Here we have two exclusive interviews on ACL injuries. The first is with Neal Reynolds, a very experienced sports physiotherapist who has worked in professional football for over 17 years and the second is with Mr. Richard Villar, a world-renowned orthopedic surgeon who specialises in the treatment of sports injuries. Neal discusses the rehabilitation process and Mr Villar discusses the treatment options for ACL tears including surgery.
Neal Reynolds is a Senior Lecturer at Buckinghamshire New University and is the current physiotherapist for the England Men’s Under 17 team. His areas of special interest are injury prevention and the prevention of re-injuries. We ask Neal about his views on ACL injuries and rehabilitating them.
Early stage treatment
Firstly, Neal discusses the early stages of treatment for ACL injuries. This begins on the training or match pitch immediately after the injury has occurred and carries on in the treatment room immediately after. Neal discusses how ACL tears are diagnosed and then how to treat the injury in the first few days and weeks.
Knee braces & supports
In this section, Neal discusses the use of braces and the need to protect the knee joint once a suspected ACL injury has occurred. Two very important elements of the treatment acronym P.R.I.C.E. are protection and rest and these are essential early on in the recovery process. In order to protect the acutely injured knee, a brace can be fitted with the aim of preventing any unwanted excessive movement of the joint. For even more protection, the use of a brace may be supplemented with the use of pair of crutches in order to minimise weight bearing in the leg and allow the injured area to settle down.
Neal discusses the option of reconstructive surgery for ACL tears and the decision making process that is involved. The choice of whether to repair/reconstruct the torn ligament through surgery depends on the individual circumstances of the athlete and Neal discusses the factors that affect the decision. If surgery is elected for, then Neal also offers his opinion on the treatment required to prepare the athlete for the operation and the importance of strengthening the quadriceps and hamstring muscles groups to ensure they are sufficiently balanced.
Preventing ACL injuries is a very important part of a sports therapist’s role and Neal discusses this aspect of his work. He highlights the factors that may increase the risk of sustaining an ACL tear and the possible link between these injuries and different types of sporting footwear.
In terms of the knee itself, Neal talks about the importance of introducing balance work (or “proprioception”) into the injury prevention program in order to improve the sensory feedback of the joint and hopefully minimise the risk of injury in the future.
Late Stage Rehabilitation
In this part of the interview, Neal discusses the latter stages of the rehabilitation program for ACL injuries and stresses the important role that both the hamstrings and quadriceps play in supporting the cruciate ligaments.
If surgery is delayed (as is often the case), then it is important to begin performing the appropriate strengthening exercises in the days and weeks leading up to the operation and improve pre-surgery strength levels as much as possible.
Following surgery, rehabilitation from an ACL injury takes a minimum of 6 to 9 months to recover from, with running permitted at any time from 12 weeks post surgery (depending on the surgeons’ recovery protocols). It is at this stage that the exercises should become more functional with the aim of improving overall cardiovascular fitness whilst also preparing the athlete to return playing their chosen sport.
Mr. Richard Villar, Orthopaedic Surgeon
Mr Villar is one of the best orthopedic surgeons in the World. As a former consultant to the British Army Special Air Service Regiment, he has practiced medicine in some of the most remote and challenging environments. Here he talks exclusively to sportsinjuryclinic.net about ACL reconstruction surgery.
Mr Villar talks about how ACL tears are diagnosed in the clinic using both manual tests and MRI scans. He talks about the surgical techniques that have been traditionally used in the past - involving tightening a tendon on the outside the knee joint in order to stabilise the joint, rather than repairing the ACL itself. Nowadays though, he informs us that the majority of operations are intra-articular reconstructions where a graft is harvested (taken from) from either the patella tendon, or the semitendinosus (hamstring) tendon. The patella tendon option is known as a bone-tendon-bone graft as the tendon is attached to bone 'plugs' at either end.
We ask the Question: who should have surgery?
This is a very controversial topic and can be a very difficult decision to make. Mr Villar offers his opinions on this subject and how different options have evolved over time. It was previously believed that the ACL may not play an important role in stabilising the knee joint and so it was deemed acceptable to remove the ruptured ligament. Recent research has highlighted that this is not true and that the ACL is, in fact, instrumental in the stability of the knee joint.
However, as mentioned before, this does not mean that surgery is appropriate in all cases and the decision on whether to operate is based on a number of factors - the resulting stability of the knee, the patient's age and finally the activities or occupations that they are involved in and want to get back to. Either way, in order to improve the stability of the knee, patients are strongly advised to build up muscle strength in the area and particularly in the hamstring and quadriceps muscle groups.
Recovery from ACL surgery
Recovery time from ACL surgery is extremely variable, but in most cases, it can take at least 4 to 5 months before the knee is beginning to function normally again and it is only at this stage that kicking actions and sudden turning movements can be introduced into the rehabilitation process. It often takes at least a year after surgery until the knee begins to feel normal again but it should be stressed that the knee may never feel 100% (as it did before the injury occurred) and the athlete may continue to suffer minor niggles every now and again.