical Treatment

Recovery after ACL reconstruction surgery is a multi-stage process:

1. Immediate post-operative phase (0-2 weeks): Focus on pain management and protecting the graft
2. Early rehabilitation phase (2-6 weeks): Gradual increase in range of motion and weight-bearing
3. Intermediate phase (6-12 weeks): Progressive strengthening and functional exercises
4. Late rehabilitation phase (3-6 months): Sport-specific training and agility exercises
5. Return to sport phase (6-12 months): Gradual return to full athletic activities

How long does it take to fully recover from ACL surgery? The total recovery time can range from 6 to 12 months, depending on individual factors and the specific demands of the person’s sport or activities.

Preventing ACL Tears: Risk Factors and Preventive Strategies

Understanding the risk factors for ACL tears is crucial for developing effective prevention strategies. Who is at higher risk for ACL injuries?

• Female athletes (due to anatomical and hormonal factors)
• Individuals participating in high-risk sports (e.g., soccer, basketball, skiing)
• Those with a previous history of ACL injury
• People with certain anatomical features (e.g., narrow intercondylar notch)

What can be done to reduce the risk of ACL tears? Implementing comprehensive prevention programs can significantly lower the incidence of ACL injuries. Key components of these programs include:

• Neuromuscular training (NMT) to improve movement patterns
• Plyometric exercises to enhance jumping and landing techniques
• Strength training, particularly for the core and lower extremities
• Balance and proprioception exercises
• Flexibility and stretching routines

These prevention programs are especially important for high-risk athletes and those who have previously experienced ACL injuries.

Long-Term Outlook and Potential Complications of ACL Tears

Understanding the long-term implications of ACL tears is crucial for patients and healthcare providers alike. What are the potential long-term consequences of an ACL injury?

• Increased risk of developing osteoarthritis in the affected knee
• Potential for re-injury, especially if proper rehabilitation is not completed
• Possible limitations in high-impact or pivoting sports
• Psychological impacts, such as fear of re-injury or loss of confidence

How can these long-term risks be mitigated? Proper treatment, thorough rehabilitation, and ongoing maintenance exercises are key to optimizing long-term outcomes. Regular follow-ups with orthopedic specialists and adherence to preventive strategies can help minimize the risk of complications.

The Role of Ongoing Care and Maintenance

Even after successful treatment and rehabilitation, ongoing care is essential for maintaining knee health and preventing future injuries. What does long-term care involve?

• Regular strength and conditioning exercises
• Proper warm-up and cool-down routines before and after physical activities
• Use of appropriate protective gear during sports
• Periodic check-ups with orthopedic specialists or physical therapists
• Listening to your body and avoiding overexertion

By prioritizing ongoing care and maintenance, individuals can maximize their knee function and minimize the risk of future ACL injuries or related complications.

Advances in ACL Treatment and Research: Looking to the Future

The field of ACL treatment is constantly evolving, with ongoing research aimed at improving outcomes and reducing recovery times. What are some of the emerging trends and innovations in ACL treatment?

Biological Augmentation

Researchers are exploring ways to enhance the healing process and improve graft incorporation. Some promising areas include:

• Platelet-rich plasma (PRP) injections to promote tissue healing
• Stem cell therapies to enhance ligament regeneration
• Growth factor treatments to accelerate the healing process

Improved Surgical Techniques

Advancements in surgical procedures are focusing on:

• More anatomically accurate graft placement
• Minimally invasive techniques to reduce surgical trauma
• Customized graft selection based on individual patient characteristics

Enhanced Rehabilitation Protocols

New approaches to rehabilitation are being developed, including:

• Accelerated rehabilitation programs for faster return to activities
• Virtual reality-based exercises for improved engagement and outcomes
• Personalized rehabilitation plans based on genetic and biomechanical factors

As research progresses, these innovations have the potential to significantly improve ACL treatment outcomes, reduce recovery times, and enhance long-term knee health for patients with ACL injuries.

