The Anterior Cruciate Ligament, usually called the ACL, is the primary stabilizer of the knee. It is called the anterior or front cruciate because it crosses the posterior cruciate ligament, which sits directly behind it. These two ligaments form an “X,” which connects your thigh bone to your shin bone. The Anterior Cruciate Ligament prevents the top of shin bone from excessively rotating and from gliding forward. This protective mechanism limits hyperextension of your knee. A torn ACL destabilizes the knee and causes it to buckle. A torn ACL requires surgery, followed by physiotherapy. Doctors usually suggest a six month recovery period before returning to your sport. The bad news: tearing your ACL increases the possibility of tearing it again – either on the same or opposite side. The good news: patient education via physiotherapy can prevent repeat ACL tears.
What the Research Tells Us
A study presented at the July, 2014 meeting of the American Orthopaedic Society for Sports Medicine’s Annual Meeting suggests that patient education about modifiable risk factors may minimize the chance of a future ACL tear.
“Our research suggests that a few risk factors such as, age, activity level and type of graft utilized may point to the possibility of re-injury,” said lead author, Christopher C. Kaeding, MD of the Ohio State University. “However, with better education about adjustments that can be made, based on these risk factors, patients may be able to minimize re-tears.”
From 2002 to 2008, Kaeding and his team analyzed data from 2,695 ACL patients. All patients had a primary ACL reconstruction with no history of contralateral knee surgery. Graft type, age, sport played after surgery, gender, smoking status, meniscal tear status and Body Mass Index (BMI) were the criteria for inclusion in the study.
The results of the study indicate that 116/2695 had a re-tear on the same side of the body and 97/2695 (3.6%) had a re-tear on the opposite side. The odds of re-tearing the same ACL, decreased by nine percent for each year of increased age. The odds of re-tear on the opposite ACL, decreased by four percent for every year of increased age.
“The study highlights that younger age, higher activity levels at time of injury and what type of graft used (allograft) may increase risk of same side ACL injury within two years. With individuals having higher activity levels and lower age re-tears on the opposite leg were more prominent,” said Kaeding. “Physicians and physical therapists need to better educate our patients about continued neuro-muscular training even after the immediate rehabilitation process has ended to help prevent future tears.”
Another study, titled “Incidence and risk factors for graft rupture and contralateral rupture after anterior cruciate ligament reconstruction,” found that risk factors for repeat ACL injury included a return to competitive side-stepping, pivoting, or jumping sports.
One does not need a degree in physiotherapy to see that repeat ACL tears are probably due to existing muscle imbalances, postural alignment and faulty movement mechanics. Your physiotherapist can help you retrain your muscles, and prevent further injuries.
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