ACL (anterior cruciate ligament) injuries are a common problem in sports, affecting both professional and amateur athletes. Orthopaedic Specialists’ Mr Raghbir Khakha and Professor Adrian Wilson offer their expertise on why ACL injuries are more common in women and girls, and how prevention, and the right form of treatment is the key to tackling this.
What is the ACL (anterior cruciate ligament)?
The anterior cruciate ligament is an important ligament in the knee joint that provides stability during physical activities such as running, jumping, and cutting. When the ACL is injured, it can be a major setback for athletes, requiring a long recovery period and potentially impacting their ability to perform at their best.
In recent news we learned about England captain Leah Williamson and Arsenal player Laura Wienroither, who have both suffered ACL injuries and will be out of action for some time.
Traditional forms of treatment
The traditional form of treatment for an ACL injury is an ACL reconstruction, which involves using tissue from around the knee joint to replace the old ACL, followed by a period of rehabilitation. Rehabilitation for this injury is typically one year, during which patients cannot engage in twisting sports. However, not all patients can return to their previous level of activity after the injury.
Professor Wilson has been at the forefront of pioneering ACL reconstruction techniques around the world. For example, two of the most popular and cutting-edge techniques practised today, the “all inside” technique and internal brace reconstruction, were first created, studied, demonstrated and published by Professor Wilson. They are now used globally as the best forms of ACL reconstruction surgery.
Working to prevent ACL injuries in women’s sport
Although such effective treatments are now available for ACL injuries, Mr Khakha and Professor Wilson agree that prevention is always better than cure, and there are validated warm-up exercises that can reduce the risk of ACL injury. Women are more predisposed to ACL injuries than men, due to a combination of anatomical and hormonal differences. The forces going through the knee joint are different in women due to their wider pelvis, putting the ACL under more stress and causing it to rupture. Hormonal changes during the menstrual cycle can also increase the risk of ACL rupture.
The first big ACL prevention program was developed by Lars Engerbretzen and his team in Norway, following a significant event with the Norwegian female handball team where every single member had at least one ACL procedure. The program has been successfully introduced in Scandinavia and has led to a 50% reduction in ACL injury. Similar prevention schemes have started in other parts of the world, such as the Australian netball association’s successful prevention scheme.
It has been demonstrated that with appropriate prevention training, the risk of ACL rupture can be reduced by 50% in children and adults. However, in the UK, there has been poor uptake of these prevention schemes, highlighting the need for increased awareness and education.
Prevention and alternative treatments
In response to this problem a team of experts, including Mr Raghbir Khakha and Professor Adrian Wilson, developed a series of warm-up videos for the Children’s Knee Clinic in London, that can be used with any sport and at any level. These exercises have been validated and can be translated across all abilities, from amateur to professional.
While ACL reconstruction is the traditional form of treatment for ACL injuries, there are other options available now, including ACL repair. ACL repair is a new technique that is being popularised globally, with Professor Wilson also helping to pioneer this alternative treatment and it’s uptake. In the UK, wider adoption has been slower than other countries, due to medical conservatism, however Orthopaedic Specialists’ clinic is only one of two in the UK that offers it and it is proving to be hugely popular with patients that Professor Wilson treats.
This technique involves repairing the torn ACL rather than replacing it, which can potentially give good outcomes with a quicker return to sports. With ACL repair, patients can return to full contact sports in four months, compared to the one year required for ACL reconstruction. This has huge implications for both children and adults, as it can significantly reduce their time away from sports.
Mr Khakha and Professor Wilson’s specialist paediatric and adolescent knee practice at the Cromwell Hospital is at the forefront of leading such techniques to help prevent and treat ACL injuries when they occur at younger ages. Ultimately the earlier effective prevention and treatment programmes can be utilised, the more likely it is that athletes, young and old, can reduce the risk of significant injury throughout their sporting practice.
Education is key here, as in addition to prevention and treatment options, it is important to recognize the impact of ACL injuries on athletes. Not only can they be physically debilitating, but they can also have psychological and emotional effects, such as anxiety, depression and decreased self-esteem. This highlights the need for a holistic approach to treating ACL injuries, which includes not only physical rehabilitation, but also emotional and psychological support for athletes.
ACL injuries are a significant problem in sports, especially for women. Prevention is key, and validated warm-up exercises can reduce the risk of ACL injury by 50%. Additionally, ACL repair is a promising new technique that can help athletes return to sports more quickly than traditional ACL reconstruction. It is important to increase awareness and education around ACL for both professional and amateur sports people.
If you’re experiencing knee pain or injury, book a consultation with an Orthopaedic Specialists Consultant.
