Addressing ACL tears in athletes

4/29/2013

Sports fans across the country cringe when they hear about anterior cruciate ligament, or ACL tear. In addition, many professional and weekend warriors have their sporting seasons come to an abrupt end because of this very common injury.

The ACL is a tough band of tissue that connects the thigh bone, or femur, to the shin bone, also known as the tibia. Its role is to prevent the bones from extending beyond normal angle and rotation. When the ligament is injured, a majority of athletes will hear a "pop." Swelling ensues, blood normally pools in the knee joint and the joint is generally unstable after injury.

"The ACL is a very important stabilizer of the knee," says Jeffrey Zacharias, M.D., a board-certified orthopedic sports medicine surgeon based at Beaumont Hospital, Grosse Pointe. "There are approximately 100,000 to 200,000 ACL tears each year in the U. S. alone."

Interestingly, the ACL can tear with both contact and noncontact movements of the knee. In fact, about 70 percent are noncontact and occur during change of direction, slowing down while running or landing from a jump. The other 30 percent of ACL injuries come from a direct impact to the knee causing unnatural bends.

The latest orthopedic research also seems to indicate that female athletes are sustaining ACL injuries up to 10 times more than their male counterparts. Soccer and basketball are two of the most common sports where injuries occur.

Fortunately, Dr. Zacharias is quick to point out there is plenty of hope for all ACL patients in 2013. He says today's reconstruction surgery has become the standard of care. With the appropriate rehabilitation and recovery time, nearly all patients can bring the injured knee back to near-normal function, allowing patients to stay active and continue participating in running, cutting, jumping and pivoting sports.

Most ACL reconstructions are now performed arthroscopically or arthroscopically-assisted with an extremely small incision. Using these minimally invasive techniques, a graft (piece of tendon) is placed into the knee, replacing the torn ACL. The grafts are secured into place in very precise positions using many different types of metal, plastic or bioabsorbable implants to allow for aggressive postoperative rehabilitation.

However, Dr. Zacharias mentions that not everyone needs surgery. Older, less active patients can do well without reconstruction if they participate in rehabilitation and modify their activities. Likewise, people who have moderate to severe arthritis may not be good candidates for ACL reconstruction.

"The best defense for preventing ACL injuries is a good offense," says Dr. Zacharias. "There are many different exercise programs that are being used to help athletes decrease their chances of an ACL tear. The programs focus on exercises that make the muscles surrounding the knee stronger and more flexible. They focus on improving core strength and teach proper positioning of the knees when jumping."

There are approximately 100,000 to 200,000
ACL tears each year in the U. S.