The following article is written by Andrew Merritt, MD.
Anterior cruciate injuries (ACL) injuries continue to increase as people are playing more competitive, year-around sports. One of the most important aspects of recovering from ACL surgery is to prevent the injury from happening again. Most ACL injuries occur from pivoting during sports and not from an accident or contact with another player. Usually the core, hip, and leg muscles are not strong enough to execute the pivot or turn and so the knee shifts and the ACL tears. This is why we see increased rates of ACL tears in sports with a lot of pivoting (soccer), in athletes with muscle imbalance (strong legs but weak hips), and when fatigued. Research into the prevention of ACL injuries has focused around good muscular control of the leg and appropriate warm-up before sports.
The thriving Seattle youth-soccer scene has led us surgeons to encounter many ACL injuries in the adolescent population. After surgery, the rehabilitation is critical to get back to sports. But, as they say, the definition of insanity is to do the same thing over and over again and expect different results. So if we go right back to sports, right back to the same warm-ups, and right back to the same poor muscle building routine; what can we expect but more injuries.
The re-injury rate of ACL reconstructions vary based on gender, sports, age, knee anatomy and other factors. Many of these things we cannot change if the athlete desires a return to full athletics. The one thing we can improve, and likely the most important factor, is our muscular control and muscle balance. Extensive research has gone into this topic and the result has been development of an “Injury Prevention Routine”. Multiple studies have shown that rates of ACL injury decline sharply when there is an implemented warm-up routine that focuses on muscle activation and mechanics of the lower extremity. The Seattle Pediatric Sports Medicine group has put together a comprehensive routine that should be incorporated into all high-risk adolescent sport teams. You can view the ACL Prevention Routine at the link here.
This routine will help prevent tears of the ACL, but it is even more important after an ACL reconstruction to prevent a re-injury. I work with physical therapists and trainers to teach these routines as the Final Stage of ACL recovery. If we work together (surgeons, therapists, athletes, families, coaches and teammates), we can succeed at returning adolescent athletes to sports and limit further injury to the knee.
Andrew Merritt, MD is an orthopedic surgeon specializing in sports injuries of the knee. He treats athletes of all ages and provides team coverage for many area high schools. For more information about ACL surgery, meniscectomy or knee injuries, please contact Proliance Orthopedic Associates at 425.656.5060 for a consultation.