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Video Blog – Understanding The Anterior Cruciate Ligament (ACL) Injury

Wednesday 5th February 2014

You wouldn’t think Arsenal striker Theo Walcott, Chicago Bulls point guard Derrick Rose, New England Patriots tight-end Rob Gronkowski, Leinster winger Luke Fitzgerald, Kilkenny legend Henry Shefflin and Tiger Woods would commiserate each other if they ever met. But they’ve all fallen victim to the cruellest little injury in sports: the ruptured ACL
.
In his quoted to the point of cliché speech in ‘Any Given Sunday’, Al Pacino as Head Coach Tony D’Amato says victories are gained “inch by inch” but sometimes it comes down to only half an inch. A half an inch wide stretch of ligament inside the knee that is rarely even considered until something goes wrong and then it is cursed and talked of in grave tones. “Ah, he’s done his cruciate…”
 
The Anterior Cruciate Ligament is a stabilising ligament in the knee that is designed to prevent excess turning of the knee joint. When the ACL is stretched beyond its stabilising function it tears or snaps completely, leaving the athlete who was in full fight only moments before lying prone on the ground in agony. Those close by hear a popping sound which is now synonymous in high level sport with the end of the season for the injured player as recovery times range from six to 12 months. When Walcott went down with no one close to him in the North London Derby that made up the third round of the FA Cup last year, the Spurs fans jeered him for feigning injury but his fellow-professionals knew it was serious. It was soon after confirmed that Walcott will miss the World Cup as Arsenal announced he was out for “at least six months.”
 
It is a cruel blow to any player but it is certainly not uncommon. That ‘pop’ is being heard more and more on fields of play as athletes grow stronger and faster. As the speed of movement increases on the pitch the chances of tearing the ACL become greater but also as more is known about the injury the possibility of prevention becomes greater. Studies have found that incidents of ACL injury are reduced by regular neuromuscular training so that movement patterns, balance and muscle strength are improved in conjunction with each other. As Eanna Falvey points out our video, a simple warm up routine centred on jumping and landing has shown significant results in preventing ACL injuries in women’s sports where they are four to six times more common due to different use of the quadriceps and hamstrings when landing.
 
Though impact can sometimes be the cause of an ACL tear as in Tom Brady’s 2008 injury generally the injury will happen away from any contact. Twisting, cutting and landing at speed are usually the cause of that ‘pop’ which is why when Walcott went down yards from any Spurs player the enlightened observer knew it was serious. He’d done his cruciate.
 
Two or three decades ago, Walcott would very likely have ‘done’ his whole career as doctors would simply not have known what to do despite a relatively long period of research and surgery. The first surgical repair of an ACL was conducted in 1895 in Leeds by A.W. Mayo Robson who stitched back together the ligament of a miner who had been injured in a fall. Six years later the miner was able to run and walk without limping and reported the knee as being ‘perfectly strong’. Since then the ACL has been treated in a number of different ways to varying success but the present surgery which uses the patellar tendon, which connects the bottom of the kneecap to the shinbone, as a replacement ACL is the most beneficial for athletes. Previously the same tendon had be rerouted through the femur and tibia which was successful for getting people walking again but less successful for getting young men such as Walcott competing at World Cup level again. Now though the patellar tendon is harvested and fed through drilled holes in the femur and tibia, giving a sturdier replacement which can see full function recovered in less than a year after the necessary rehabilitation.
 
The surgery itself takes around an hour and a half to three hours to harvest the patellar tendon and rehome it through the knee. It is then really that the hard work begins, as the athlete must endure the rehab process of regaining the strength and muscle in the afflicted leg. In fact some findings suggest that the new ACL – the tendon vascularises to be become an organic part of the knee after eight months – is stronger than previously.
 
It is cold comfort for Theo Walcott in a World Cup year but he can be thankful that his ACL injury occurred in such a time of surgery and prevention strategies for future injuries.
 
Aaron Rogan ‘SSC Sports Correspondent’
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