Understanding the ACL: The Impact on all Players

The Anterior Cruciate Ligament, better known as the ACL, is an important ligament for our knee’s stability and function. Unfortunately, the ACL is famous for all the wrong reasons as it has the reputation as being one of the most common serious injuries faced by both contact and non-contact athletes world wide. 

Besides leading to a tough long term rehabilitation with obvious physical impairment, ACL injuries have been shown to correlate with negative emotional, social, and economic effects. The annual economic costs for ACL reconstruction are estimated to be up to $1 billion for high school athletes alone in just the United States.(Ngatuvai et al., 2022)

We absolutely know that we do not want to suffer an ACL injury! 

So the big question remains, how can we prevent them from actually occurring?

Fortunately, this is an area in which significant research is being currently placed. This blog will therefore detail modifiable and non modifiable risk factors to consider and look out for this winter sports season. Whether you are a netballer, footballer (of any code), and/or basketballer this one's for you!

Modifiable Risk Factors

Muscular Strength

Muscle strength imbalances around the knee joint can increase the risk of ACL injuries. Weakness in the muscles that support and stabilise the knee, such as the quadriceps, hamstrings, and hip abductors, can lead to poor joint stability predisposing athletes to ACL injuries. A 2021 systematic review highlighted the importance of addressing muscle strength in ACL injury prevention programs. The findings indicated that targeted strength training, particularly for the quadriceps and hamstrings, can significantly reduce ACL injury risk among athletes (Stephenson et al., 2021).

Neuromuscular Control and Movement Patterns

Another modifiable risk factor for ACL injuries is poor movement patterns or neuromuscular control. Factors contributing to poor neuromuscular control include strength deficits as highlighted prior, deficits in proprioception (how we perceive our body in space), and inefficient movement biomechanics.

A study in 2018 demonstrated the effectiveness of neuromuscular training programs in reducing ACL injury risk among female athletes. These programs typically incorporate exercises focused on improving balance, strength, agility, and proper landing techniques. By enhancing neuromuscular control and movement patterns, athletes can reduce excessive stress placed on the ACL for knee stability. This can look like strength exercises such as Bulgarian/single leg squats, plyometric exercises aimed at landing and rotation mechanics or balance training with unstable surfaces. 

The type of footwear worn by athletes are another modifiable risk factor that have been shown to be associated with ACL injury risk.This is due to the influence on the amount of rotational and translational force an athlete experiences when moving around the field. The big takeaway here is you want to be comfortable and confident in a high quality pair of shoes/boots.

Non Modifiable Risk Factors

Unfortunately, some things as an athlete are not in our control. We can not change the weather and the surface we play on. But does the surface we play on increase or decrease the risk of an ACL injury?

A 2022 study demonstrated that ACL injuries were more likely to occur on artificial turf than on natural grass; however, this relationship was not statistically significant for all sports. This trend was especially demonstrated in both boy’s and girl’s soccer, with a higher percentage of non-contact injuries occurring on artificial turf in football player’s. (Ngatuvai et al., 2022)

Furthermore, weather is another non-modifiable extrinsic risk factor for ACL injuries. Studies have shown both high evaporation rates and low rainfall is a risk factor for ACL injuries in AFL (Smith et al., 2011). 

Ultimately, ACL injuries and more specifically ACL ruptures are debilitating injuries that no one wants to experience. Understanding your body, understanding both the modifiable and non-modifiable risk factors can best prepare yourself against them this sporting season. 

Any further questions? Want to reach out and chat regarding ACL or other sporting injuries?

We have Sports & Exercise Physiotherapists ready to help!

Call ☎️ 9873 2770

Book online: https://bookings.nookal.com/bookings/location/39XKS

References:

Ngatuvai, M.S. et al. (2022) ‘Epidemiological comparison of ACL injuries on different playing surfaces in high school football and soccer’, Orthopaedic Journal of Sports Medicine, 10(5), p. 232596712210923. doi:10.1177/23259671221092321. 

Stephenson, S.D. et al. (2021) ‘A comprehensive summary of systematic reviews on Sports Injury Prevention Strategies’, Orthopaedic Journal of Sports Medicine, 9(10), p. 232596712110357. doi:10.1177/23259671211035776. 

Smith, H.C. et al. (2011) ‘Risk factors for Anterior Cruciate Ligament Injury’, Sports Health: A Multidisciplinary Approach, 4(2), pp. 155–161. doi:10.1177/1941738111428282.