Anterior Cruciate Ligament (ACL) Injuries
The Day I Ruptured my Anterior Cruciate Ligament
On Wednesday 20th February 2008, I ruptured my Anterior Cruciate Ligament (ACL) whilst playing football. It was the first major injury I had ever suffered and something which led to ACL reconstruction surgery in on 3rd March 2009, over a year after the initial incident.
In this Lens I am going to share with you the events leading up to and after the incident which caused my knee injury. I will alos provide you with some information on the cruciate ligament itself before going in to as much detail as I can rememeber on topics such as surgery, after care, rehabilitation and physiotherapy.
5 years after my injury, my scars have almost healed (I will show you later) and I have returned to competitive sports which include football, running and martial arts. With the right approach to recovery and a lot of hard work in the gym, you can return to the same physical condition prior to your injury.
All images in this Lens are either from my camera or have been purchased from Istock Photography.
What is an Anterior Cruciate Ligament
Your ACL is one of 4 extremely important ligaments within your knee and its primary function is to provide stability to your joint. The four main ligaments in the knee are:
- Anterior Cruciate Ligament (ACL) -
- Posterior Cruciate Ligament (PCL)
The 2 ligaments outlined above are situated behind the patella (knee cap) and attach the femur (thigh) to the tibia (leg bone). ACL injuries are more common than PCL injuries
- Medial Collateral Ligament (MCL) - Situated on the inner side of the knee
- Lateral Collateral Ligament (LCL) - Situated on the outer side of the knee
Injury to any of the above ligaments are extremely common within the sporting world and will ultimately result in a great deal of pain and time spent hobbling around felling helpless; I can vouch for this :)
The ACL provides femur to tibia stability which is essential when performing ranges of motion such as, twisting, rotating, turning, jumping - basically everything you need to be active and have fun.
My Football Injury...
That Fateful Day
The day I ruptured my ACL has got to go down as one of my worst days ever and one which I will not forget in a hurry.
I have always been heavily involved in sport and have competed in football and athletics at county standard. As I got older, my thirst for sport continued and ultimately intensified when I joined the Royal Air Force in 2003 at the tender age of 18. I represented the Air Force at football and at one time was playing up to 6 days a week including training. To say that things were going well was an understatement, at 24 years of age, my physical fitness was at an all-time high and sport was starting to infringe on my work life which is always a good thing :)
On the 20th February 2008, that all changed when I went up to Pride Park (Derby County's home ground) to compete in an Air Force wide football tournament. The format was 5-a-side and consisted of about 20 teams from different stations across Europe.
I think it was the fourth game of the day when I did the initial damage...the ball had bounced loose on the edge of the penalty area when I saw the oncoming attacker wind up to shoot. I met his shot with the exact same action in an attempt to clear the ball and what seemed like the coming together of an unstoppable force and an immovable object, my leg gave way and I felt instantaneous pain in my knee. Other than the sharp shooting pain, the only thing I can compare it to is being winded but completely centralised around my knee. It felt like all the blood had gone from knee and it felt empty; needless to say I left the pitch and went to sit on the side line.
If this had been any other format of football, I would have went straight in to the changing room and wrapped it up for the day. Because it was 5-a-side it meant that we had about 30 minutes before our next game and being a young and eager (stupid) 24 year old in the military, I shrugged it off as nothing and tried to play on. The next game was only about 3 minutes old when, completely on my own I tried to change direction; as I shifted my weight on to my left leg, I heard a sound which will stay with me forever. The sound I heard was an audible pop, which when combined with the strange crunching sensation and blinding pain I felt in my knee, I knew that something was seriously wrong. My first reaction was to look in the rafters of the arena for snipers because the way I went down felt like I had been taken out.
The pain of the injury is pretty hard to describe because it is like nothing I had ever felt before. Regularly you see footballers given gas and air to cope with the pain but I did not have this luxury so just got up and limped in to the showers. Incidentally, I tried gas and air at my first son's birth and it would have come in handy that day...