Understanding ACL tears, from initial injury to long-term management, is crucial for both patients and healthcare providers. By recognizing the signs of an ACL tear, seeking prompt medical attention, and following appropriate treatment and rehabilitation protocols, individuals can optimize their recovery and minimize the risk of future complications. As research continues to advance, we can look forward to even more effective strategies for preventing, treating, and recovering from ACL injuries in the future.

Anterior Cruciate Ligament (ACL) Tears (for Parents)

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 (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 ACL Tears?

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 involving turning, cutting, and pivoting like skiing, soccer, football, basketball, and tennis. Women tear their ACL more often than men. This is most likely due to different anatomy.

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.

Imaging tests that might be done include:

• 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 during recovery.

Some complete ACL tears will need surgery. Whether someone has 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, with or without bones attaching to it, 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. A person may use crutches and a leg brace after surgery, and 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 We Prevent Another ACL Tear?

Having an ACL tear puts someone at higher risk for another one. Training programs may help your child 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 is right for your child.

How Can Parents Help?

Recovering from an ACL tear takes time. It’s normal for kids with ACL tears to feel angry, frustrated, or down, especially if they can’t play a sport they love. Help your child find ways to stay involved in sports, such as keeping score or being a team manager. Or, if your child wants to do something besides sports, help him or her try a new hobby like playing the guitar, painting, or drawing.

To help your child get the best treatment possible:

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

What Happens When You Tear Your ACL: Crescent City Orthopedics: Orthopedic Surgeons

When you tear your ACL, you typically experience a popping sound or sensation in your knee when you have the injury. It begins to swell and causes pain when putting weight on it. This common injury happens to 100,000-200,000 Americans every year.

At Crescent City Orthopedics, we’re ACL specialists with the expertise to treat ACL tears. To help you understand more about this injury, let’s look at an overview of the function of your knee.  

Understanding the makeup of your knee

Your knee has four ligaments that help it operate with fluid movement, which include the following:

• Anterior cruciate ligament (ACL)
• Medial collateral ligament (MCL)
• Lateral collateral ligament (LCL)
• Posterior cruciate ligament (PCL)

Your ACL sits at the front of your knee and connects your thigh to your shin bone. It’s responsible for stopping you when moving forward and helping your thigh bone and shin bone with rotation.

Why ACL tears aren’t all the same

When we evaluate the severity of your ACL tear, we classify its injury into one of three categories:

Grade one

This classification means that you have stretched your ligament, but it’s still strong enough to stabilize your knee.

Grade two

A grade two category indicates that your ligament has not only been stretched, but it’s been loosened, causing a partial tear.

Grade three

If you have a grade three injury, your ligament has been torn into two pieces, which is very severe.

An ACL tear can also accompany other injuries to your knee.

Signs of a torn ACL

ACL injuries usually occur during a noncontact moment. ACL tears usually occur when you stop running too quickly, land awkwardly, or change direction too quickly.

As soon as the injury occurs, you might feel:

• A “giving out” sensation when trying to walk
• Pain
• Swelling
• Tenderness
• Lack of range of motion in your knee
• Discomfort when putting pressure on your knee

If you think you’ve torn your ACL, you should book an appointment with our team as soon as possible. We can evaluate your knee and advise proper treatment immediately.

Treating your ACL injury

Treatments vary depending on the severity of your injury. No matter how intense your injury is, you should immediately apply the RICE (rest, ice, compression, elevate) method.

After a medical evaluation, we will talk with you about your options. Unfortunately, an ACL tear won’t heal on its own. However, you can strengthen the surrounding muscles with physical therapy to give your knee the support it needs.

You may want to consider surgery to return to your sport and participate at 100%. During your consultation, we discuss the projected outcomes of your various options to help you make the best decision.

To learn more about an ACL tear, call us at our office in Metairie, Louisiana. You can also click here to use our online scheduler.

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How to Avoid Re-Tearing Your Cruciate Ligament: 14 Steps (with Pictures) Fitness

The ACL is the ligament in the knee joint that connects the femur (femur) to the tibia (tibia). This helps stabilize the knee, preventing it from moving in or out. Unfortunately, if you break an ACL once, you are much more likely to break it again. However, you can take steps to prevent this from happening by doing exercises to strengthen the knee and surrounding muscles, as well as by taking certain preventive measures.

