Many footballers have suffered recently from cruciate
knee injuries.
It results in a lengthy period on the sidelines, but why is it
so serious?
There are four main ligaments in the knee - one on either side
and two across the middle.
The ACL is behind the kneecap (patella) and is in front of the
PCL.
It's the second strongest ligament in the knee and stabilises
the joint, connecting the thigh bone (femur) and the leg bone
(tibia).
The ACL and PCL limit the over straightening, over bending and
rotation of the knee.
The average length of the ACL is around 35mm, weighing around
20g. The medial ligament is one the inside of the knee, with the
lateral on the outside.
OPERATE OR NOT?
Surgery is not always essential when the ACL is ruptured. But in
the case of a young sportsman looking to return to sport as soon as
possible, it will be.
A middle aged or older person could recover without going under
the surgeon's knife. However, it is believed that repairing the
ligament can reduce the risk of getting arthritis in the joint
later in life.
Surgeon's will usually graft tissue from either the patella or
hamstring tendons to repair the ACL.
Basically the new tendon replaces the ACL and is usually
attached to the bones above and below the knee by screws.
The success rate for such operations is high and while the
injured person can soon be up and walking, running and twisting are
some months further down the line.
ROAD TO RECOVERY
Medical expert Bevan Ellis says: "Many top athletes will go
through an accelerated rehabilitation programme to get them back in
action within six months. "It requires intensive physiotherapy
which needs to be monitored very closely at every stage.
"For a typical person, an ACL injury would normally take between
8-12 months to get back to full fitness."
Phase one (0-2 weeks after surgery)
The knee will be swollen after the operation, so the first job
is to reduce the swelling. After that, the physio will make the
patient do a few light exercises like isometric contractions -
keeping the leg still but moving the muscles around the knee.
Phase two (2-6 weeks after surgery)
The swelling should have disappeared, but the graft usually
weakens around this time. The physio may have to back off from the
rehabilitation programme until the ligament is up to more
exercises.
The patient should be walking normally by then.
Phase three (6-12 weeks after surgery)
By this stage, the knee should be getting stronger and able to
take more strain. The patient should be able to go swimming and use
a road bike to get the knee back on track, as well as doing more
strength exercises.
Phase three (3-6 months)
The patient will have their full range of movement and strength
back, so they can start running properly once more. They should be
able to get back to specific drills and training.
Phase four (6-12 months)
The patient should be able to return to playing sport with their
surgeon's approval.
