ACL injuries in Australian rules football

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In Australian rules football, injuries are common and consistent due to the nature of the game as a contact sport. The Anterior cruciate ligament (ACL) knee injury is one of the three major and common injuries which occur in the sport.[ citation needed ] The ACL injury can have long-term effects on the player, not only in physical activity but also in their own daily lives in the future. Studies have attempted to understand and find prevention techniques for ACL injuries, but the scarcity of data precludes any conclusions for male athletes. Female athletes, however, have shown reductions in the rate of ACL injuries through the use of strength training and technique improvement. [1] Once a player has injured their ACL, there is a very high possibility that the injury can occur again to the same knee. There is also the chance of the opposite knee being injured due to the player protecting the reconstructed knee. [2]

Contents

Structure of the knee and the ACL

Diagram of the ACL; and a torn ACL. ACL Tear.png
Diagram of the ACL; and a torn ACL.

An ACL rupture is the most common injury that takes place in the knee.[ citation needed ] The ACL is very small; the average length is 38mm and only 11mm wide.[ citation needed ] The knee is formed by the connection of the femur (upper leg bone) and the tibia (lower leg bone) with another two bones been the fibula (small bone next to the tibia) and the patella (the kneecap). Within these two main bones tendons attach the bones to the muscles that give the knee movement, while the ligaments provide the knee with stability. The ACL looks like a mixture of an oval and triangle shape, and is located in a very compact area within the knee. The ACL fibres are in place to give direction for the knee to move, such as a kicking or twisting motion. If an ACL rupture occurs, it immediately forces an increase not only to the anterior tibial translation but also the internal tibial rotation. This is because, as the femur is pushed back to rotate, trauma is caused to the knee due to a lack of stabilisation. The ACL is there to create rotational stability within the knee to be able to produce different motions. Importantly, the ACL restrains the anterior tibial translation, providing 85–87% total restraining force. [3]

Cause of injury

While Australian rules is a contact sport, not every ACL injury occurs due to contact. Studies show that out of 34 ACL injuries assessed, 56% of injuries were due to no-contact situations. These studies showed that ACL injuries occur most of the time due to type of movement, change of direction resulting in the knee giving way, speed of player, angle of knee when landing and lack of stability. [4] Australian footballers typically wear boots with studs on their soles; this creates grip and friction between the player and the surface. Although boots help the player play football, they also increase risk of injury to the ACL. [5]

Angle of the knee

The process of an ACL injury where no contact from a player is applied is mostly due to the player landing after jumping for a mark. The nature and severity of the injury is impacted by the hardness of the ground, the quality of the grass and how well the player lands. [6]

Lack of stability

Lack of stability in the knee is a main cause of ACL ruptures. Most advanced athletes struggle to gain enough stability within the knee while exercising, causing the possibility of injury. [7]

Prevention

While there is no guaranteed way to stop an ACL injury from occurring, there are ways to lower the risk. Once an athlete has had an ACL injury, it is often extremely difficult to return to football. This is exacerbated by the risk of further ACL injuries, which is much higher after the first injury. Due to these risks, building strong muscles and bones is considered highly beneficial for Australian rules footballers. [8] Small doses of training can help prevent ACL injuries as it helps avoid overtraining, which often causes fatigue and soreness. These small doses of training should include strength, balance, plyometrics or agility to achieve best results in avoiding an ACL injury. [9]

Post surgery on left knee, high swelling causing discomfort ACL reconstruction hamstring autograft 02.jpg
Post surgery on left knee, high swelling causing discomfort

Recovery

After an injury, it is important that the player recovers properly. Recovery includes rest, low activity, diet, strength and training. Balance is a useful way of preventing ACL injuries as it builds strength within the knee. Studies have also found the knee is strengthened by training focussed on jumping, landing, posture and changes of direction. [2] Balance is the ability to maintain the centre of mass of a body within the base of support. The two types of balance are static (the ability to control one's body while in a stationary position) and dynamic (the ability to control one's body while moving). When trying to understand balance, it is important to acknowledge three factors: mass, the area of the base of support, and the position of the centre of gravity. Balance evolves around the base of support as well as the centre of gravity. [10] For an injured footballer to obtain maximal benefits from this training, they should work on their balance consistently to build strength within both knees and around the body. [2]

