Anterior cruciate ligament (ACL) injury

Author: Raphael Fung Registered Physiotherapist | Sports Injuries

This injury is common among athletes participating in sports involving rapid pivoting and jumping, such as football, basketball, skiing, and volleyball. The anterior cruciate ligament (ACL) can be damaged by abnormal twisting or direct impact, leading to pain and instability. Athletes, especially those with a history of ligament injuries, are at high risk.

The anterior cruciate ligament (ACL) is a major ligament in the knee joint that stabilizes the knee and prevents the tibia (shin bone) from sliding forward beneath the femur (thigh bone). ACL injury is one of the common severe knee injuries in sports. Detailed causes include:

1. Non-contact injuries:

• Sudden stopping:
  Rapid deceleration followed by a sudden stop during sports, especially when running or moving quickly.
• Rapid change of direction:
  Quick pivoting during sports, especially when the knee is locked.
• Improper landing:
  When landing from a jump, if the knee is hyperextended or twisted inward, it can lead to an ACL injury.
• Sudden deceleration with simultaneous turning:
  This movement can lead to an ACL tear, especially in sports like basketball, football, or skiing.

2. Contact injuries:

• Direct impact:
  Direct impact to the outside of the knee, common in contact sports such as football, rugby, or ice hockey.
• Collision with another person's knee:
  During a game, collision between another athlete's body or leg and the injured person's knee, causing the knee to move in an abnormal direction.

3. Biomechanical and anatomical factors:

• Female athletes:
  Studies show that female athletes are more prone to ACL injuries than male athletes due to anatomical and biomechanical differences, especially in certain sports.
• Leg alignment and muscle strength:
  Bow legs or knock knees, as well as insufficient strength in the thigh and calf muscles, can increase the risk of injury.

4. Playing surface and footwear:

• Improper playing surface:
  Such as surfaces that are too hard or too slippery.
• Footwear:
  Inappropriate athletic footwear can also increase the risk of injury.

5. Muscle fatigue:

• Fatigue can lead to decreased motor control in athletes, increasing the likelihood of injury.

Strategies for preventing ACL injuries include strengthening leg muscles, especially the quadriceps and hamstrings; improving movement techniques, particularly jumping and landing techniques; and increasing knee stability. For individuals who have already sustained an ACL injury, treatment options may include physical therapy and, in some cases, surgical reconstruction. After surgery, 6-8 months of physical therapy and rehabilitation are still required to restore the knee's original level of activity and muscle elasticity and strength, to prevent the ACL from being re-injured during its vulnerable stage.

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