Anterior Cruciate Ligament (ACL) Injuries.
Mechanism of Injury:
A 26 year old footballer was playing on a Saturday afternoon in December 2009. The player challenged for the ball in a 50/50 challenge and landed awkwardly. The player said he heard a popping sound and immediatly felt pain around the knee. Furthermore he desribed the feeling of his “leg being swollowed up by the ground like it he had falled down a hole”. The initial assessment identified the knee was very unstable when performing special tests. An MRI scan was booked in for the next day. This scan confirmed that the player had in fact rupthured his ACL. Reconstructive surgery was booked in for 2/52 post injury to allow for the swelling to subside.
There are two main reconstruction procedures , which are equally as effective as each other and the procedure used normally depends on the consultants preference. Research shows different effects on the knee however depending on which procedure chosen. Some evidence suggests the patella tendon graft is quicker to rehab due to the stength of the tendon.
1. Reconstruction using the Mid – Third Patellar Tendon.2. Reconstruction using a Hamstring Graft. After two weeks post injury the footballer had a reconstruction using the mid – third patellar tendon procedure. Following the surgery the player was given 2 weeks recovery to allow for the wound to heal and swelling to subside.
When the player was handed over to me, I used the surgeons protocol and month by month we stepped up his rehab.
Initial goals were to subside swelling, achieve full flexion and extension of the knee, mobilise the patella and stop muscle atrophy.
Once the above was achieved the player from Pontefract was moved onto hydrotherapy, cycling and closed chain knee exercises. The next step was to introduce stretching programme along with speed and agility exercises and a proprioception programme to facilitate normal knee function. Finally gait re-education along with running drills, open chain strength work and sports specific activities bringing in rotation exercises.
The player returned to full competitive football after 8 months of rehab. The player did complain of feeling stiff in his hamstrings in his first competitive game back, however this is not uncommon due to the the length of time he had been out of action. Since the injury in 2009 the player is still playing professional football and has never had any problems with his knee since.