Related Research Articles

<span class="mw-page-title-main">Sports injury</span> Physical and emotional trauma

Sports injuries are injuries that occur during sport, athletic activities, or exercising. In the United States, there are approximately 30 million teenagers and children who participate in some form of organized sport. Of those, about three million athletes age 14 years and under experience a sports injury annually. According to a study performed at Stanford University, 21 percent of the injuries observed in elite college athletes caused the athlete to miss at least one day of sport, and approximately 77 percent of these injuries involved the knee, lower leg, ankle, or foot. In addition to those sport injuries, the leading cause of death related to sports injuries is traumatic head or neck occurrences.

<span class="mw-page-title-main">Knee</span> Leg joint in primates

In humans and other primates, the knee joins the thigh with the leg and consists of two joints: one between the femur and tibia, and one between the femur and patella. It is the largest joint in the human body. The knee is a modified hinge joint, which permits flexion and extension as well as slight internal and external rotation. The knee is vulnerable to injury and to the development of osteoarthritis.

<span class="mw-page-title-main">Posterior cruciate ligament</span> One of four major ligaments of the knee

The posterior cruciate ligament (PCL) is a ligament in each knee of humans and various other animals. It works as a counterpart to the anterior cruciate ligament (ACL). It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. This configuration allows the PCL to resist forces pushing the tibia posteriorly relative to the femur.

<span class="mw-page-title-main">Anterior cruciate ligament</span> Type of cruciate ligament in the human knee

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee. The two ligaments are also called "cruciform" ligaments, as they are arranged in a crossed formation. In the quadruped stifle joint, based on its anatomical position, it is also referred to as the cranial cruciate ligament. The term cruciate translates to cross. This name is fitting because the ACL crosses the posterior cruciate ligament to form an "X". It is composed of strong, fibrous material and assists in controlling excessive motion. This is done by limiting mobility of the joint. The anterior cruciate ligament is one of the four main ligaments of the knee, providing 85% of the restraining force to anterior tibial displacement at 30 and 90° of knee flexion. The ACL is the most injured ligament of the four located in the knee.

<span class="mw-page-title-main">Stress fracture</span> Medical condition

A stress fracture is a fatigue-induced bone fracture caused by repeated stress over time. Instead of resulting from a single severe impact, stress fractures are the result of accumulated injury from repeated submaximal loading, such as running or jumping. Because of this mechanism, stress fractures are common overuse injuries in athletes.

<span class="mw-page-title-main">Segond fracture</span> Avulsion fracture of the lateral tibial condyle of the knee

The Segond fracture is a type of avulsion fracture from the lateral tibial plateau of the knee, immediately below the articular surface of the tibia.

<span class="mw-page-title-main">Osgood–Schlatter disease</span> Inflammation of the patellar ligament

Osgood–Schlatter disease (OSD) is inflammation of the patellar ligament at the tibial tuberosity (apophysitis) usually affecting adolescents during growth spurts. It is characterized by a painful bump just below the knee that is worse with activity and better with rest. Episodes of pain typically last a few weeks to months. One or both knees may be affected and flares may recur.

<span class="mw-page-title-main">Anterior cruciate ligament reconstruction</span> Surgical process

Anterior cruciate ligament reconstruction is a surgical tissue graft replacement of the anterior cruciate ligament, located in the knee, to restore its function after an injury. The torn ligament can either be removed from the knee, or preserved before reconstruction through an arthroscopic procedure. ACL repair is also a surgical option. This involves repairing the ACL by re-attaching it, instead of performing a reconstruction. Theoretical advantages of repair include faster recovery and a lack of donor site morbidity, but randomised controlled trials and long-term data regarding re-rupture rates using contemporary surgical techniques are lacking.

