An athlete’s torment: ACL Injury

If you’re a football fanatic, the sight of an athlete falling to the ground writhing in agony while holding onto their knee is pretty common. But did you know that one of the leading causes is a significant ligament tear, making an individual scream in pain?

The particular part in question here is the Anterior Cruciate Ligament (ACL), one of the two cruciate ligaments in the knee area that provide knee stability. It is an essential structure in one’s body connecting the femur (thigh bone) to the tibia (shinbone of the lower leg) through the middle of the knee joint.

The ACL is about 1 to 1.5 inches long and about 10 mm wide. It prevents the tibia from moving forward on the Femur, thus holding the leg together and keeping the knee rotationally stable.

What happens when the ACL tears is that there is an immediate popping sound in the knee, followed by intense pain, throbbing and severe swelling. When the soreness subsides, the injured person can walk; however, the knee might give away, losing steadiness, causing the individual to fall.

Causes of ACL injuries: ACL injury is common amongst footballers, gymnasts, soccer and basketball players, etc. It frequently happens in fast-paced and high-impact sports. Non-contact injuries occur when the player plants a foot on the ground, puts all the bodyweight on it and tries to rotate. The ACL, if unable to bear the immense force from motion, ruptures with the pop sound. This is also known as ‘cutting and pivoting footwork’ in sports.

With significant sports tournaments taking place worldwide after a year of hiatus due to the pandemic, athletes are training hard to return to the field again. A lot of conversations are ongoing around a professional player’s well-being. Recently, one of the most serious risks they face, the ACL injury, is gaining awareness.

Recently, Italy faced off England in the much-awaited Euro 2020 final. One of the youngest talented Italian players, Nicolo Zaniolo, suffered ACL injuries on both his legs, preventing him from playing in the mega championship. Despite starting light training, a Dutch player and captain of the national football team, Virgil Van Dijk had to sit out Euro 2020 because of his ACL tear.

This year, Spanish badminton champion, Carolina Marin had to pull out of Olympic Games Tokyo 2020 due to an ACL tear in her left knee. In the 2016 Rio Olympics, she won against India’s P V Sindhu for the gold medal. These are just three athletes who have suffered a knee injury. Every year approximately, 2 million players have an ACL tear.

According to a Yale medicine study, female athletes are more prone to ACL tear than their male counterparts. The reason for the same is unclear, but experts suggest it is because of the difference in anatomy. Women have a broader pelvis that puts additional stress on the soft tissues supporting the joints. Multiple other research inferences have supported the above reason.

ACL injuries often affect a chunk of an athlete’s career, and sometimes even surgery cannot guarantee their return to the sport. There are possibilities of a re-tear after recovering. Recent studies have also determined that those who suffer ACL tear eventually develop Arthritis in the knee if not treated adequately.

Apart from this, ACL reconstruction surgery can bring changes in the brain structure, leading to a lapse in the player’s performance. The brain alters its communication to the body, joints, muscles, and changes the organ’s overall functioning mechanism. This happens post-surgery to adapt to the changes in the body. Hence, medical practitioners should focus on reviving swift movement in the knee and re-wiring the brain for smooth functioning.

The torn ligament is replaced with a tendon graft harvested from the patient. However, the crucial part lies in post-operation rehabilitation for satisfactory recovery. There are non-surgical treatment procedures as well, but those are for less active patients. Generally, young athletes require surgical reconstruction.

There are no absolute ways to prevent an ACL injury; it can happen to an athlete anytime in training or playing a match. Knee braces can provide increased stability to the player. Specific exercises which focus on strengthening, balance and stability can prove to be helpful.

(The writer is Director, Orthopaedics at a network of hospitals in Maharashtra)