This is something that no athlete wants to hear.
Of the hundreds of ligaments (i.e. conveniently labeled thickenings of connective tissue) in the human body, athletes all over the word in both contact and noncontact sports are at least somewhat familiar with where and what this structure is. Maybe you've heard of what an ACL is through following sporting news, studying the anatomy of the knee region, knowing someone that has had an ACL injury or having an ACL injury yourself. Perhaps it's the significant 6-12+ months of rehabilitation post injury/post surgery that comes to mind when people hear of an ACL injury.
ACL is an acronym that stands for "Anterior Cruciate Ligament". This ligament is one of several that provides stability to the knee joint. The ACL provides both rotational stability to the knee and prevents the tibia (shin bone) from moving forward relative to the femur (thigh bone) more than it should with normal movement. Non-contact ACL injuries typically result from cutting/pivoting maneuvers in sport or one-leg landings where the force put through the ligament exceeds its capacity to prevent the motions it is meant to control.
ACL injuries are a HUGE problem in the sporting world. But don't be fooled, ACL injuries are not something that only the elite athlete can sustain - these injuries also occur with competitive and recreational athletes and weekend warriors. ACL injuries are also more common than you may think. It's estimated that ~250,000 ACL reconstructions occur in the US annually to the tune of $2 billion in surgical intervention costs. And this $2 billion annually doesn't include the rehabilitation costs associated with the recovery/return to sport process!
There are a number of factors that can increase ones likelihood of sustaining an ACL injury. Some of these factors are internal and non-modifiable such as being a female and having certain biomechanical/anatomical variations. Some of these factors are external and modifiable such as poor neuro-muscular control and changing shoe-playing surface interface. There is also a good chance of there being other factors we just don't know about yet. Knowing that there are so many factors to consider and various mechanisms of injury, it's fair to say that not all ACL injuries are created equal. It also makes sense to treat and rehabilitation each ACL injury differently depending on a multitude of factors.
Mechanisms and injury factors aside, there are also many different surgical and non-surgical interventions for ACL injuries.
This past weekend I sat in on a seminar which went over the diagnosis, maintenance, and prevention of ACL injuries. The seminar was great and provided too much information to possibly fit in one blog post. Some alarming stats were reviewed during the course. One that caught my attention in particular is that there is a 15-16x greater risk of ACL re-injury 2 years post return to sport compared to non-injured athletes, with ~30% suffering an another ACL injury within that 2 year period. And this could be in either the previously injured surgically repaired knee or the opposite, previously uninjured one. This shocking statistic sparked a bit of conversation among those attending the event. What is causing this increase in re-injury? Is it the result of an unsuccessful surgery? Maybe less-than-adequate rehabilitation? Or maybe it's some of those uncontrollable intrinsic factors I mentioned earlier rearing their ugly head?
Can we really blame the surgeon? Or the rehabilitation professional? As long as you, the patient are informed on topics such as surgical vs. non-surgical treatment, rehabilitation goals, return to sport times and risks involved with return to play, can the finger be pointed at anyone in isolation? Risk is assumed with EVERYTHING we do. Playing football involves certain risks. Crossing the street involves certain risks. The unfortunate reality is that re-injuries can happen. Yes, your healthcare team will do their best to minimize the likelihood of re-injury. With 70% of ACL injuries being non-contact related, your healthcare team doesn't need to get you back to where you were before injury (after all - you tore your ACL with your previous state of conditioning), they need to get you to be BETTER than where you were before the initial injury. Keeping this in mind through the rehabilitation process is important. It's a long road consisting of many hours of rehabilitation, the occasional emotional hurdle, and may include financial barriers for some.
You may have heard of the occasional 5 month post-operation return to sport. These speedy recoveries are often in professional and semi-professional athletes who have the resources and means (money, time for rehabilitation, and access to top-notch services and health professionals). In fact, only 60% of people recovering from surgery following a non-contact related ACL injury return to sport at their prior level within the first 12 months of rehabilitation. Expectations are everything. Speak with your healthcare team early on after your ACL injury about what to expect during the rehabilitation process. Leave no rock unturned in trying to understand your injury.