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Knee Pain

ACL Injuries in Sport

Minute Read

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1 month ago

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by james

The anterior cruciate ligament of the knee is one of the four key ligaments that control the movement of the knee joint. The ACL’s main function is to limit anterior movement of the tibia relative to the femur, and rotation of the knee. Therefore, injuries are sustained when this movement is forced beyond the control of the ligament and the ACL becomes stretched. An injury is tearing and breaking some or all of the collagen fibres that make up the structure of a ligament. These injuries are classified relative to the severity from 1 to 3.

The mechanism that injures an ACL, is a high force with a sudden change of speed, direction or rotation of the knee. ACL tears are therefore prevalent in sports that are more likely to generate this mechanism. Contact sports and those that have high impact with rotational landing are most at risk. Three sports are most at risk of this injury: football/soccer, skiing, basketball and gymnastics. 

Prevalence between men and women varies depending on the sport. Men are more at risk of ACL injuries than women in contact sports, while women are more likely in high impact rotation landing sports such as gymnastics (Montalvo et al, 2019).

ACL Injury Soccer/Football

ACL injuries in football are common due to the movements of the players and the way the game is played. The sport requires sudden changes in speed and direction. Therefore, the knee joint has to cope with high acceleration, deceleration, and rotational forces.

A frequent factor in the cause of an ACL injury in soccer is that the foot was planted on the ground. Players wear studded shoes, or football cleats, in order to have a better grip when doing these fast actions on the grass. Unfortunately, if the foot is fixed to the floor and a strong force is applied to the leg, more than the knee can cope with, there is no release of this through the foot if it is gripped to the floor with studs. This is a common cause of an ACL tear in football. 

Can You Play Football With A Torn ACL?

You will not be able to play football, and it is not recommended to try to play, with a torn ACL. If the ACL tear is minor it may only be a few weeks of rest and recovery until you can return to play. But with higher grade tears it may take up to 3 months.

 

Surgery is offered to those who have a complete, or near-complete, rupture and this will further lengthen the time to return to playing football.

Return To Football After ACL Surgery

Return to soccer after ACL surgery is a long process taking 9-12 months and in some cases longer. 83% of elite athletes return to play and the surgical graft ruptured in 5.2% (Lai et al, 2018).

Soccer players with ACL injuries who have returned to play after surgery include Roy Keane, Francesco Totti, Xavi, and Alessandro del Piero. 

Return To Football Without Surgery for ACL Rupture

There is comparatively little evidence for the management of ACL rupture without surgery for elite footballers, but as this case report discusses it can be a viable option. This English Premier League football player returned to play just 8 weeks after a complete ACL rupture (Weiler et al, 2015).

ACL Tear Skiing

Unfortunately, skiing is a sport that has a high prevalence of injuries per time practised. The most common ski injury is a knee injury skiing. Of all the knee injuries, ACL tears are the most likely skiing knee injury.

Many people get general knee pain after skiing, this is often due to the positions held and the duration. Another factor is that for many people it isn’t a sport they do daily or weekly. People often go skiing for a holiday and ski for several hours per day on consecutive days. This means that their body is not specifically conditioned to the sport.

General knee pain is different to getting an ACL injury skiing. ACL injuries are caused by high impact, often from a fall or collision. 

Typically ACL injuries occur from a twisted knee skiing with the addition of high force. This can include a fall and landing awkwardly on the knee or the ski getting caught on the snow or another person’s ski and twisting the knee as the body continues to move.

Can You Ski With A Torn ACL?

It is not recommended to ski with a torn ACL. A low-grade injury may only need a few weeks of rest but higher-grade injuries will need 4-8 weeks or longer. If the ACL is injured even minorly it will provide poor control of the knee and poor proprioception, therefor it is at a far greater risk of further damage.

How To Protect Knee While Skiing

As skiing is a high-risk sport for knee injuries and ACL tears, in particular, it is useful to do your utmost to protect your knee. There are two ways you can protect your knee.

 

  1. Learning good skiing technique and skiing within your limitations is undoubtedly the most important of all. Getting ski lessons is invaluable for any level of experience.
  2. Preparation with strength and conditioning before going skiing. Improving muscular strength with ski-specific exercises is the best way to prepare your body for skiing.
  3. Braces and supportive sleaves are often only used for those who have had a previous knee injury but can be an effective way to prevent injury and are sensible for those who are at higher risk.

Photo of woman skiing

Skiing After ACL Surgery

With the correct management and treatment, most people can return to skiing in about 9 months. To return to skiing safely after ACL surgery you must be dedicated to your rehabilitation exercises and seek the advice of an experienced physical therapist who can prepare you fully for skiing. Sport-specific testing to ensure you are physically prepared to tolerate the stresses of skiing will significantly reduce your risk of re-injury.

For many people, there can be a fear of skiing after ACL surgery. Testing in the gym can help build confidence and a graded exposure in terms of ski slop difficulty can also really help. 

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.

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