The most feared injury in Football: Anterior Cruciate Ligament

Six to nine months of recovery. This is the period of time that an Anterior Cruciate Ligament injury can take a footballer away from the pitch and competition. As such, it’s one of the most feared injuries in the world of football. Do you want to know how it happens and what treatments professionals will use for its recovery? Here are the keys from the professional point of view of a top sports rehabilitator 🙂

What is the Anterior Cruciate Ligament?

The anterior cruciate ligament (ACL) is a ligament located within the articular capsule of the knee (intracapsular ligament) that connects the distal head of the femur to the proximal head of the tibia.

It’s main function is to bring stability to the knee joint.

Acting in conjunction with the posterior cruciate ligament, the anterior cruciate ligament prevents the tibia bone from sliding forward with respect to its alignment with the femur, both during flexion and during extension; while the posterior cross prevents it from sliding back. In addition, it controls hyperextension of the knee joint.

Why is it the most feared injury in football

Its breakage is one of the most feared injuries by any football player because it takes the footballer out of the game for one of the longest period of time.

In addition, the player’s own fear of re-injury after such a long time out of action during recovery may be a conditioning factor for the player’s performance once recovered.

How does a footballer injure their the cruciate ligament?

When talking about the mechanism of injury of the anterior cruciate ligament we have to distinguish, first of all, between contact injuries and non-contact injuries.

A contact injury is one in which the ligament is torn by direct trauma to the injured leg by an opponent; whereas a non-contact injury is one in which there is no direct intervention by an opponent in the injury mechanism, although there may be actions on their part that facilitates the injury.

An anterior cruciate rupture, in the majority of cases (approximately 85%) is a non-contact injury.

The most common way for this injury to occur is when there is an internal rotation of the knee while it’s in a valgus position, which produces an excessive torsion in the joint, with the foot being fixed to the ground, which generates an excessive traction on the ligament that is impossible for it to support, meaning it ends up breaking in its eagerness to stabilise the movement.

This situation, in football, occurs mainly in two specific situations.

The second most common mechanism for this injury in football is when landing after a jump, in which the impact against the ground in the landing destabilises the joint (either by a collision with the opponent or by a loss of balance in the air), and the ligament isn’t able to stabilise the movement, breaking in the attempt.

Cómo se produce la lesión de LCA⁉️⚽️

📊88% lesiones SIN contacto directo en Rodilla

🔎Perturbación Mecánica Previa en mayoría casos

⚠️Situaciones Riesgo

1️⃣Presionando
2️⃣Recibir Entrada
3️⃣Reequilibrio tras Golpeo
4️⃣Aterrizajes

✅Entender Situaciones Riesgo = Mejor Prevención pic.twitter.com/uEsrM6rupf

— Carlos Gallardo (@GallardoC90) July 9, 2020

While it’s true that these injury mechanisms are non-contact and intrinsic, it is also true that there is usually, in the vast majority of cases, involvements from the opponent that facilitate these injury situations.

A clear example of this would a player dribbling and forcing us to change direction abruptly and quickly; or a clash in the air with the opponent when disputing an aerial ball that destabilises us in the fall.

In both cases, contact with the opponent is not the main culprit that the injury has occurred, but it has acted as a facilitator of it.

Anterior Cruciate Ligament rupture types

With Anterior Cruciate Ligament ruptures we can distinguish 2 types:

In the first, the traction tension in the joint has been enough for some ligament fibres to break, but not so aggressive as to tear the ligament in its entirety.

In a complete rupture, however, the traction force generated in the ligament is stronger than its structure can withstand, completely losing continuity in its fibres and creating great instability in the injured knee.

Treatment of an Anterior Cruciate Ligament

After suffering an Anterior Cruciate Ligament rupture, there will be, mainly, two types of treatment:

The first will consist of not replacing the torn ligament with a new structure but strengthening all the structures surrounding the knee joint to perform the stabilising function that the anterior cruciate ligament used to perform.

