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Anterior Cruciate Ligament (ACL) Injury in Football Players

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Introduction

Anterior Cruciate Ligament (ACL) injuries are one of the most serious knee injuries faced by football players as they usually require surgical repair and a lengthy rehabilitation period. These injuries can have a profound impact on players’ performance and participation in the sport. In this blog, we will explore the management of ACL injuries specifically tailored to football players. We will cover what an ACL injury is, the available treatment options, rehabilitation techniques, and the importance of a comprehensive approach in effectively managing the injury.

Understanding ACL Injuries

The ACL is a ligament that stabilises the knee joint, preventing excessive forward movement of the shin bone relative to the thigh bone. An ACL injury refers to a tear or sprain of the ligament, often resulting from sudden stops, changes in direction, or direct trauma to the knee. An ACL injury can often be combined with damage to the medical collateral ligament (MCL) or meniscus.

Symptoms of ACL Injury in Football Players

The following symptoms may be present in football players with an ACL injury:

  • Sudden pain: Football players may experience an immediate onset of pain at the time of injury. The pain is often severe and can cause difficulty bearing weight on the affected leg.
  • Swelling: Swelling of the knee joint is a common symptom of an ACL injury. The knee may become swollen and feel tight or tender to the touch.
  • Instability: An ACL injury can lead to a feeling of instability in the knee joint. Football players may notice a sense of the knee giving way or buckling, especially during activities that involve twisting or pivoting.
  • Restricted range of motion: The injured knee may have a limited range of motion. Football players may have difficulty fully straightening or bending the knee.
  • Audible popping sound: In some cases, an ACL injury can be accompanied by an audible popping sound at the time of injury. This may indicate a tear or rupture of the ligament.
  • Difficulty with sports activities: Football players with an ACL injury may find it challenging to participate in their sport. Cutting, pivoting, and jumping movements can be particularly difficult and may cause pain and instability.

If you suspect an ACL injury, it is important to seek medical attention from a healthcare professional specialising in sports injuries. They can provide an accurate diagnosis through a physical examination and diagnostic imaging tests, such as an MRI. Prompt treatment and appropriate rehabilitation are essential for football players to regain strength, stability, and function in the knee joint.

Causes of ACL Injury in Football Players

ACL injuries can occur due to various factors, including:

  • Non-contact mechanisms: Sudden deceleration, pivoting, or cutting movements that place excessive stress on the knee joint can lead to ACL injuries.
  • Contact mechanisms: Collisions or direct blows to the knee during football matches can result in ACL tears.
  • Pre-existing risk factors: Certain anatomical, genetic, or biomechanical factors, such as joint laxity, muscle imbalances, or previous knee injuries, may increase the susceptibility to ACL injuries.

Read Also

Common Knee Injuries in Football Players

Assessment of ACL Injury in Football Players

Accurate assessment of ACL injuries is important for appropriate management. The assessment may involve the following:

  • Medical history: Gathering information about the player’s symptoms, mechanism of injury, previous knee injuries, and any relevant medical conditions.
  • Physical examination: The football physiotherapist will evaluate the knee’s range of motion, stability, and associated signs of injury, such as swelling or tenderness.
  • Special tests: Specific tests, such as the Lachman test, anterior drawer test, or pivot shift test, may be performed to assess the integrity of the ACL and identify the severity of the injury.
  • Diagnostic imaging: Imaging tests, such as MRI or X-rays, may be ordered to confirm the diagnosis, assess the extent of ligament damage, and identify any concurrent injuries.

Surgical Treatment Options

Surgical intervention is often recommended for complete ACL tears or cases where functional stability is compromised. Common surgical options include:

  • Patella tendon graft: This involves using a segment of the patella tendon, along with a small portion of bone from the patella and tibia, to create a new ACL.
  • Hamstring graft: In this technique, the graft is usually harvested from the semitendinosus tendon and is used to reconstruct the ACL.
  • Lateral extra-articular tenodesis: This procedure is often performed in addition to the ACL graft reconstruction. It involves taking a strip of tissue from the iliotibial band and reattaching this to another part of the knee to further increase stability of the joint

The choice of surgical technique depends on various factors, including the player’s age, playing level, and the surgeon’s preference.

Products that may help

Foam roller with mini bands – View this product on Amazon for more details

The foam roller can be used for self massage on the quadriceps, IT band and hamstrings. The mini bands are useful for strengthening or muscle activation work.

Knee Ice Pack – View this product on Amazon for more details

This gel ice pack wrap is specially designed for the knee, targeting both the front and back of the knee and providing relief for pain and inflammation.

Muscle Stimulator – View this product on Amazon for more details

ACL injury is associated with a significant loss of muscle bulk and strength following injury, this well priced muscle stimulator is useful for reducing muscle atrophy to the quads and other large muscle groups in the legs.

Injury Recovery Supplement Pack – View this product on Amazon for more details

Injury Recovery Pack includes collagen and key vitamins, scientifically formulated to support the joints, tendons, and ligaments of football athletes.

Rehabilitation of ACL Injury in Football Players

Rehabilitation plays a crucial role in the successful recovery and return to football after ACL surgery. Particular areas of focus during ACL rehab include restoring range of motion of the knee, achieving sufficient muscle bulk and strength in the injured leg and progressing functional performance in the field.

