By Courtney Hypes
One of the most common and serious knee injuries in sport is an anterior cruciate ligament (ACL) sprain or tear. A typical ACL injury will take a player away from sports for 6 to 12 months and can result in long-term consequences for their health and athletic career. They are often left with functional deficits, knee instability and early-onset osteoarthritis. Once an athlete injures their ACL they have a 25% risk of sustaining a second ACL injury. However, many of these long-term consequences can be avoided with successful rehabilitation and a safe return to sport.
Anatomy of the Knee
Mechanism of Injury
What Puts You at Risk?
Treatment & Rehabilitation
Treatment for an ACL injury varies depending on the degree of damage done to the ACL and the surrounding structures. ACL injuries often require surgical reconstruction, especially if there is a complete tear of the ligament. Non-surgical management may be sufficient in elderly or less active individuals if the stability of the knee joint is intact. Whether your treatment involves surgery or not, rehabilitation is highly important for regaining function of the lower extremity.
When Can I Go Back to Aport?
With the risk of ACL re-injury being as high as 25%, it is crucial that the athlete is fully prepared both physically and mentally before returning to play. This is achieved through a rigorous course of rehabilitation, lasting for 6 to 12 months after injury. It is very important when designing a rehabilitation program that you have an understanding of the physical demands of the sport. For example, soccer players repeatedly produce forceful actions (running, cutting, jumping, sprinting) with short recovery periods. This requires power, co-ordination, balance and proprioception. If the rehabilitation program touches on each of the key elements and skills required for the sport, the athlete will be able to return to sport with a much lower risk of re-injury. The following section will outline the key concepts and exercises that should be included in a rehabilitation program to ensure a safe return to play. The focus will be on return to play for a soccer athlete, however the exercises and skills can easily be modified and applied to different sports.
PHASE 1 GOALS: Early Stage Rehabilitation (weeks 0 to 6 — timelines are approximate)
PHASE 2 GOALS: Progressive Strengthening and Neuromuscular Retraining (weeks 4 to 12)
During Phase 2, weight-bearing, closed-chain exercises are introduced to rebuild lower extremity strength. Particular attention must be paid to proper lower extremity alignment to prevent rotation and valgus at the knee joint. The exercises in this phase should begin on a stable surface and gradually progress to unstable surfaces to challenge the neuromuscular control of the knee. Incorporating the soccer ball (or any sport-specific equipment) into exercises in this phase will help the athlete prepare for the more advanced, sport-specific exercises during the later phases of rehab.
Exercises to include in Phase 2
Trunk and Pelvis Stability:
PHASE 3 GOALS: Sport Specific Training, Plyometrics and Agility (months 4 to 12)
During Phase 3, the drills become more complex and the player is gradually introduced back into a team setting at a reduced level. It is important that the athlete is progressed gradually during this stage as a lot of rehabilitation programs fail when there is a rapid increase in exercise load.
Exercises to Include in Phase 3
Sport Specific Agility:
PHASE 4: Return to Sport (months 6 to 12)
The following criteria must be met in order for the athlete to return to sport:
How Do I Prevent ACL Injury?
Many of the drills and exercises that are incorporated in the ACL rehabilitation program can be used on a regular basis for ACL injury prevention. Many studies have shown the positive effects of a neuromuscular training program in preventing knee injury. Prevention programs that address neuromuscular control of the lower extremity through strengthening, plyometrics and sports-specific agility exercises can reduce injury rates by as much as 30 to 50%. The FIFA 11+ is an excellent prevention program and, when incorporated regularly into training, can drastically reduce the incidence of ACL injury.