<span class="mw-page-title-main">Cruciate ligament</span> Type of ligament shaped like an X

Cruciate ligaments are pairs of ligaments arranged like a letter X. They occur in several joints of the body, such as the knee joint, wrist joint and the atlanto-axial joint. In a fashion similar to the cords in a toy Jacob's ladder, the crossed ligaments stabilize the joint while allowing a very large range of motion.

<span class="mw-page-title-main">Sprained ankle</span> Medical condition

A sprained ankle is an injury where sprain occurs on one or more ligaments of the ankle. It is the most commonly occurring injury in sports, mainly in ball sports such as basketball, volleyball, football, and tennis.

<span class="mw-page-title-main">Anterior cruciate ligament injury</span> Ligament injury near the knee

An anterior cruciate ligament injury occurs when the anterior cruciate ligament (ACL) is either stretched, partially torn, or completely torn. The most common injury is a complete tear. Symptoms include pain, an audible cracking sound during injury, instability of the knee, and joint swelling. Swelling generally appears within a couple of hours. In approximately 50% of cases, other structures of the knee such as surrounding ligaments, cartilage, or meniscus are damaged.

<span class="mw-page-title-main">Unhappy triad</span> Medical condition of the knee

The unhappy triad, also known as a blown knee among other names, is an injury to the anterior cruciate ligament, medial collateral ligament, and meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, "combined anterior cruciate and medial collateral ligament disruptions that were incurred during athletic endeavors" always present with concomitant medial meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.

<span class="mw-page-title-main">Meniscus tear</span> Rupturing of the fibrocartilage strips in the knee called menisci

A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear'. Especially acute injuries can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the joint. The joint will be in pain when in use, but when there is no load, the pain goes away.

Posterolateral corner injuries of the knee are injuries to a complex area formed by the interaction of multiple structures. Injuries to the posterolateral corner can be debilitating to the person and require recognition and treatment to avoid long term consequences. Injuries to the PLC often occur in combination with other ligamentous injuries to the knee; most commonly the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL). As with any injury, an understanding of the anatomy and functional interactions of the posterolateral corner is important to diagnosing and treating the injury.

<span class="mw-page-title-main">Tibial plateau fracture</span> Medical condition

A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. This could involve the medial, lateral, central, or bicondylar. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.

<span class="mw-page-title-main">Medial knee injuries</span> Medical condition

Medial knee injuries are the most common type of knee injury. The medial ligament complex of the knee consists of:

High tibial osteotomy is an orthopaedic surgical procedure which aims to correct a varus deformation with compartmental osteoarthritis. Since the inception of the procedure, advancements to technique, fixation devices, and a better understanding of patient selection has allowed HTO to become more popular in younger, more active patients hoping to combat arthritis. The idea behind the procedure is to realign the weight-bearing line of the knee. By realigning the knee, the force produced from weight-bearing is shifted from the arthritic, medial compartment to the healthy, lateral compartment. This decrease in force or load in the diseased part of the knee joint decreases knee pain and can delay the development or progression of osteoarthritis in the medial compartment.

<span class="mw-page-title-main">Posterior cruciate ligament injury</span> Medical condition

The function of the posterior cruciate ligament (PCL) is to prevent the femur from sliding off the anterior edge of the tibia and to prevent the tibia from displacing posterior to the femur. Common causes of PCL injuries are direct blows to the flexed knee, such as the knee hitting the dashboard in a car accident or falling hard on the knee, both instances displacing the tibia posterior to the femur.

Movement assessment is the practice of analysing movement performance during functional tasks to determine the kinematics of individual joints and their effect on the kinetic chain. Three-dimensional or two-dimensional analysis of the biomechanics involved in sporting tasks can assist in prevention of injury and enhancing athletic performance. Identification of abnormal movement mechanics provides physical therapists and Athletic trainers the ability to prescribe more accurate corrective exercise programs to prevent injury and improve exercise rehabilitation and progression following injury and assist in determining readiness to return to sport.