Steps

Part One of 3: ACL Strengthening Exercises

1. one Do squats to strengthen your knees and hips. Squats are a very effective exercise for avoiding re-injury to the ACL as they strengthen the gluteal and lean muscles that help support the hip and knee joints. To squat:

   • Stand about 30 cm from a wall, then lean back until your back touches it.
   • Slide down the wall, bending your knees until your thighs are parallel to the floor. Don’t let your knees go past your toes.
   • Hold this position for 10 to 15 seconds, then return to the starting position and repeat 5 to 10 times.

2. 2 Try single leg bridges to strengthen the muscles that support the knee joint. This exercise helps strengthen the tibialis anterior, gastrocnemius, and rectus femoris muscles, the group of muscles that support the knee joint. To make bridges on one leg:

   • Lie on your back on the ground facing a wall. Bend one knee and extend the other leg so that the foot rests against the wall.
   • Use your bent leg for support as you lift your hips and straight leg off the floor so that your body forms a diagonal line from your feet to your shoulders.
   • Hold this position for 10 to 30 seconds, then relax. Repeat the exercise 10 to 12 times.

3. 3 Perform forward lunges to strengthen your hip and support your knee. This forward lunge exercise helps support the rectus femoris, vastus lateralis, gastrocnemius, and gracilis muscles—muscles that support the hips and knees. Performing a forward lunge:

   • Stand straight with your feet shoulder-width apart. Take a big step forward with one foot and bend your knees until your front knee forms a 90-degree angle and your back knee almost touches the floor. Make sure that the knee of the front foot does not extend beyond the ends of the toes.
   • Then take a big step forward with your back foot and repeat the exercise, this time with the opposite foot in front. Perform walking lunges until you have taken 10-15 steps. This counts as 1 set. Repeat 2-3 sets.

4. 4 Jump to practice control. Performing small controlled jumps allows you to properly practice landing with minimal stress on your knees. This landing technique can then be applied when you return to sports. To jump:

   • Stand with your feet shoulder-width apart and take a small jump forward. Try to land on both feet at the same time, as this helps distribute the weight and avoid putting more stress on one knee than the other.
   • It is very important to bend your knees when landing as this absorbs the impact of the jump and avoids stress on the knee joints and the ACL. Try to maintain the correct body position by placing your hips on your knees and your knees on your ankles.
   • Repeat this exercise 10-15 times for 2-3 sets. As your knees get stronger, you can increase the intensity of this exercise by jumping off a low box (up to 12 inches high) instead.

5. 5 Do balance exercises to restore stability in your knees. Performing balance exercises helps the injured knee regain stability and also strengthens the gluteal and gluteal muscles that support the hip and knees.

   • Stand on the injured leg on a stable surface with a slight bend and proper body position (knee over ankle, hip over knee). Try to hold a one-legged handstand for 10 to 30 seconds before relaxing. Repeat 8 to 12 times on each leg.
   • As your balance improves, you can make the exercise more difficult by closing your eyes while doing it, raising and lowering your opposite knee, standing on an unstable surface, or throwing the ball back and forth with a partner.

6. 6 Use a resistance band. Bands help strengthen the knee joint and surrounding muscles, making them work harder for a simple action. Expanders can be used in a variety of exercises to increase their level of difficulty. Here are some simple exercises you can do:

   • Sit in a chair with a straight back and wrap an elastic band around your ankles. Raise your injured leg until the band stretches and you feel resistance in your quadriceps. Repeat 10 times.
   • Lie on the floor on your stomach and wrap one end of the elastic band around the ankle of the injured leg and the other end around a strong object (such as a table leg). Bend your knee, bringing your heel closer to your buttocks, until the band stretches and you feel resistance in your hamstrings. Repeat 10 times.

