BENGALURU: Professional sports bring with it fame, money, and fan-following. However, injuries can result in severe knee problems. An injury to the ACL of the knee during sports may cause irritability, pain and inflammation and may affect the ability to play further. It is thus necessary to reduce the occurrence of factors that increase the risk of ACL injury and to treat it appropriately.
Anterior Cruciate Ligament and Meniscus
The anterior cruciate ligament is a ligament that connects the femur to the tibia. There are two C-shaped structures present in the knee that act as a cushion between the thigh bone and tibia (shinbone) and are known as meniscus.
ACL and knee stability
The primary task of the ACL is to stabilise the knee, especially during the front and back movement and pivoting movement of the knee. It comprises mechanoreceptors that help detect the changes in acceleration, tension, speed, and direction. It also has sensory receptors that maintain proprioception and kinaesthesia. These mechanisms play a critical role in neuromuscular control over the knee joint. It provides functional stability to the knee.
Injury pattern
There are two types of ACL injuries — contact, and non-contact injuries. Quick change of direction, landing and jumping are non-contact injuries. The contact injuries include the player-to-player collisions that directly hit the knee.
Sports prone to ACL injuries
Players associated with those sports that require a sudden change of direction and excessive tension on the knee joint are more prone to ACL injuries. Such sports include netball, football, basketball, downhill skiing, gymnastics, handball. ACL injuries may also occur due to PTA and swift fall at home.
Types of ACL injuries
Depending upon the severity, the injuries are of various grades. Grade 1 injury involves mild damage, and the ligament stretches slightly. The knee joint is stable in Grade 1. In Grade 2, the ligament becomes loose due to excessive stretching. It is also known as a partial ligament tear. Grade 3, the most severe form, involves a complete ligament tear, causing instability in the knee joint.
Conservative treatment
The doctor may recommend rehabilitation therapy to patients with a milder ACL injury. The rehabilitative treatment may continue for several weeks, depending upon the severity of the injury. Several exercises are available for reducing pain and swelling and for improving knee stability. Rehabilitative therapy restores knee motion and strengthens the muscles. Rehabilitative therapy is effective in those patients who are usually engaged in recreational activities, have relatively low physical activity, and engaged in sports that put less stress on the knees.
Surgical management
The doctor may recommend the surgery when the patient has an injury in other tissues of the knee along with ACL injury. The patient may also undergo surgery in high grade (complete) ACL tears. Surgery is more likely in those patients engaged in sports that involve excessive tension on the knees. During the surgery, the doctor replaces the damaged ligament with a tissue graft. The doctor may obtain tendons for grafting from other knee parts.
Returning to sports after surgery
The return to play after ACL injury depends upon several factors. These are the severity of the damage, other accompanying injuries, and type of sports. Studies concluded that 81 per cent of the patients return to any competition within one year after ACL surgery.
(The writer is consultant orthopaedic, joint replacement and arthroscopic surgeon, Manipal Hospital Millers Road)