Repair Process for Anterior Cruciate Ligament Injuries in Athletes

Zane Chitwood
Liberty High school

REPAIR PROCESS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES IN ATHLETES.

Many people get injured playing sports every year luckily most of those injuries are small
and wont cause any major damage long term and will heal in only a couple of weeks. However
that is not the case with an injury to the anterior cruciate ligament more commonly known as the
ACL. An injury to the ACL is devastating to any athlete because a tear in your ACL not only
ends their season it could put them out for multiple seasons and if it is not taken care of properly
it could end their athletic career. Fortunately it is possible to come back from an ACL injury and
it is becoming more common to have a successful comeback each and every year. It takes lots of
hard work and patience to be able to come back and play a sport again because it is a process that
can take anywhere from six months to a year. The road to recovery has many steps starting with
getting their surgery done which is typically done with a patella tendon graft. After their surgery
they have to go through an extensive rehabilitation process to get their knee back up to strength
so they can return to a sport as soon as possible, this is a very important step because this will not
only strengthen their knee it will also help prevent future injury. After the knee is healed and
rehabilitation has been done they can finally be cleared to return to physical activity but some
they will never be the same again, not necessarily because their knee will not allow them to do
the things that they were able to do but because psychologically they cannot get over the fear of
reinjuring themselves. Of all of the people in a prospective clinical investigation (2006) Among
the 100 patients who have undergone ACL reconstruction, 65% returned to the same level of
sports, 24% changed sports so it shows that a large amount of people can return to activity
following an ACL reconstructive surgery. With the advances in the medical field people are able
to have an ACL surgery and get back to the sport they love at a rate that was not possible in the
past, these advances have made it possible to get back to playing in six to eight months and this
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REPAIR PROCESS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES IN ATHLETES.

has saved many athletes careers. For a professional athlete getting back to their respective sport
after an injury is the most important thing to them and it is easier to return to some sports than it
is to return to others. Professional athletes in the National Football League have a different return
rate than athletes who play in professional soccer even though they some of the best athletes in
the world based on the sport they play their success in being able to return to sport is going to be
different.
The first thing that must be taken care of following an injury that results in a tear in the
ACL is the patient must go through a surgical repair of the ACL. The doctor can do this by either
replacing the torn ACL with a graft from either the patella tendon or by taking a graft from the
hamstring muscle, it is more common for the doctor to choose to take the graft from the patella
tendon. To do the surgery they will have to take the inner one third of the patella tendon and a
bone plug from the knee cap as well as the tibia. Next holes are drilled in the femur and tibia and
the graft is placed in the knee and secured with plastic buttons (Rask 2014) and that completes
the ACL reconstruction surgery. All doctors do their ACL reconstruction surgeries a little
differently but the patient may be required to be in a continuous passive movement machine
(CPM) for a week immediately following surgery and they will already be in the CPM when they
wake up following the surgical procedure. The CPM will move the patients leg continuously
from 0 degrees of bending up to 35 degrees of bending and back down all day long for a week.
The patient if they are required to be in the CPM will have to be in it all day unless they are
eating, going to the bathroom or doing the exercises that the physical therapist showed them
when they were done with surgery, they will even have to sleep in the CPM. The patient will also
have a cryo cuff which is a machiene that constantly pumps cold water into a wrap around the
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REPAIR PROCESS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES IN ATHLETES.

knee. After the patient has finished with their week in the CPM they will go back to see their
surgical doctor for their first checkup. If everything goes well in their first checkup they will
move on to the next stage which is physical therapy.
After the surgical procedure is done, the week in the CPM is finished and the patient has
their first check up with their doctor it is time for them to start their rehabilitation process, this
process is not to be taken lightly. Many people will want to jump right into the rehabilitation
process and try to get through it quickly but that will not work because the patient will need to let
the new ACL and the rest of the knee heal because it has gone through a drastic change in a very
short time. During the first trip to physical therapy they will look at how many degrees the
patients newly repaired knee can bend to and compare it to their healthy knee by doing this it
will give them a target to work toward for the bending ability of the newly reconstructed knee.
The patient will spend the first three weeks for physical therapy doing activities that will work
towards getting the full range of motion back into their newly reconstructed knee, the goal is to
have all of the measurements in the newly reconstructed knee match those in the knee that is
healthy. At the start of the fourth week of physical therapy the patient should have regained full
range of motion in their reconstructed knee and they can begin to work on strengthening their
leg. The muscles around their knee will be a little weaker from lack of use and some might not
want to work right because of all of the swelling that has been happening in the area around the
knee. The patient will have to work hard with the physical therapist to make sure these muscles
start to work properly again and that they start to regain strength. One of the major parts of
strengthening will be to make sure that the patient is able to regain stability in their reconstructed
knee. At first the patients knee will want to give out when they are walking and that can be very
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REPAIR PROCESS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES IN ATHLETES.

