Hoyer, Rondo,Torres: Another day, another ACL tear

Injury is on the rise, but so is research

Peng Lee had to work hard to return from her ACL injury.
Peng Lee had to work hard to return from her ACL injury. (christinelee_3002)

Gymnast Peng Lee had seen it happen many times before.

So when her feet hit the ground and her knee gave out, she knew her 2012 Olympic Games dreams were dashed.

Lee was performing a Yeschenko double twist off the vault, when she landed and torqued her leg.

The 20-year-old elite gymnast from Richmond Hill, Ont., who was en route to the Olympics after making the Canadian team, had torn her anterior cruciate ligament (ACL), and she would require surgery and months of rehab.

“It wasn’t like I was thinking about the pain,” said Lee of the days after the injury, “I was more thinking about the Olympics.”

An ACL tear is one of the most common sports injuries. Three athletes — Colorado State guard Jesse Carr, Cleveland Browns quarter back Brian Hoyer

and star quarterback for Utah State, Chuckie Keeton — have all had their seasons end this past week due to a torn ACL, and over the last 17 months, seven NBA players have been sidelined.

“You see the highest incidence of them in soccer, rugby, basketball and football,” said Sabrina Morelli, a physiotherapist at Athlete’s Care, a Toronto-based sports medicine clinic.

Morelli previously worked for Toronto FC of Major League Soccer.

“In skiing you see it too, but in skiing you see it more in the recreational level than in the higher level.”

The ACL is two bands that run from the femur (thighbone) and the tibia (shinbone) and provides stability to the knee. Think of them like cables that keep the knee bones in their proper place.

“[An ACL tear] usually happens when there is a deceleration or change in direction of movement, like a pivot, cutting, turning, or a change in jumping,” said Morelli, adding that 75 per cent of incidents happen in non-contact sports, like gymnastics, and the other 25 per cent is because of blunt trauma to the knee, like in contact sports.

“When it is contact, it is usually from a direct blow to the knee and then it’s a hyperextension, or what we call a ‘valgus force.’ The knee collapses inward and you get that rotation as well, and then you get the ACL tear.”

Because ACL’s are so common — Morelli says she sees roughly four new patients a month — treatment has become streamlined.

If the patients want to continue playing sports at the level they were at the time of the injury, then surgery is almost always necessary.

Ligament grafts help fuse the damage

Tiny holes are drilled into the knee area and the portion of the ligament that is torn is removed. Then, a graft is taken from either the patellar ligament or hamstring to help fuse the damaged ligament. The whole surgery takes roughly an hour.

Because Lee had other issues with her knee, a graft was harvested from a cadaver and used to ensure she had a healthy implant.

Recovery time, including physiotherapy, takes six to 12 months, but for professional athletes, they can get back to playing within six to eight months, says Morelli.

Today, 17 months later, the only indication Lee has of her injury are four cigarette burn-sized holes around her knee. She has started back training at UCLA, where she is a sophomore on a gymnastics scholarship, and is able to work on most of the skills she had leading up to the Olympics.

Now, it’s just getting back to top form, and she has the Pan Am games in her sights. She’s spent months doing squats and working her glutes to strengthen the area around her knee and time on a wobble board to teach her legs get used to feeling instability.

“You always think about re-tearing it, but I also have to trust all the rehab that I did,” she said.

“I think coming back from an ACL injury, it’s a lot of mental, because you normally don’t use your ACL all that much in gymnastics, it’s more for a defence mechanism, so it’s not like you’re relying on it, like a big muscle like your quad.”

Research finds surprising results 

Morelli doesn’t just help to treat ailments, she’s also actively involved in the study of why they happen so frequently and what can be done to prevent them.

And something that researchers have found that is surprising is that there is a higher incidence of ACL tears in women’s soccer and basketball than any other sports spanning both genders.

“Overall, more men get [more] ACL injuries, but that is because the amount of sports men play, but if you look at the rate of injury, the rate is higher in women, said Morelli.

Morelli added that plenty of research has been done looking at why women soccer and basketball players have such a higher ratio of ACL tears, and theories have been thrown around, such as pelvic alignment of hips, bone structure, hormonal factors and neuromuscular control.

“That’s a big one,” she said. “Optimizing neuromuscular control.

“So it’s not just strength, but also the muscle patterning. We know what happens, we get this collapsing of the knee: it rotates in. What we want to look at is the strength and the ability to counteract that. How the muscles are firing, not just at the knee, but at the hips. “

But there are no definitive answers.

Another theory that addresses the overall rise in ACL tears is the prevalence of artificial turf as the surface of choice for new playing fields.

Morelli suggests that the turf isn’t as slippery as natural grass, and therefore doesn’t allow the foot to slide on impact to move with the body’s momentum.

“People that have played soccer their whole lives, and no issue, then boom, they get it when they’re playing on turf,” she said, adding again that this is purely anecdotal based on her observations and not fact.

Orthopaedic specialists seem to have a fairly good grasp on how ACL tears happen and how to treat them. Now, says Morelli, the focus is on preventing them. This includes developing conditioning and warm-up programs like FIFA 11+, a 20-minute routine to help strengthen the lower body.

“So, the reason why it happens is because the knee is in a poor position and your loading weight is on the knee, so it is vulnerable,” she said. “If you brain is pattering the muscles better, then you are less likely to be in that position of vulnerability.

“That’s what we really want to do at the end of the day is look at how can we even prevent this from even happing, because everyone is getting it. What can we do? And that’s where all the research is going.”