Brace yourself

ACL or Anterior Cruciate Ligament, the footballer’s most feared injury.

Picture this: When you read of international footballers suffering from anterior cruciate ligament (ACL) injury, you shake your head and thank your stars that your sedentary life means you are not at risk. Later that day, you are chasing a deadline across the office, and your knee hits a chair, your foot twists, and you hear a pop. Soon you realize your knee is swollen and hurts like hell. A visit to the doctor reveals what you considered unthinkable: you have managed to injure your ACL. It is true: ACL injury is not limited to footballers.

The ACL is one of four ligaments in the knee that connect the femur (thigh bone) to the tibia (the shin bone). Any injury to the knee from direct and indirect trauma can rupture this ligament. The ACL is injured when you twist your ankle or swerve suddenly while running. Often, loss of speed, coupled with cutting, pivoting or sidestepping maneuvers, and awkward landings could lead to ACL injury. If you are a sportsperson and have not received adequate training or you play when you are not fully fit, you are more likely to injure your ACL. The knee is hurt because the body shifts forward and the weight strains the ACL, causing damage.

Did you know that the ACL is one of the most commonly injured ligaments of the knee? While the likelihood of ACL injury is higher among people who participate in high-risk sports, such as basketball, football, rugby, skiing, skating, and soccer, such injuries can also be caused when running or jumping rope.

For some reason, a popular misconception is that women are unlikely to suffer ACL injuries. In fact, women are more susceptible to ACL rupture. Recent studies suggest that among women, the joint through which the ACL passes and the ACL itself is smaller than in men. This, along with lesser hamstring activation among women, might actually make it easier for the ACL to tear when executing certain cutting or pivoting movements. Women’s hormonal changes, which make their muscles more flexible, are also cited as the reason for greater susceptibility to ACL tears. Famous Alpine skier Lindsey Vonn recently pulled out of the Sochi 2014 Winter Games citing an ACL injury. She has suffered similar injuries in the past and recovered to return to the sport.

ACL tears cannot be sewed back together because such a procedure does not guarantee stability to the knee. So, a tendon graft is surgically applied instead. The success rate of such a process is usually 82-95%. The graft aims at restoring pre-injury mobility in the knee. Surgery alone is not enough though. Physical therapy is also vital. Exercises are usually prescribed immediately after the surgery. Regular application of ice to reduce swelling in the knee might also be required. In some cases, a brace may also be prescribed.

If you are a sportsperson, your doctor will likely recommend a return to active sports only after three-four months of rest and therapy. This is how much time it will take for the swelling and pain to subside and for full range of motion and muscle strength to return. Thereafter, you might need to re-train for your specific sport, so do not expect to jump back into the field immediately. You will only be exposing your knee to further and longer-lasting damage by doing so. Remember, your role in recovery is almost as critical as your doctor’s; diligently following the doctor’s advice on rest, therapy, and strengthening exercises will hasten your recovery.

Not all ACL injuries need surgical intervention. For instance, doctors might not recommend surgery (or might defer surgery) to treat ACL injury in children because of the risk of growth plate injury. Simply put, it means that since a child’s bone structure is still in the nascent stage, surgery to correct an ACL tear might affect bone growth. Older patients who live largely sedentary lives might also be considered capable of managing reconstruction of the ligament without surgery. If the ACL tear is partial and does not affect knee stability surgery is unlikely to be advised.

An ACL tear might also be accompanied by injury to other ligaments or other parts of the knee. However, most patients with a partial ACL tear recover within three-four months of surgery and rehabilitation. In fact, if your doctor believes that surgery is not needed, medical advice and physiotherapy might suffice to get you back on your feet. However, in some cases of complete ACL tear, a return to challenging sports might be impossible and even walking might prove to be difficult.

While treatment for ACL injury is readily available, it is better to try and prevent such a rupture. It is a myth that people can play sports to get fit. Not true at all. First, get fit; then, play sports to maintain that fitness. It is important to strengthen muscles to reduce the risk of injury. Proper and professional training is also important. Inadequate training in a sport is often responsible for ACL injuries. When playing, also use knee guards and other such protective gear to reduce contact injury.

In spite of these precautions, if you happen to injure your knee, consult a doctor as soon as possible to rule out or treat potentially debilitating injuries.

If you hear your knee pop or if your knee gives way entirely, you should know that you are likely to have injured your ACL. The injury is likely to be accompanied by pain in the knee and you will find it difficult to walk or stand. The knee would also be swollen. In such cases, you should contact a doctor immediately because these could be indicators of ACL injury. Your doctor might order X-rays or an MRI scan to determine the nature and extent of the damage to the knee.