Females and males are built differently, and women experience more knee injuries than their male counterparts. Especially for females, tearing the ACL (Anterior Cruciate Ligament) is one of the most common athletic injuries.
Orthopedist Derek K. Lichota, MD at the Temple Roney Bone and Joint Institute treats a number of patients with ACL problems, and offers insight and advice for athletes and others alike.
“The ACL is the most common injury that we address in sports medicine,” Dr. Lichota said.
Get to Know Your Knee
Dr. Lichota says there are four big ligament structures around the knee.
“Each ligament is designed to protect the knee from different forces,” Dr. Lichota said. “Each is descriptive of the forces that they are supposed to stop the shin bone related to the thigh bone.”
The four ligaments are:
- ACL—Anterior Cruciate Ligament—stops the shin bone going in front of the knee.
- PCL— Posterior Cruciate Ligament—stops a force going behind the knee.
- MCL—Medial Collateral Ligament—stops the knee from going to the inside.
- LCL—Lateral Collateral Ligament—stops a force going to the outside of the knee.
“When you have torn the ACL this can lead to instability in the knee,” Dr. Lichota said.
You may think such an injury occurs in harsh contact or rough play, but this is not the case for ACL tears. Dr. Lichota says 70 percent are non contact injuries and that is why more females hurt their ACL, because soccer and basketball are the most common sports where they are hurt.
When you injure your ACL, you’ll usually be running and your knee buckles or gives way.
“Athletes often will hear a pop or feel one,” Dr. Lichota said. “The knee usually swells quickly and they are unable to continue with their sport.”
From there, you’ll usually be evaluated as soon as possible to check the looseness in the knee joint. This is called the Lachman’s test and if you’re taken to the sidelines during a game, your athletic trainer or doctor may perform this test. They may also do a pivot shift to look for rotational looseness in the knee.
“In clinic after the injury, the exam may not be reliable because of swelling and pain,” Dr. Lichota said. “So we rely on on-field exam by ourselves or the trainers. Our recommendations will be based on your history, the physical exam and possible MRI imaging.”
Back to Normal?
If you’ve had an ACL injury, chances are your doctor will recommend surgery. Dr. Lichota says this is an outpatient day procedure where they make a new ligament for you and replicate the original structure. It can be done with several grafts, trying to mimic the soft tissue of the ACL that connects the femur bone to the tibia.
“We expect our athletes to get back to the same level of function prior to their injury,” Dr. Lichota said. “Talking to athletes, I don’t feel that their knee is ever truly normal from their standpoint.”
Even after the six to 12 months it takes for full recovery, it can be hard to feel like your knee is completely back to normal. Even though doctors are much better at this surgical technique than they were 10 or 20 years ago, it takes disciplined rehab and patience on the part of the athlete.
“This used to be the career ending injury, but many of our patients have resumed all of their activity,” Dr. Lichota said.
In fact, Dr. Lichota’s son had surgery on his ACL as a sophomore and played at the same level his junior year. However, according to Dr. Lichota, “He would tell you, it’s not what it was before the injury.”
Unfortunately, our resilient bodies do their best to repair, but the best way is to avoid an ACL injury altogether.
Preventing ACL Injuries with Proper Technique
A number of local high schools have started programs to teach the junior high and high school athletes “proprioceptive training,” or knowing where your knee is while playing sports.
“There is great literature to support that the reason ACL injuries in females are more common is that they don’t get the same proprioceptive training that males get,” Dr. Lichota said.
He says they are still wrongly taught by coaches to do a jump stop in basketball, which can injure their knees. Universities have also instituted this preventative program for females, including UT and Stanford.
“UT has got their female athlete injury rate down by at least 30 percent,” Dr. Lichota said.
To avoid ACL injuries, it comes down to proper technique when playing and being aware of your body. Don’t miss the big picture and suffer the consequences of a painful ACL injury.