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Keyword: acl

Guest Post by:

Stephanie Davey, ATC
Certified Athletic Trainer
MUSC Sports Medicine

Kansas Jayhawk fans held their breath on March 3 as star forward Perry Ellis was clutching his right knee after a teammate fell into him.  He was assisted off the court and taken to the locker room.  He returned back to the bench at the end of the game wearing the team warm ups.  It was reported at that time that Ellis had a MRI that showed a sprained knee, but otherwise was negative.  Ellis, a first team All Big 12 power forward, averages 13.8 points per game and 7.0 rebounds per game.  He is considered Kansas’s best player and the key to a deep run in the NCAA Tournament.

A sprained knee is a diagnosis that many teams release to the media.  It can encompass multiple different injuries of different ligaments.  The knee has 4 main ligaments that provide stability to the joint.  The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) cross through the middle of the knee from the femur to the tibia. The ACL prevents anterior translation and medial rotation of the tibia.  The PCL prevents posterior translation of the tibia from the femur.  The medial collateral ligament (MCL) and lateral collateral ligament (LCL) provide side to side stability of the knee.  The MCL goes from the inside of the femur to the inside of the tibia and prevents a valgus stress.  The LCL attaches from the outside of the femur to the head of the fibula and prevents varus stress.  Ligament strains are typically graded from 1 to 3.  Grade 1 is generally mild tearing of the ligament.  The joint is usually still stable.  Grade 2 is more severe tearing of the ligament with joint instability and moderate to severe pain.  Grade 3 is typically a complete rupture of the ligament.

In Ellis’s case, it was later reported that he sprained his MCL.  When his teammate fell into the outside of his right knee, he forcibly pushed his knee to the inside creating a valgus stress.  Coach Bill Self said that Kansas doctors were optimistic that Ellis’s injury was not severe and that he would be able to return to play for the post season.  Treatment for a MCL sprain varies depending on the severity of the injury, but typically does not include surgery.   Managing pain and swelling should begin immediately, followed later by range of motion and strengthening exercises.  An athlete should have full range of motion and strength prior to return to play.  He or she should also be comfortable with the mobility necessary for the sport.  A brace with medial support is usually used for additional protection.  While an athlete may be fully cleared to play, it is difficult to say how effective he will be once he returns to play and what the effect of the injury will have on his skills.

Fortunately, Ellis was able to return to play in the semi finals of the Big 12 Tournament.  He missed two games.  Kansas went 1-1 in those two games.  He played in the final two games of the Big 12 tournament reporting that he felt good after the games.  Kansas will need a healthy and effective Perry Ellis to make a deep March Madness run and no doubt the sports medicine staff will be working overtime to make sure that happens.

 

Guest authored by:
Shane K. Woolf, M.D.
Associate Professor of Orthopaedics and Chief of Sports Medicine
MUSC Health

Anterior Cruciate Ligament Injuries in Soccer Players

For the next four weeks, the world’s attention will turn to Brazil, as nations from around the globe compete in soccer’s greatest event- The World Cup.  Soccer continues to grow in popularity and is a sport shared around the globe. Indeed, according to FIFA over 265 million men and women participate in soccer worldwide.  As one might imagine, with such a high number of participants there is also a potentially high number of injuries involving bones, joints, and ligaments. One injury among the most common in sports such as soccer is a tear of the anterior cruciate ligament (ACL). This small strip of collagen connective tissue in the center of the knee helps to stabilize the leg bone (or tibia) with the thigh bone (or femur). Recent understanding of the function of the anterior cruciate ligament tells us that it is important for stability of the knee from front to back as well as controlling rotation of the joint.

Around 300,000 ACL injuries occur annually. Sports such as soccer, which involve deceleration, turning, cutting, twisting, pivoting and jumping can place the ACL at risk for injury because of the nature of the stresses applied to the ligament. In addition, direct contact, as occurs during a slide tackle or fighting for the ball can also place stress on the knee joint. While both male and female athletes are at risk for ACL injury, female soccer players are known to experience a much higher rate of injury. In some studies female soccer players are up to 3 times more likely than their male counterparts to suffer ACL tears. In fact, a many as 5 out of 100 year round female soccer players are at risk for tearing the ACL. This gender variation is thought to be related to anatomic differences, knee alignment, hormonal profiles, strength and sporting technique.

In general, when ACL injuries occur, an athlete’s ability to participate in sports like soccer is compromised because of knee instability. This limits the athlete’s ability to fully stress the leg and perform at a high level. Pain is common, but also lack of confidence in the knee and actual instability are significant and limiting issues. Physiotherapy and rehabilitation of the knee can be helpful but may not eliminate the sensation of an unsteady joint. Often, surgical reconstruction of the damaged ligament is performed to restore stability and function. Recovery and return to play are possible when the surgery is successful, but demands lengthy rehabilitation, dedicated therapy protocols, and patience. Most athletes are unable to return to the soccer pitch for at least 6-9 months after surgery.

 Variations in our physical anatomy and gender-based differences are obviously not within the control of the athlete. So what can be done to reduce the chances of injury altogether? How can the competitive soccer player maintain a healthy knee that performs well throughout a lifetime of competition? While nothing can eliminate injury risk, there are several measures that the athlete can take to at least lessen the chance of experiencing an ACL tear. These include:

  • Proper conditioning, including strength training of the quadriceps and hamstrings as well as cardiovascular endurance
  • Proper cleats and boots/footwear
  • Practice and application of proper technique in jumping, sliding tackling, and tracking the ball
  • Neuromuscular education programs designed to optimize the function of muscles around the knees. Such programs are available through a physiotherapist like those in the MUSC Sports Medicine Program and can be performed in the off-season as a dedicated conditioning program. Up to 50% of ACL tears can be prevented from a specialized neuromuscular training program.

Whether a recreational or elite level athlete, the ultimate goal is to remain active and to enjoy the sport you love! These tips can help keep you on the pitch for years to come. If your knee suffers an injury, though, make certain to see an orthopaedist for an assessment. For now, enjoy the fantastic World Cup soccer, and get inspired to go out and play next chance you get!

 

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