The start of a new school year also means school sports are back in swing — and unfortunately, that also means the potential for injuries among young athletes.
One of the most common sports-related injuries in teenagers is the anterior cruciate ligament, or ACL, tear. Each year, 750-800 adolescents in Kentucky suffer from ACL injuries requiring surgery. These injuries happen in children as young as five, though most occur between the ages of 15 and 24. These injuries are becoming more frequent, showing a 15 percent increase from 2009 to 2012.
What is the ACL?
The ACL is a ligament of the knee that helps control the motion between the thigh (femur) and the shin (tibia) bones. It is most important in sports that require pivoting, cutting, jumping, or landing.
The ACL can be injured by landing awkwardly, cutting or a direct blow to the knee, though it most often tears during a landing without contact from another player. Patients may hear a "popping" sound when the injury occurs.
Symptoms include swelling with a sensation of instability and "giving away" of the knee, pain, and a "locking" feeling if there is also injury to the meniscus cartilage. Athletes will generally be unable to continue their current activity following this injury.
A torn ACL does not heal, although it may attach by scar tissue to other structures of the knee.
How are ACL tears treated?
A mild tear may only require physical therapy with activity modification. However, most ACL tears in young patients will require reconstructive surgery.
Orthopaedic surgeons may use a variety of techniques for ACL reconstruction, including an allograft (tissues taken from a cadaver donor) or an autograft (tissues taken from the patient's own body).
Allograft reconstruction is recommended for patients over 35. An autograft frequently uses the patient's own hamstring or patellar tendon to reconstruct the ACL and is the preferred method for younger patients.
Following surgery, patients can expect to be in recovery and physical therapy for roughly 4-6 months, and it may take an additional three months until they are cleared for action. Overall the failure rate is low (5-7 percent) but can be as high as 20 percent in teenagers.
How can ACL injuries be prevented?
Injury prevention is key. Specific injury prevention programs focusing on core strength, balance and movement control can easily be integrated into warm-up procedures for every sport. These programs should also be a major part of the pre-season conditioning.
Injury prevention programs are especially important in those who have already torn an ACL, as they have a slightly higher risk of re-tear for both the repaired and the intact ACL. Unfortunately, about half of these patients will develop wear, tear and/or pain due to arthritis 10-15 years after the injury, even with a successful ACL reconstruction.