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Part 2 of 3: ACL Protection

1. one Wear a knee brace to support and protect your knee. Wearing a knee brace after an ACL tear can help you avoid re-injury. The orthosis is made of lightweight materials that support the knee and protect the ligaments inside the joint.

   • Depending on the type of activity you’re going to be doing, there are different types of knee brace – light for people who just want to take a daily walk, or heavier for athletes returning to sports.

2. 2 Always warm up properly before training. Before doing any exercise, it is important to warm up properly, as this warms up the muscles, joints and ligaments and prepares them for physical activity. This greatly reduces the chance of injury.

   • You can warm up by doing 5 to 10 minutes of dynamic stretching such as ski jumping, straight leg kicking, or running in place.

3. 3 Don’t push yourself too hard. Pushing yourself too soon is a sure way to re-break the ACL. It is very important to go through the entire rehabilitation process after an injury in order to fully restore the strength and mobility of the knee joint, and to postpone returning to your usual exercises or sports until you have been given permission by a physical therapist.

   • When doing rehabilitation exercises, it is important that you stop or reduce the intensity of the exercise as soon as you start to feel pain. These exercises should work the muscles, ligaments, and joints, but should not be painful.

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Part 3 of 3: Caring for a Re-torn ACL

1. one Recognize the symptoms of a re-torn ACL. If you have already experienced an ACL injury, you are probably familiar with the symptoms of an ACL tear. It’s important to recognize the signs and symptoms early so you can seek treatment and start on the road to recovery. Symptoms of an anterior cruciate ligament tear include:

   • Click or pop at the time of injury.
   • Pain varies from moderate to severe, depending on the extent of the injury.
   • Swelling and inflammation in the knee joint, accompanied by soreness, redness and a feeling of warmth.
   • Inability to move or extend the knee or instability of the knee.

2. 2 Use the RICE method to heal an ACL tear. Immediately after injury or rupture of the ACL, the RICE method should be used to prevent worsening of the injury and begin the healing process. The RICE method works like this:

   • Rest: The knee must be at rest for at least the first 72 hours after injury. Avoid any form of physical activity.
   • Ice: Apply an ice pack or cold compress to the injured knee for 10-20 minutes at intervals. This reduces swelling and inflammation.
   • Compression: Wear an elastic knee brace around your injured knee to support the joint, prevent unnecessary movement, and prevent swelling.
   • Elevation: The knee should be elevated above heart level with pillows and cushions to prevent and reduce swelling.

3. 3 Take medicine to relieve pain. After an ACL rupture, your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce swelling. The most commonly prescribed NSAIDs include ibuprofen and voltaren.

   • If you have a history of gastrointestinal disorders, stomach or peptic ulcers, kidney or liver disease, or are currently taking any anticoagulants such as warfarin, you need to be very careful when taking NSAIDs, so talk first with your doctor.

4. 4 Reschedule surgery after major tears. For most people, following the RICE protocol and undergoing a thorough rehabilitation program is sufficient to fully restore knee mobility and strength. However, in severe injuries, surgery may be required to repair a torn ACL. This operation is especially common among athletes.

   • Surgery is usually performed a few weeks after the injury to allow time for the swelling and inflammation to subside.

5. 5 Follow a rehabilitation program to regain mobility and strength in your knees. Whether you have had surgery or not, a thorough rehabilitation program (usually up to 6 months) will be required to bring your knee back to full strength and mobility. For more information on how to repair your knee after an ACL injury, see this article. Advertisement

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Injury to the crosses is a nightmare.

In the Premier League, they are torn more often, 30% get relapses, and there are a million reasons (even boots) in football.

You should immediately start with the main one. 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, damage to the knee ligaments was 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 a cruciate ligament injury 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 (about 20 ruptures of the anterior ligament for 1 injury of the posterior 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 happen?

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: falling, sudden change of 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 Barça, 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 later career of football players.

The figures are so-so: among those who returned to football, almost a third (30.3%) were again faced with a cross injury. 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 United’s super talent: 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 an anguish and if the knee remains stable at the same time. 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.

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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.