Our Physio Julia recently attended the Sports Medicine Australia Conference in Queensland and here is her summary on all the latest research around ACL injuries.
Latest Research on Surgery VS Rehab Only for ACL Injury:
Did you know that there is now research that shows not everybody is required to have surgery for ACL ruptures? A study known as the KANON study conducted in Sweden looked at 121 young active adults with an acute ACL injury and were put into two groups which included early surgical ACL reconstruction with rehabilitation and structured rehabilitation only (with the option to have surgery later if required).
They compared the two groups and this is what they found:
- No difference between the two groups in their KOOS questionnaire which evaluates pain, knee symptoms, daily function, sport and recreation function and knee-related quality of life.
- No difference in arthritis development at the 5 years
- No real difference in return to sport at 2 years:
Immediate surgery group – 44% returned
Rehab only group – 39% returned
- It is important to understand that the study did not define what classifies as “return to play” and whether the patients returned to their pre-injury level of competition. Therefore, if the patient wants to return to a high level of competition in a high-risk sport that involves lots of cutting and pivoting (netball, football) it may still be better to opt for the surgical option.
- There are many factors that determine whether you are somebody that would likely succeed in the conservative rehabilitation along with management and to determine this we recommend you see your local sports physio.
- To read more specifics on this study you can access it via this link:
ACL Injury and the risk of developing Osteoathritis:
Unfortunately when you rupture your ACL your risk of developing knee osteoarthritis (OA) early goes up by approximately 4 times! The research shows us that 1 in 3 individuals post injury will develop symptomatic OA within 5-10 years after injury and unfortunately once joint disease starts it is progressive.
What are the Risk Factors for developing OA after an ACL injury?
- Medial Meniscus Injury at the same time (regardless of if repaired or not).
- Quadriceps weakness
- Poor hopping function/power at 6-12 months – (physio test)
- Early return to sport (< 10 months post injury + poor knee function = 4.6 x risk of knee bone damage at 1 year post injury).
But it’s not all bad news!
- Those returning to pivoting sports such as basketball and football at an appropriate time actually had reduced odds of developing knee osteo arthritis (60-70%).
- Were your a runner? That’s fine! ….. It has also been found that returning to recreational running when guided by your physio also does not increase the risk of OA.
- If you decide with your physio & surgeon to rehab your ACL injury without surgery there is no increased risk of developing OA as long as you complete a full 9-12 months of strength and rehabilitation.
- Good physio management early on post injury is crucial in preventing the development of OA as we can address a lot of the modifiable risk factors.
- The latest research has also showed us that ensuring patients continue with their physiotherapist after 6 months post injury is very important as regaining full leg strength, power and function can significantly help reduce the risk of developing OA. It is sometimes hard to keep motivation but the proof is in these studies!!
Do ACL Prevention Programs work? – YES THEY DO!
- Australia has the highest rate of ACL injury in the world with the rate increasing by 6% per year.
- Females are more at risk than males and this is seen the recent stat from AFLW where females are 9 times more likely to rupture their ACL compared to males.
- These injuries are expensive due to surgery costs, physio rehabilitation costs, time of work and approximately 12 months off sport with a high portion of injured patients never returning due to fear of re-injury.
- Research has evaluated multiple studies testing the effectiveness of prevention programs and they DO work cutting the risk down by 50%!
Components of ACL Prevention Programs:
- Neuromuscular control exercises
- Landing and cutting/pivoting technique
- > 20 minutes per session
- Needs to be done ideally all year round
- Best if supervised by expert to ensure good quality movement
There are many programs out there designed for different sports that are worth using in your local club or team. Educating the coaching staff and athletes is crucial into understanding why these programs are important and how to implement them. Here is a list of a few available online:
- FIFA 11 Plus https://www.slideshare.net/PedMenCoach/fifa-11-warmup-to-prevent-injuries
- AFL Prep to Play – https://coach.afl/prep-play-warm
- Netball KNEE Program – https://knee.netball.com.au/
- Footy First – http://www.aflcommunityclub.com.au/index.php?id=906
- PEP Program – https://www.aclstudygroup.com/pdf/pep-program.pdf
- GET SET – Free Injury Prevention App for Olympic Sports – https://www.olympic.org/news/make-sure-your-body-is-ready-for-exercise-with-get-set-an-easy-to-use-injury-prevention-app
Take Home Messages:
- Good strength rehabilitation is required after an ACL injury to help return to good function, return to sport and prevent early osteoarthritis from developing.
- Just because you have ruptured your ACL does not mean you have to have surgery – there are many factors that determine whether you need surgery or if you can rehabilitate your knee without it. Talk with your physio about this decision!
- Prevention Programs have been proven to be effective in preventing ACL Injuries.
About the Author:
Julia has 7 years of elite sports physio experience across many different sports including netball (Collingwood Magpies), volleyball (Volleyroos) and soccer (Melbourne City). She is very experienced in working with athletes post ACL injury to get them back to their sport and is also very passionate about injury prevention. She has conducted many injury prevention talks at different sporting clubs to show athletes and coaches simple warm up/strength drills that can be implemented into training to help reduce the risk of injury and in particular ACL injury.
Feel free to contact us at the clinic on 5277 2151 or email Julia at firstname.lastname@example.org if you would like to organise an injury prevention talk for your local sports team or if you would like individual advice on your knee.