painful and is an overall uncomfortable and awkward sensation for the patient to go through. At
about two months after surgery if all has gone well the patient will be able to start some sport
specific exercises this will be different for everyone depending on what sports they are involved
in. The knee may still hurt from time to time especially after a hard physical therapy session or
when something new is introduced so patients should continue to use their cryo cuffs for two
hours after every physical therapy session. In all the patient and the physical therapist will
continue to work on strengthening the knee and getting it ready for a return to activity for
anywhere from six months to a year and even after all that work there is no grantee that the
patient will be ready psychologically for a return to physical activity.
After all of the hard work most of the patients will be looking forward to getting back to
doing an athletic activity that they love but for others it wont be that easy. Many athletes after
dealing with a major injury are afraid of reinjuring the same thing that they just worked so hard
so get back to a stable level. In a study they looked at athletes who had undergone and ACL
reconstruction to see how many of them would be too fearful to return to sports after surgery and
rehabilitation was over. In this study they found that two thirds of the athletes who decided not to
return to sports said that the driving factor in that decision was the fear of reinjuring their knee.
They decided to do this after being given all of the statistics and being shown how to properly
take care of their knee but they still could not get over the fear for reinjuring their knee.
Fortunately the number of people who decide to return to sports is much higher that the number
of those who decide not to.
The goal after having any major surgery is to be able to return to all of the activities that
you enjoyed before having to undergo the surgery and for majority of the people who need to
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REPAIR PROCESS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES IN ATHLETES.

have an ACL reconstruction that is playing sports. With the way that modern medicine is always
advancing more and more athletes are able to return to sport each year with a minimal fear of
reinjuring their knee. According to a study done by the British Journal of Sports Medicine,
(1543-1552.) on a study done of 7556 patients 81% of them were able to return to a level of
sporting activity of some kind while 55% were able to return to a competitive level of sports and
65% of people felt like they had returned to the same level of play that they were at before
surgery. In the same study it showed that patients that had underwent surgery with a graft from
the patella tendon had better success rates than those who had undergone a surgery where a
hamstring graft was used. This information and statistics are a good sign for athletes who want to
continue their career after such a tragic injury.
Being a professional athlete is many young peoples dreams but participating at such a
high level of activity for so long puts an amazing amount of strain on their bodies and injuries
happen to them. Fortunately professional athletes have access to the best doctors in the world so
they already have a leg up on everyone else when it comes to chances of getting back to play.
According to a study done by the American Journal of Sports Medicine A study was done on 49
NFL football players who had undergone an ACL reconstruction surgery and it showed that 31
out of the 49 athletes (68%) were able to return to play. These athletes returned in an average of
10.8 after they had completed their surgery. (p.2233-2239 Lemak, Lawrence J, Fleisig, Glenn S,
McMichael, Christopher S, Andrews, James R, Shah, Vishal M, 2010). Just like football players
many soccer players also suffer from ACL injuries but more of them are able to recover and
return to playing professionally, After 12 months 95% of the studied patients had returned to the
same level of activity as before surgery. (p731-735, Marcacci, M, Della Villa, S, Bragonzoni, L,
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REPAIR PROCESS FOR ANTERIOR CRUCIATE LIGAMENT INJURIES IN ATHLETES.

Ricci, M, Tsapralis, K, Marcheggiani Muccioli, G. M, Grassi, A, Zaffagnini, S, 2014). Both
professional sports leagues have a high return to play rate after an ACL injury but the return to
play rate in professional soccer is truly outstanding.
An ACL injury 30 years ago almost always resulted in the athletic career of the
unfortunate patient to be over. Luckily today with what the doctors now know it is no longer the
case. Athletes who have suffered from such a painful and heartbreaking injury that is an ACL
tear no longer have to be saddened by the fact that their athletic career is over, athletic careers are
being saved every day by the hard work of the very skilled doctors that we now have. Athletes
are still afraid of having such a tragic injury that can cost them a season but they can breathe a
little easier knowing that they wont have to hang up their cleats forever. The numbers keep
getting better with every passing year so pretty soon athletes will have nothing to fear if they are
unlucky enough to have a need to receive an ACL reconstruction surgery. The numbers
incredible numbers of 68% of athletes being able to return to professional football which is an
incredibly physical sport as well as the 95% of professional soccer players being able to return
can only show one thing. That one thing is that athletes are in very good hands, clean, nimble,
surgical hands.

Citations
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