Gerard Deulofeu, a football player for Premier League club Watford, injured his knee at the weekend during an awkward fall after a challenge. This week, it has been revealed that he sustained a complete tear of his Anterior Cruciate Ligament as well as some damage to the meniscus. Read more about Deulofeu’s ACL Injury in this week’s Physio In The News.
As we know, the knee is often considered to be one of the most intricately designed joints in the body and is required to withstand large volumes of forces from multiple directions during activity, particularly in sport.There are various structures within the knee complex that help to withstand these forces – some of these are called ligaments, which act as ‘restraints’ around the joint and stop unnecessary movement of the bones leading to more stability. There are five key restraints of the knee, with the ACL being considered as the most important. This runs from the rear of the bottom part of the thigh bone (femur) and travels diagonally forwards towards the front of the top surface of the shin bone (tibia); because of this design, it helps to stop unwanted movement of the shin forwards or rotating outwards.
The meniscus is the correct name for the cartilage between the tibia and femur, and acts as a shock absorber for impact whilst also helping the joint to move due the shape creating a deep pit as well as having a lubricated surface.
Classically, these injuries can occur through a direct contact to the outside of the leg with the foot planted or fixed into the floor, but can also occur without contact if there is sufficient force directed onto the knee during a task such as changing direction, landing or pivoting on the spot.
There are some risk factors for developing an injury to the ACL, including a higher risk of injury if you are female due to potential imbalances in strength and power of the thigh muscles, increased rate of bones and joints naturally occurring in a more vulnerable position as well as suspected links to influences from menstrual cycles. Other factors include improper footwear – particularly in relation to the training or match environment – as well as artificial pitches, the possible influence of fatigue and poor movement control during tasks requiring jumping and landing or accelerating or decelerating.
Recovery for this type of injury is sadly a lengthy process due to having two areas of concern to rehabilitate and will almost invariably require surgery. If either injury is sustained on its own, then depending upon the severity of the damage, surgery may still be required but there is a growing level of evidence to suggest rehabilitation alone from these injuries is sufficient enough. However, there are some other crucial factors to consider when making this decision such as age and type of desired activity to return to as well as the level of performance required.
Once the surgery is performed, rehabilitation will normally take between 9-12 months for most people performing at a competitive level. It is important to note that rehabilitation is not progressed in accordance with time but when strict criteria are met. This accounts for the fluctuation in timescales, as well as the ability to monitor and progress athletes through their rehabilitation more frequency in an elite and/or professional environment. Research suggests that people who return to sport within two years have increased risk of re-injury to the knee as well as a higher risk of developing a similar injury in the opposite knee.
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