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A Crucial Need: The Story Of ACL Injuries

Wed 25th Nov 2015 | IT & Technology

As we discussed in our first post, tackling injuries in the Premier League is a serious challenge and one with ongoing consequences for all players and teams.

In particular, Anterior Cruciate Ligament (ACL) injuries are one of the most debilitating injuries in professional sports.

The ACL is one of the two cruciate ligaments, the other being the posterior cruciate ligament (PCL), that stabilises the knee joint by resisting forward translation and rotation of the lower leg in relation to the upper leg. Feared greatly due to their severity, these injuries are followed by a lengthy recovery period and an arduous rehabilitation process. Most diagnoses require a minimum 6 to 9 month recovery period, though some cases require up to a year. Despite medical advances in ACL procedures, it is still very difficult for players to return to pre-injury form, and ACL injuries frequently alter the trajectory of even the most promising careers.

Soccer requires many explosive movement patterns, like sudden changes of direction, hard accelerations, decelerations and landings, along with a high degree of body contact. As such, the game puts significant pressure and stress on the ACL which, in combination with inadequate recovery, can lead to a tear, or worse, a complete rupture. This makes ACL injuries a frequent occurrence in the Premier League.

However, this type of injury adversely affects many other professional sports. In the NBA, 4 players experience an ACL injury every year on average. Most notably, 2010-11 MVP Derrick Rose suffered a tear in the first round of the 2011-12 playoffs that has completely changed the course of his career. Additionally, of 30 players analysed by ESPN’s Kevin Felton who suffered an ACL injury since 2005, 22 saw a decline in their Player Efficiency Rating (PER) the season following their injury. Only 14 reached or surpassed their pre-injury mark, and many of them were under 23 years of age at the time of their injury.

And in American football, the NFL has experienced a surprising spike in ACL injuries in the last two years. After 25 players were sidelined in the 2011-12 season, a total of 32 players were lost the following year. In 2013-14, that figure nearly doubled to 62, and in the current season, 38 players have already been diagnosed with ACL injuries, a mark that’s on pace to break last year’s staggering total.

A handful of ACL injuries have already occurred in the Premier League this season. At Liverpool, the Reds lost striker Danny Ings last month to a clear tear of the ACL. Ings will have company on the sideline, as promising left back Joe Gomez also suffered an ACL injury while serving U-21 duties for England. Down south, Bournemouth kicked off its first-ever Premier League season with a trio of ACL injuries to Callum Wilson, Max Gradel, and Tyrone Mings, who joined the Cherries after the club broke its transfer fee record to get him.

As ACL injuries continue to make headlines, there continues to be much speculation as to their root cause. Some people engaged in the sport contend that the footwear is to blame, while other explanations suggest that hard playing surfaces which don’t offer enough cushioning are the major contributing factor.

However, these speculations are often just that: speculation. Research indicates that non-contact ACL injuries account for 70-84 percent of all ACL tears in both females and males. ACL injuries tend to occur during the landing phase of a jump or during a cutting movement, precisely when the ACL is working against the translation and rotation of the lower leg. Causative factors may include asymmetry, lack of strength or indeed the level of fatigue of the muscles which surround the ACL which are normally called upon to control the high force portion of these movements.

Peer reviewed research suggests that the angle of both knees during the landing phase of a jump is a useful indicator of future ACL injury. As a result, Kitman Labs uses a markerless biomechanical camera-based system to capture, amongst other variables, knee valgus and varus during the landing phase of a counter movement jump (CMJ) – all within 30 seconds! This forms one portion of the daily “stress” and “response” screening process which defines an individual athlete’s injury risk analysis.

In summary, ACL injuries are a critical piece of the injury puzzle in the Premier League, as well as in other sports like rugby and American football. While ACL injuries are complex, one of the best ways to assess an athlete’s risk and give practitioners the best chance of preventing this type of injury is through a thorough understanding of knee mechanics and other risk factors, to ensure the best players are available to take to the field.


Image: Action Images via Reuters / Alex Morton Livepic

Posted by: Aaron Gourley 



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