This type of treatment could be an option for people who don’t want to practice sport to do so with reduced mobility, as, if wanting to continue playing sports, the displacement of the tibia on the femur would end up degenerating the joint and giving rise to knee osteoarthritis, so this option should really be disregarded by footballers.

As such, for footballers, the best option would is surgery.

Operation

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Before the player can undergo the operation, blood must be drained from the knee and the inflammation reduced in order to perform diagnostic tests to confirm the injury.

Once operated on, the player will start with the knee joint being immobilised and will progressively gain flexion angles throughout their rehabilitation until normal knee flexion is restored.

Regarding the rehabilitation and readaptation process after surgery, the most important thing is to ensure that it is supervised by a multidisciplinary team, and that makes decisions based on the player’s progress and not guided solely by deadlines.

How can you prevent such an injury in football?

As we’ve mentioned, injuries can’t be prevented no matter how much work you do. However, what we can do is reduce the odds of them occurring as much as possible.
An ACL injury, like all injuries, will have a multifactorial etiology, so taking into account the maximum number of possible factors we can seriously reduce the chances of suffering the injury.

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One of the main risk factors is the imbalance between the adductor and abductor muscles, as their activation (specifically the gluteus medius) is responsible for preventing knee valgus. As such, one of the basic exercises will consist of strengthening the gluteus medius.

In addition, intermuscular and intramuscular coordination are factors to take into account with this type of injury as we’ll need our muscles activated at the right time and with the necessary intensity to avoid the knee valgus that triggers the injury.

Of these factors, there are a multitude of others to bear in mind too, such as correct rest to ensure that our muscles aren’t fatigued, which will cause us to lose stability in the knee; correct nutrition and hydration to ensure the full recovery of our structures; etc.

In terms of external factors, the correct choice of boots according to the pitch is an important risk factor in reducing the chances of suffering an ACL injury.

ACL ruptures have skyrocketed in recent years in football due, among other reasons, to this factor.

Prevention work routine

The anterior cruciate ligament injury prevention training routine should bring together all the factors that can trigger such an injury, as the only way to reduce the chances of the injury occurring is for our structures to be prepared and trained for these injury-triggering situations.

🏋️‍♀️Propuesta de protocolo de fuerza en fase de readaptación tras cirugía LCA🏋️‍♀️
⚡️⚪️🔴⚡️@GallardoC90 @torrijos92 @svazquez94 pic.twitter.com/sNGMCu7Jt5

— Carlos Gallardo (@GallardoC90) November 7, 2019

So, we should be doing plyometric work, resisted or challenged changes of direction, working on the adductor and abductor muscles, strengthening the quadriceps and hamstrings, as well as mobility work to ensure the correct functioning of our joints.

Tips and recommendations

The main advice when facing recovery from a ruptured Anterior Cruciate Ligament is not to rush it

That said, it’s hugely important to respect the biological processes of our body as, however well you feel, it will take several months for the plasty to consolidate structurally, and too much work before this time could mean you’ll end up where you started.

Sources consulted:

• Yu, B., & Garrett, W. E. (2007). Mechanisms of non-contact ACL injuries. British journal of sports medicine, 41(suppl 1), i47-i51.
• Dragoo, J. L., Braun, H. J., & Harris, A. H. (2013). The effect of playing surface on the incidence of ACL injuries in National Collegiate Athletic Association American Football. The Knee, 20(3), 191-195.
• Waldén, M., Hägglund, M., Magnusson, H., & Ekstrand, J. (2011). Anterior cruciate ligament injury in elite football: a prospective three-cohort study. Knee surgery, sports traumatology, arthroscopy, 19(1), 11-19.
• Hägglund, M., Atroshi, I., Wagner, P., & Waldén, M. (2013). Superior compliance with a neuromuscular training programme is associated with fewer ACL injuries and fewer acute knee injuries in female adolescent football players: secondary analysis of an RCT. British journal of sports medicine, 47(15), 974-979.

Other related content you can’t miss out on:

• Find out the most common knee injuries in the world of football, here.
• How important is rest for footballers? Very – it can prevent injuries. Find out more in this dedicated post.
• Diets and football, find out what you need to know from the professionals.