It is typically advised that football players do not return to competitive match play until at least 9 months of post-operation rehabilitation, sometimes this may take up to 12 months. This is to ensure full maturation of the new ACL graft and that muscle strength, power and all aspects of physical performance are at optimal levels to ensure return to play criteria are safely met.

The rehabilitation process typically consists of several phases with specific goals and timelines:

Pre-Operation Phase:

The pre-operation phase generally lasts from a couple of weeks following the injury to potentially a few months. This can be quicker if there are associated injuries such as a meniscus tear which require more urgent treatment, as well as this if you are undergoing private surgery this will usually take place faster than it would through the NHS. While these factors may influence how long you may need to wait for your operation, it is generally agreed that a period of prehabilitation before surgery is important to minimise swelling, regain normal range of motion of the knee and to start to work on strength and proprioception training.

Early post-operative phase (0-2 weeks):

  • Control pain and swelling: Utilising modalities such as ice therapy, compression, and elevation.
  • Restore knee range of motion: Gentle knee movements and stretches to regain full knee extension and flexion.
  • Basic strengthening: Introductory exercises such as quad sets and straight leg raises exercises to activate the quadriceps muscle.

Intermediate phase (3-12 weeks):

  • Walking: Gradually increasing the weight-bearing capacity of the injured leg using crutches initially and then transitioning to full weight-bearing with a normal gait pattern.
  • Range of motion: Focus on working towards full knee extension and flexion range of motion. Also aim for a full range of motion squat and lunge with good symmetry and control.
  • Proprioception and balance training: Enhancing joint position sense and stability through various exercises progressing from stable to unstable surfaces.
  • Cardiovascular training: Introduction and progressive build-up of bike work, use other cardiovascular machines towards the end of this phase such as the cross trainer or rowing machine.
  • Strengthening exercises: Incorporating exercises to build muscle strength and size in the quadriceps, hamstring, calves and gluteal muscle groups. Using moderate loads with a slightly increased focus on bilateral (double leg) than unilateral (single leg) exercise. Blood flow restriction training could be implemented by an experienced practitioner to increase muscle mass, it important to follow the recommended screening protocols if using this type of training.

Advanced phase (3-6 months):

  • Running: Introduction to straight line jogging with gradual increase of distances. As this phase progresses begin to introduce higher speed runs, change of direction and controlled accelerations and decelerations.
  • Strength training: Moderate to heavy loads with a slightly increased focus on unilateral exercise than bilateral. Include a combination of multi-joint and isolation exercises.
  • Plyometric exercises: Introduce plyometric training with basic jump and landing drills and then gradually progress the intensity of the plyometrics.
  • Change of direction and introductory sport-specific drills: Introduce change of direction focussing on improving movement control. Also begin to incorporate some introductory sport specific work towards the end of this phase such as dribbling, passing and head tennis.

Return-to-sport phase (6-12 months):

  • Strength & Fitness Testing: Evaluating any muscle strength imbalances such as quad-to hamstring ratio and limb circumference measures, and focusing on correcting any deficits. Fitness tests such as the maximum aerobic speed (MAS) test, work towards achieving maximum fitness levels.
  • Strength training: High level strength and conditioning programme focussing on improving any remaining muscle imbalances and working towards full performance. This should include progressing maximum strength as well as power training.
  • High intensity sport specific training: Establishing normal movement patterns during acceleration, deceleration, change of direction, high speed running and maximal sprinting. These parameters should be progressed towards a level in line with the players pre-injury training loads.
  • Training load integration: Continue working towards maximum fitness, speed and agility in individual drills. All pitched based movements and ball striking should feel and look normal. The player may begin to be included in some appropriate non-contact technical drills with the rest of the squad.
  • Return to performance: Player is back in full training and is working to achieve training loads that are specific to their position and in line with the rest of the squad. The player will undergo a progressive return to football with restricted training (e.g. floating or non-contact), unrestricted, match play and competitive match play.

Conclusion

ACL injuries are a significant concern for football players, but with proper management, players can successfully recover and return to the sport. Understanding the nature of ACL injuries, accurate assessment, appropriate surgical interventions, and comprehensive rehabilitation are essential for effective management. By following a structured rehabilitation program, players can regain knee stability, strength, and functional abilities necessary for football. Collaborating with a football physiotherapist, and adhering to a well-designed plan will ensure a safe and successful recovery process, allowing players to resume playing the game with confidence.

Further Reading

Mick Hughes – ACL Rehab Programme

Kotsifaki et al, (2024) – Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction

Forelli et al, (2020) – Optimizing Return to Play After Anterior Cruciate Ligament Reconstruction in Soccer Players: an Evidence Based Approach

Jenkins et al, (2022) – Rehabilitation After Anterior Cruciate Ligament Injury: Review of Current Literature and Recommendations

Buckthorpe (2019) – Optimising the Late-Stage Rehabilitation and Return-to-Sport Training and Testing Process After ACL Reconstruction

Charles et al, (2020) – A systematic review of the effects of blood flow restriction training on quadriceps muscle atrophy and circumference post ACL reconstruction

Evans et al, (2014) – ACL reconstruction‐it’s all about timing

Disclaimer

The information provided in this article is for educational purposes only and should not substitute professional medical advice. Always consult with a qualified healthcare professional for diagnosis, treatment, and personalised recommendations based on your specific condition. Some affiliate links may also be used in this article, these are from products we have specifically selected to display based on our own experience.

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