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What do Liz Ellis, Stephen Hoiles and Andrew Johns all have in common? Apart from being fully minted, and majorly famous athletes at the top level of their chosen sports, they have all been unlucky enough to tear their anterior cruciate ligaments (ACLs) and have had reconstructive knee surgery in order to return to playing sport.
There are two cruciate ligaments in the knee, the anterior and the posterior. The ACL is the weaker of the two and is more readily torn. It attaches to the tibia (the shin bone) at the front of the knee joint, passes backwards through the knee and attaches to the femur (the thigh bone) at the back of the joint. It prevents the thigh from moving backwards on the shin, and prevents knee joint hyperextension.
Landing from a jump, pivoting or decelerating suddenly are the most common ways of tearing the ACL. Often the incident is minor and no contact from other players is involved eg: Ricky Stewart who tore his ACL changing direction in back play. Most people report hearing a “crack” or a “pop” and initially feel extreme pain in the knee. The joint will usually swell very quickly and becomes very difficult to move.
The knee joint becomes very unstable when the ACL is torn. Living without an ACL can involve frequent falling down stairs, falling off ladders and embarrassing knee buckling episodes, usually when you are carrying a tray of drinks. Generally if athletes wish to return to twisting, turning and pivoting sports, and not resign themselves to a life of lawn-bowls, then surgical repair of the ACL and any other damaged structures such as other ligaments or cartilage is highly recommended.
The operation is done via keyhole surgery, or arthroscopically, and replaces the torn ACL with a graft that is most commonly taken from the hamstring tendons at the back of the knee, or the patella tendon at the front of the knee. Alternatively, you could be like Alisa Camplin and take your graft from the Achilles tendon of a dead man! I kid you not!
Surgery is followed by at least six months of intensive rehabilitation before the athlete can even consider returning to sport. It doesn’t matter how diligent people are with their rehab programmes, the graft has a mind of its own and will strengthen itself with time. People who do not follow the instructions of their surgeons/physios will often find themselves “under the knife” a second time when their first graft tears. Physiotherapy gets the joint moving again, builds up the muscles around the joint, and regains the balance, co-ordination and skills required to return the athlete to their chosen sport. If you have any queries about this article please contact Simon at firstname.lastname@example.org