The Anterior Cruciate Ligament (ACL) is a very strong ligament in the middle of our knee that prevents our tibia from moving forward relative to the femur. It also provides rotational stability of the knee. The ACL also shares a connection with the medial meniscus and the medial meniscus shares a connection with the Medial Collateral Ligament (MCL) which is why it is not uncommon to see a tear of all three structures following a severe knee injury. Some of the most common ways an athlete injures the ACL is when an athlete is tackled from the side when the foot is on the ground, a basketball player hyperextends the knee on landing, or a sudden deceleration when attempting to cut. Hyperextension and deceleration injuries are more likely to produce isolated injuries to the ACL. Ironically enough this is exactly what happened to me when I said goodbye to my ACL in 2009. I was playing basketball driving to the net and an offensive lineman stood in-between me and the hoop. Natural instincts took over and I drove into him to draw a foul and put the shot up. He stood firm, very firm, and I ricocheted off of him several feet and landed with my right leg hyperextended. Once my foot hit the floor and my knee was locked out, my momentum kept going and that’s when I felt and heard the loudest ‘pop’ in my knee. A lot of pain and swelling later I knew my ACL was torn and after getting the confirmation on the MRI I was set for surgery in May of 2009. So how could have this been prevented?
Basketball, football, and soccer have the highest incidents of tearing the ACL in sports due to the factors mentions above. Female athletes are at a higher risk factor than their male counterparts. Studies have shown that learning how to jump and land correctly dramatically reduced the risk of an ACL tear. This occurred by having athletes performing cuts using a three-0step pattern in which the knees were flexed and the feet were kept beneath the hips. Over a 2-year period just performing this exercise reduced ACL injuries by 89%! Weight training, plyometrics, and stretching also showed a great reduction in ACL injuries. Wobble board exercises are also highly beneficial. Standing on an uneven surface performing squats or throwing a ball to another player are just some examples as well. Strengthening the VMO complex is also important as this muscle keeps the patella tracking properly. Having players take a jump shot from a box approximately 30-40cm high and having them land with flexion in the hip and knees is beneficial.
Other factors to include are proper footwear for the sport and conditions, good ankle and hip mobility, and overall skill and awareness of an athlete. There isn’t a one size fit all approach to preventing ACL injuries but more of a multifactorial approach seems to have better outcomes in reducing that injury. After going through the injury, surgery, and recovery I want to help as many people try and avoid this injury.
Hyde, T. E., & Gengenbach, M. S. (2007). Conservative management of sports injuries. Jones and Bartlett Publishers.
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