After my shower, I got on the bus back to base, later I would find out that I had ruptured my Anterior Cruciate Ligament
Have you Ever Suffered a Knee Injury?
Knee Injuries are extremely common and not just within the sporting world. Knee problems can be the result of severe trauma (one time incident) or degeneration over time. My question to you is this...
Have you ever suffered a serious knee injury?
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Knee supports are a great way to provide extra stability to your injury. If you have suffered ACL damage in the past then the harsh truth is that your knee will always be vulnerable to further damage in the future. While you may experience up to 95% recovery in the joint, it will never be perfect. Get your knee support today and continue to particpate in your favourite sport with more confidence
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My Road to Surgery
I have had my fair share of minor injuries over the years so know the difference between a niggle which will pass in a few weeks and something that should be seen by a doctor. If you have ever suffered a similar injury to mine then you will agree with me when I say that something was obviously wrong. The documented symptoms of an ACL injury are as follows:
- Audible pop or crunching at moment of impact
- Instability in the joint. Your knee will feel like it is about to give way at any moment
- Severe pain around the knee, all over at first but then more targeted toward the back and outside.
- Intense swelling
- Inability to walk
Almost instantly after the event, my knee began to balloon, and that is my medical interpretation for serious swelling and the pain was quite intense. The following morning I took myself straight to the doctors, already convinced in my own mind that I had ruptured my cruciate ligament.
Prior to this point, I had only ever read about ACL injuries through professional sportsmen but the whole process seemed simple enough
- MRI Scan
- Rehab...I would be back playing football within 6 months
Surgery is only really advised to those who intend to return to sport in later life so naturally this was never a subject for contention. I wanted to get in get out and be back on the field within no time at all...
How Wrong I was...The first visit to the doctors was merely a formality, too much swelling to perform any diagnosis so take a couple of weeks on light duties and come back in a fortnight...Take these tablets twice a day to help with the pain and walk on crutches if need be. Two weeks on, pretty similar outcome, referred to a physiotherapist. I had to wait 4 more weeks to see the physio in which time:
- Pain had started to reduce but still sore
- Swelling still evident
- Range of motion in the joint was minimal
- Walking was severely hampered with a severe limp
My first physio appointment was more of an assessment and a discussion about what was going to happen. I enquired about the possibility of an MRI scan but that was not going to be the route and instead I was to go down the route of rehabilitation, I think it was a cost related decision.
I am not going to bore you with the details but in short, this went on for a further 9 months of intense rehabilitation programs before my specialist referred me for an MRI scan. During this 9 month period I was constantly subjected to what is known as the Lachman test (I will post a video link at the bottom of this post because it is one of the main things I remember about the whole process). The test always consisted of someone pulling at my leg, writing down a few notes, comparing it with the good leg and then more notes. Either way, nothing conclusive enough to say yes there is a rupture.
So after 9 months, I finally got my MRI scan which confirmed that there was a rupture and I was booked in to have ACL reconstruction surgery within the next 3 months. Finally :)
I know professional sportsmen are subjected to the best care possible but to measure the difference...Michael Essien (Chelsea footballer) ruptured his ACL in the same week as me and he was playing football 6 months down the line. I was still going through diagnosis at the time and did not kick a football until about 18 months after the incident.
From The Experts - And The Surgery required to mend it
I am no medical expert so have provided this video to give you an in depth explanation of what the ACL is and what function it performs in the body.
This video then goes on to explain what is involved with the ACL reconstruction surgery which I had in March 2009. There are 2 methods of ACL reconstruction, 1 takes a graft from the Patella tendon and the other from the hamstring. The video shows the method from the hamstring which is the procedure which I had performed on me. I had specifically asked for this method because the hamstring is known to regenerate over time and does not leave you with a huge scar down the front of your knee.
