What’s the big deal?
ACL – anterior cruciate ligament- is a major stabilising ligament of the knee- it controls the forward sliding motion of the lower leg and provides rotational stability with movement.
Commonly there will be accompanying bone bruising or fracture, possible cartilage or meniscus tears, or damage to other ligaments in the knee.
In the short term, the injury can result in time off work, inability to participate in sport, and prolonged rehabilitation. On average, professional elite athletes require 9 months out of sport and recreational athletes will take 12 months. Longer term, there is a high risk of osteoarthritis in people who have suffered an ACL injury, particularly if you sustained a concurrent meniscus injury. The cost of primary ACL reconstructive surgery in Australia between 2014-2015 has been estimated at $142 million, which includes surgical costs only and not the rehabilitation, burden of injury or time off work (Zbrojkiewicz, D., Vertullo, C. & Grayson, J., 2018).
How do they occur?
There is a small subgroup of ACL injuries that occur with contact- that is a direct blow to the knee- e.g. another skier collides with your leg resulting in injury.
The vast majority of these injuries however occur in a “non contact” manner. In other words, because of a landing error or twisting movement. It may be a movement that you have done countless times before, a small bump in the air prior to landing, or a timing error causing an awkward movement.
What can we do about them?
There is a growing body of evidence that many of these non-contact injuries can be prevented, and with the cost of ACL injury and the rate of injury on the rise it is crucial that we do everything that we can to avoid them.
“Neuromuscular” training programs have been shown to be effective in reducing the rates of ACL injuries. These programs are warmup routines that include balance, agility, plyometrics and landing control. Soccer, netball and AFL have all released sport specific programs that are readily available and should become part of your team’s warm up today (see links below).
A 2018 study (Webster & Hewett) showed neuromuscular training programs reduce the overall rates of ACL injuries by 50%, and in females by 67%. The research shows that the more you do these routines, the more effective the programs are at reducing the rate of injury. They are not only effective at reducing the rate of serious knee injury, but also all lower limb injuries. And if that’s not enough to get you started they have also been shown to be PERFORMANCE ENHANCING! Vertical jump and sprinting ability can improve with regular performance of a neuromuscular program (Garrison et al, 2011).
It is essential that we implement these widely from grass roots level up, and that if you’re not already doing them that you start today!
Netball Knee https://knee.netball.com.au/
FIFA 11 Soccer http://www.footballfedvic.com.au/fifa-11plus/
Clifton Hill Physiotherapy
Dargo, L., Robinson, K. & Games, K. (2017). Prevention of Knee and Anterior Cruciate Ligament Injuries Through the Use of Neuromuscular and Proprioceptive Training: An Evidence-Based Review. Journal of Athletic Training, 52 (12), p 1171-1172.
Donnell-Fink, L. et al, (2015). Effectiveness of Knee Injury and Anterior Cruciate Ligament Tear Prevention Programs: A Meta-Analysis. PLoS ONE 10(12): e0144063.
Garrison, T., Smith, T., Tutalo, S., Barber-Westin, S., Campbell, D. & Noyes, F. (2011). Benefits of neuromuscular training program for knee injury prevention and performance enhancement in high school female basketball players. Journal of Strength and Conditioning Research, 25, pS12-S13.
Ramirez, R., Baldwin, K. & Franklin, C. (2014). Prevention of anterior cruciate ligament injuries in female athletes. Journal of Bone and Joint Surgery, 2 (9): e3.
Shaw, L. & Finch, C. (2017). Trends in Pediatric and Adolescent Anterior Cruciate Ligament Injuries in Victoria, Australia 2005–2015. International journal of environmental research and public health, 14, 599.
Webster, K. & Hewett, T. (2018). Meta-analysis of meta-analyses of anterior cruciate ligament injury reduction training programs. Journal of orthopaedic research. doi: 10.1002/jor.24043. [Epub ahead of print]
Zbrojkiewicz, D., Vertullo, C. & Grayson, J. (2018). Increasing rates of anterior cruciate ligament reconstruction in young Australians, 2000–2015. The Medical Journal of Australia, 208 (8): 354-358.