Every year, more than 3% of amateur athletes suffer an ACL tear. For top athletes, depending on the type of sport, this can even exceed 15%. In the Netherlands, more than 9000 ACL reconstructions are performed per year and approximately 70% of all ACL ruptures are based on a “non-contact” trauma mechanism, where the forces that caused the rupture came from the person's own movement.
The cruciate ligament provides stability in forward and backward directions, as well as during turning movements, and is especially indispensable in the latter. A tear often occurs without the intervention of an opponent, especially in external rotation valgus stress trauma (a twisting movement in which the knee buckles inward and the upper leg turns outward, while the lower leg is stationary). This injury mainly occurs in football, hockey, korfball and skiing.
The policy after diagnosis depends on the nature of the sport and the level at which the athlete wants to (continue to) perform. Some doctors choose to wait and train the knee first, but this often leads to further surgery. It is wiser to immediately consider a new anterior cruciate ligament, especially for young athletes who want to continue practicing their knee-straining sport. Anterior cruciate ligament surgery is radical, especially for rehabilitation, and takes approximately a year before the athlete is competitively fit again.
This choice will mainly apply to younger athletes. An older age in itself is not a reason not to operate, but as the years progress it is often better to opt for less stressful sports. Anterior cruciate ligament surgery is a fairly major operation, especially with regard to rehabilitation. The operation itself only takes an hour and a half, after which you have to move around on crutches for six weeks. It takes about a year before the athlete is competitively fit again. Choosing such a route has a major impact on both sporting and daily life. The athlete often manages to return to his or her old level through an intensive rehabilitation process.
What does the physiotherapist do?
Initially after an anterior cruciate ligament injury, the patient, physiotherapist and orthopedic surgeon will discuss whether surgery is necessary. This depends on the patient's goals and the functional stability of the knee.
The physiotherapist will help to restore the function of the knee. Initially, passive and active mobilizations are used to achieve optimal extension and flexion of the knee, which is important for the walking pattern. Exercises that improve the strength, stability and coordination of the knee are also started. During the process, the physiotherapist will expand the exercises and provide creativity, so that the patient receives the right stimulation.
In addition to physical recovery, the psychological response to the ACL rupture and the rehabilitation after the rupture, such as fear of recurrence, appears to influence the extent to which someone resumes sporting activities. The physiotherapist plays an important role here by motivating and reassuring the patient during the rehabilitation process.