Were you watching the National’s game last Monday?
When the man they call “the buffalo,” due to his reputation as an “unstoppable backstop” and “portly hitter,” fell in agony after going up for a high throw?
If you saw it, you knew, something was wrong. Wilson Ramos pointed to his knee right away after landing from the jump and the pain was clearly evident. Ramos was helped off the field in pain, due to what was reported as a torn ACL. Now, out for the season with surgery ahead, let’s discuss this injury.
Anterior Cruciate Ligament (ACL) Injuries:
Typically ACL injuries affect athletes in late adolescence. Female athletes participating in soccer and basketball are 2-7 times more likely than male athletes to suffer from torn ACL injuries.
Other sports at high risk for ACL injury include men and women’s: soccer, basketball, lacrosse, football and skiing.
The anterior cruciate ligament (ACL) is a primary stabilizing structure of the knee made of collagenous fibers. This ligament prevents anterior translation and internal rotation of the tibia.
ACL injuries are likely to take place when certain risk factors are present. Natural risk factors may include: genetic predisposition, hormonal changes (in females), valgus deformity (the direction of one’s knee, more common in females), increased quadriceps strength in relationship to the hamstrings, leg dominance, and ligament laxity. Outside risk factors that can result in injury include: wet, muddy terrain, high level of play, aggressive conditions, shoe-surface interaction (cleat length and traction), playing field conditions.
The anterior cruciate ligament is one of two cruciate ligaments that form an “X” in the knee. The anterior and posterior cruciate ligaments control back and forth motions in your knee. The ACL in particular provides rotational stability to the knee while preventing the tibia from moving in front of the femur.
How Does an ACL Injury Occur?
30% of injuries to this structure are reportedly due to contact, an athletes foot may be planted at the time of contact which causes enough torque to tear the ligament. 70% of ACL injuries are non-contact injuries. Non-contact injuries can occur during rapid deceleration or change of direction in which the quadriceps contraction results in increased stress on the ligament. Landing on a slightly hyper-extended knee can also result in increased stress on the ligament resulting in injury.
At the time of injury many athletes may report hearing or feeling a “pop,” along with immediate pain and swelling of the involved knee. Further reports of the knee giving out while “pivoting” or “cutting,” may be indicators of potential ACL injury.
How To Treat an ACL Injury?
Shortly after the injury takes place, in the acute stage, the R.I.C.E. principle applies. Regardless of whether surgical intervention is deemed necessary.
Depending on the injury, non-surgical management in the form of rehabilitation may be appropriate. This is for those in the older population, those with sedentary lifestyles or those willing to modify activity accordingly.
Surgical methods are typically recommended within 5 months of injury for those with skeletal immaturity, ACL laxity with associated instability, and active young adults.
While bracing can provide comfort and the idea of protection, it does not provide the proper rotational support the knee requires during high force and velocity sports. Routine use of functional knee braces is not recommended after ACL reconstruction.
Regardless of non-surgical or surgical treatment methods proper rehabilitation is important in the proper management of ACL injuries!
Rehabilitation goals should include:
- Restoring range of motion
- Regaining muscle strength of lower extremities and core muscles
- Neuromuscular control
- Return to pre-injury levels of function
- Minimize further risk of damage to knee structure
How To Prevent an ACL Injury?
Check out this video, featuring another professional athlete who suffered a devastating ACL injury, Ali Krieger from Team USA. Safekids.org provides this training video with 7 exercises to prevent ACL injuries:
If you have any questions regarding ACL injuries or if you are interested in prevention tips or evaluation, feel free to reach out to Dr. Reilly at firstname.lastname@example.org or call for an appointment today (703)-760-8110!
“Anterior Cruciate Ligament (ACL) Injuries.” American Academy of Orthopaedic Surgeons. N.p., Mar. 2014. Web. 3 Oct. 2016.
“Anterior Cruciate Ligament (ACL) Injury.” DynaMed [EBSCO]. N.p., 18 Aug. 2015. Web. 3 Oct. 2016. <http://web.a.ebscohost.com.proxy.palmer.edu/dynamed/detail?vid=2&sid=a065f585-93e6-45c1-b865-674d194913fc%40sessionmgr4007&hid=4112&bdata=JnNpdGU9ZHluYW1lZC1saXZlJnNjb3BlPXNpdGU%3d#AN=114675&db=dme>.
Game Changers: 7 Exercises to Prevent ACL Injuries. Perf. Ali Krieger. N.p., n.d. Web. 3 Oct. 2016.
Janes, Chelsea. “Nationals’ Wilson Ramos out for the Season with Torn ACL.” Washington Post. The Washington Post, 27 Sept. 2016. Web. 03 Oct. 2016.