The Rise of ACL Injuries in Soccer Players
Are you wondering about the likelihood of ACL injuries in soccer players? As lockdown is removed and athletes everywhere start returning to the field, more attention is being paid to the serious risks they might face. The anterior cruciate ligament (ACL) is one of four ligaments that holds and stabilizes the knee. Over 2 million athletes tear their ACL every year, and it is one of the most brutal and immobilizing injuries an athlete can go through.
In the soccer industry, this number continues to increase. ACL injuries in soccer players are usually a consequence of fast-paced movements or cutting. Most injuries to the ACL are considered non-contact (70%), meaning they are not caused by collisions with other players. It is becoming noticeably clear just how devastating and preventable this injury really is! Our innovative care strategies at MoveMend will help you find quick relief.
What is the ACL? What is its Purpose?
The ACL connects the thigh bone (femur) to the shin bone (tibia) and crosses in front of the posterior cruciate ligament (PCL). Its primary job is to prevent the tibia from shifting too forward in relation to the femur. It also stabilizes during rotational movements and some side-to-side movements as well.
How Do You Injure the ACL?
The most common cause of ACL injury in soccer players is deceleration tasks when the foot is planted into the ground, full body weight shifted to the injured side, and other internal forces that stress the ACL. Non-contact injuries encompass a quick change in direction or cutting, combined with slowing down abruptly, landing from a jump with the knee fully extended, and pivoting on a planted foot with the knee near full extension. There is a certain point at which the force on the ACL is greatest and that is when the knee is slightly bent (~30-40 degrees). Studies have shown that females demonstrate a reduction in proper landing mechanics/ techniques during cutting, landing, and decelerating tasks.
How Can I Prevent ACL Injuries as a Soccer Player?
The best way to reduce your risk or avoid non-contact injuries is to work on the mechanics of landing, strength, and control. You cannot plan for contact injuries and avoiding all injuries is impossible, but if you work on strength, landing mechanics, and control, it is a suitable place to start. It is important to talk to a physical therapist and performance coach to devise a plan that addresses your deficient areas.
Are there ACL Injury Prevention Programs?
We have devised a 12-week program that addresses mobility, foundational strengthening, and movement control & coordination. You can have all the strength in the world, but if you do not have proper mechanics during decelerating tasks, having only strength without control isn’t going to protect you from this injury.
See examples of what you will work on in our 12-week injury prevention and performance program in the video below. This is ideal to reduce the risk of ACL injuries in soccer players.
Does Everyone Who Tears their ACL Need Surgery?
This is a common question. The short answer is no. If you do not participate in activities that require significant amounts of cutting or pivoting, then you might be able to successfully return to pre-injury condition without surgery. If this is the route you select, concentration should be focused on physical therapy & rehab. This is something you would need to discuss with your orthopaedic surgeon.
Which Graft Selection is the Best?
If you are indicated for an ACL reconstruction, picking a graft is an important part of your discussion with the surgeon. Unfortunately, there is no perfect graft choice, as all have their risks & benefits. You will have to decide whether to use your own tissue (autograft) or someone else’s tissue (allograft). If you are young (under 30) & playing sports (high school, club, college, professional), an autograft is the better option. Using your own tissue has shown a 5x lower likelihood of re-tearing. If you are playing or performing at a lower level and are over 40 years old, you will have equivalent success with an allograft.
Autograft options include patellar tendon, hamstring tendon, and quadriceps tendon. Each graft has its advantages & disadvantages. The most common option is the patellar tendon (gold standard). The patellar tendon is taken from the front of the knee & has bone on both ends of the kneecap. When using this option, the bone can heal within the bone tunnels they create to make it more reliable. Disadvantages: front knee pain is present particularly with bending/ kneeling.
The hamstring tendon is also an excellent choice. Studies have shown there to be a 10–15-year excellent outcome. There is a difference between the hamstring and the patellar tendon in that with the hamstring there is no pain in the front of the knee, but there is a higher chance of failure in this tendon but the possibility of that happening is quite small.
The Quadriceps tendon has gained popularity for use as a graft source. The quadriceps tendon is all soft tissue and offers many advantages over other graft choices such as having 20% more collagen fibrils (what tendons are made of), can withstand more than 70% greater load, and more importantly, is more like the native ACL than other graft options. After harvesting fibres of the quadriceps, the remaining quadriceps muscle is still 80% stronger than the intact patellar tendon! Clinical outcomes are excellent.
Biggest takeaways from this: 1) find a well-experienced orthopaedic surgeon you are comfortable with, 2)discuss which grafts the surgeon is most comfortable using, and 3) discuss all your options with your surgeon as it pertains to you as the individual and the graft selection that best fits you and the demand of your sport. Our trained physical therapists are dedicated to helping you achieve a pain-free life.
How Long is the Recovery After an ACL Reconstruction?
The recovery process can be 9-12 months. The most important part of recovery is listening to your physical therapist and surgeon and do not attempt to go back to sports until both providers feel that you are ready. There is a return to sports criteria that are necessary to pass prior to being released to full participation in sport. These include but are not limited to strength (quadriceps symmetry), quality & quantity of hop testing, & psychological factors. Remember, not every athlete has the same recovery, and you should never return to sport until you feel physical, mentally, and emotionally ready. Contact us today.
Blog written by Dr. Micaela E. Riley, PT, DPT