After The Operation
The All Important Rehabilitation
After my operation I remember waking up in the hospital bed with a morphine drip which was quickly removed due to annoyance. My knee was still heavily anaesthetised so could not really feel much apart from pressure due to the heavy bandaging. One thing I could feel was my hamstring and that was exceptionally sore.
As outlined in the video above, there are two main areas where the tendon can be grafted from to make the new ACL: the patella tendon and the hamstring tendon. My procedure used the hamstring and that was clear when waking up.
To my surprise, rehabilitation started the same day as my operation as I was informed of the road which lay ahead. Rehabilitation for ACL reconstruction is in my opinion, a life long process but something which is sure to take up to 9 months post operation.
Week 1 after Surgery
The first week after surgery is the start towards regaining range of motion within your knee. Applying cold to reduce the swelling is advised. The most important thing post operation is to try and straighten out the leg to achieve full extension. Initially you will be encouraged to prop your heel up on a towel or similar to allow the leg to fully straighten. I remember this specifically as it is a very strange feeling and can be quite painful. By the end of the first week you will be performing light exercises to strengthen the muscles around the joint. Quad tensions and straigh leg raises to start.
The Next 3 Months
Over the next 3 months you will be encouraged to carry out increasingly strenuous activities designed to strengthen the muscles around the knee. It is important that you exercise the full range of muscles as it not just a case of working your quads and hamstrings. One thing I learnt from all of my physiotherapy is that problems are commonly the consequences of issues elsewhere in the body. Back pain can be traced to problems in the feet or calf and knee problems can be traced to foot alignment etc. It is important that you start to think of your body as clock and all of the cogs need to be working together to compliment each other. You may find that you go in to preservation mode over this period and make a real effort to do things right. For me it was the first sign that my body was susceptible to injury, this sounds weird but I had never suffered anything like this in the past.
Exercises carried out in this phase will begin with basic stair walking and culminate in exercises such as squats, all designed to strengthen the quads and hamstrings. By the end of this phase you may be progressing on to cycling activities and stepping
3 - 6 Months
Continued strengthening exercises with the introduction of more strenuous movements. If you are working to get back in to a specific sport then you can begin carrying out basic drills to simulate expected range of movements. I was keen to get back in to football and running so started out with some basic shuttle running working up to SAQ training and intervals. Your knee should be getting up to 90% functionality at the end of this phase
You are always going to have to remember what has been done to your knee and it is important to keep the strength element up and rest when needed. The best advice I can give you is to listen to your own body. You know your own thresholds better than anyone else so read the signs and take care not to repeat the injury
Since my operation, I have worked extremely hard to try and get back to the same level of fitness as I was before the incident. As you can see from the image (that is my knee) my scars have pretty much disappeared and there is little sign of the work that was carried out. Amazing really :)
The sport I carry out now is largely centered around running and I regularly compete in 10K road races. Never being one for just running before the op, I cannot really compare my times but I can complete the race in less than 40 minutes which is not too bad, even for an able bodied athlete.
I have also since taken up Martial Arts and continue to play football on a regular basis. To say that my recovery has gone better than ever expected is an understatement. Sure I get occasional pain and some seriously strange clicking noises but on the whole it has not stopped me from doing the sports I enjoy.
If there is anything which I really wanted to get across from this Lens, it is that an injury like this is not the end of the world; while it may seem earth shattering at the time, there are always options ahead of you. I have returned to my original standard of fitness and has actually allowed me to broaden my training endeavors in to something more beneficial. It sure takes a lot of hard work in the gym to get there but it can be done.
I hope that you never have the mis-pleasure of going through this but if you do then good luck with it and you will get out the other side :)
The All Important Lachman Test
As Promised, below is a video which clearly outlines the process invloved when carrying out the Lachman test.
Below are a few products which got me though my whole experience. Everyone is different but feel free to try them out...
Reduce the swelling post operation by applying cold treatment to the swollen area
Not a fan of the cold, why not try this heat pack instead
Build strength to greater effect with this Swiss Ball
If you have had knee surgery or are due to have knee surgery then please share you experiences here.