More than 31 TP3T of amateur athletes suffer an ACL rupture every year. Depending on the type of sport, this can even exceed 15% for top athletes. In the Netherlands, more than 9000 ACL reconstructions are performed per year and about 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 crotch strap provides stability in forward and backward directions, as well as during rotational movements, and is especially indispensable for the latter. Often a tear occurs without the intervention of an opponent, especially in external rotational valgus stress trauma (a twisting motion in which the knee bends inward and the upper leg rotates outward while the lower leg is stationary). This injury is most common in football, hockey, netball 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 surgery again. It is wiser to think about a new anterior cruciate ligament immediately, especially for young athletes who want to continue practicing their knee-stressing sport. Anterior cruciate ligament surgery is major, especially for rehabilitation, and takes about a year before the athlete is fit again.
This choice will mainly apply to younger athletes. A higher age in itself is not a reason not to operate, but as the years progress, it is often better to opt for less stressful sport. 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 fit again. The choice for such a route has a major impact on both sporting and daily life. The athlete often manages to return to the old level through an intensive rehabilitation process.
What does the physiotherapist do?
In the beginning after an anterior cruciate ligament injury, the patient, physiotherapist and orthopedic surgeon discuss whether surgery is necessary. This depends on the goals of the patient and the functional stability of the knee.
The physical therapist will help restore knee function. In the beginning, passive and active mobilizations are used to optimally extend and bend the knee, which is important for the gait pattern. We also start with exercises that improve the strength, stability and coordination of the knee. During the process, the physiotherapist will expand the exercises and ensure creativity, so that the patient receives the right stimulus.
In addition to the physical recovery, the psychological response to the ACL rupture and post-rupture rehabilitation, such as fear of recurrence, appear to influence the extent to which a person resumes sports activities. Here the physiotherapist plays an important role by motivating and reassuring the patient during the rehabilitation process.