<span class="mw-page-title-main">Injuries in netball</span>

Netball is a sport that has one of the largest female participation rates within the Commonwealth, most popular in the United Kingdom, Australia and New Zealand, with more than 20 million athletes participating in the sport. Netball is a ball sport played by two teams of seven players in which goals are scored by shooting the ball through a netted ring. Netball relies heavily on muscular endurance and bursts of rapid acceleration to “break free” from an opponent as well as, sudden and rapid change of directions in combination with jumping to receive a pass, intercept a ball or rebound. The sudden stop-start motion of the game is what often leads to serious injuries in participants. Higher grade players, in both senior and junior competitions, are more susceptible to injuries than lower grade players, due to the high intensity and rapid pace of the game. An injury is most commonly defined as one that has occurred while participating in sport and which led to one of the following consequences: a reduction in the amount or level of sports activity; need for medical advice or treatment; and/or adverse economic or social effects for the athlete.

References

  1. ↑ Hong, Y. (2012). ACL injury: Incidences, healing, rehabilitation, and prevention: Part of the routledge olympic special issue collection. Research in Sports Medicine, 20(3), 155. doi:10.1080/15438627.2012.682526
  2. 1 2 3 Hrysomallis, C. (2013). Injury incidence, risk factors and prevention in Australian rules football. Sports Medicine, 43(5), 339-354. doi:10.1007/s40279-013-0034-0
  3. ↑ Noyes, F. R., & Barber-Westin, S. (2012). ACL injuries in the female athlete: Causes, impacts, and conditioning programs (1. Aufl.; 1 ed.). Dordrecht: Springer-Verlag.
  4. ↑ Cochrane, J. L., Lloyd, D. G., Buttfield, A., Seward, H., & McGivern, J. (2007). Characteristics of anterior cruciate ligament injuries in Australian football. Journal of Science and Medicine in Sport, 10(2), 96-104. doi:10.1016/j.jsams.2006.05.015
  5. ↑ Renstorm, P., Ljungqvist, A., Arendt, E., Beynnon, B., Fukubayashi, T., Garrett, W., Georgoulis, T., Hewett, T. E., Johnson, R., Krosshaug, T., Mandelbaum, B., Micheli, L., Myklebust, G., Roos, E., Roos, H., Schamash, P., Shultz, S., Werner, S., Wojtys, E., & Engebretsen, L. (2008). Non-contact ACL injuries in female athletes: An international olympic committee current concepts statement. British Journal of Sports Medicine, 42(6), 394-412. doi:10.1136/bjsm.2008.048934
  6. ↑ Smeathers, J., Urry, S., Butler, A., Nichols, C., Wearing, S., & Hooper, S. (2010). Non-contact ACL injuries: Association with clegg soil impact test values for sports fields, soil moisture and prevailing weather. Journal of Science and Medicine in Sport, 12, e9-e10. doi:10.1016/j.jsams.2009.10.020
  7. ↑ Chmielewski, T. L., Rudolph, K. S., & Snyder-Mackler, L. (2002). Development of dynamic knee stability after acute ACL injury. Journal of Electromyography and Kinesiology, 12(4), 267-274. doi:10.1016/S1050-6411(02)00013-5
  8. ↑ Ostojic, S., & Stojanovic, M. (2012). Preventing ACL injuries in team-sport athletes: A systematic review of training interventions. Research in Sports Medicine, 20(3), 223. doi:10.1080/15438627.2012.680988
  9. ↑ Myklebust, G., & Steffen, K. (2009). Prevention of ACL injuries: How, when and who? Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA, 17(8), 857-858. doi:10.1007/s00167-009-0826-9
  10. ↑ Whipp, P.R., Elliott, B., Guelfi, K., Dimmock, J., Lay, B, Landers, G, & Alderson, J. (2010). Physical education studies 2A-2B: A textbook for teachers and students. Perth, WA: UWA Publishing.
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