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The author Robert Marx is an American surgeon so the book has an American emphasis. Here are some details from the book:
'There are an estimated 41 million American kids playing competitive youth sports today, and estimates run as high as 200,000 ACL surgeries per year in the U.S. alone, a large percentage of which are being performed on the knees of prepubescent kids.' The worst affected U.S. sports are soccer and basketball. According to the author this is due to the increased intensity and frequency of youth sport.
There has been a very large increase in ACL injuries among women. 'Females are as much as six times more likely to tear their ACLs than their male counterparts in the high-risk sports.'
The two main causes are what the author calls 'cutting' (turning suddenly with one foot planted on the ground, with your weight on the planted foot) and jumping. An aggravating factor is having your knee bent inward (knock-kneed position).
Most ACL injuries (about 70 percent) occur in non-contact situations.
A significant part of the book is about the anatomy of the knee. I found it hard going as I didn't know my femur (thigh bone) from my tibia (shin bone). Basically, ligaments connect bone to bone, and the ACL connects the femur to the tibia.
ACLs are slow to heal because very little blood goes to the ACL, which is bathed in a fluid inside the knee. Most athletes can't return to their sport for at least six months. An ACL injury can't normally be operated on immediately after the injury - it normally takes a month for the swelling around the knee to subside. The ACL, which may be completely broken, is normally repaired/rebuilt with tissue from the injured patient's tendons.
It's also not simply bad luck to have more than one ACL injury. Having had a previous ACL tear is a risk factor for future ACL injuries: 'if you've torn your ACL before, you are at a higher risk of tearing it again, or of injuring the other knee.'
Prevention. Studies have been done in American and Norway on reducing the risk of ACL by using ACL prevention programs. These focus on strengthening the knee and teaching players not to bend their knees inward, and to keep their knee above their toe. For example see the walking lunges exercise at 1:20
Once again thank you TacticaLR for the link. We met with a Surgeon who suggested waiting 4 weeks for the swelling to go down and try strengthening it before the operation He suggested using a piece from the Quad instead of Hamstring or Patella Tendon .One reason is because her growth plate /bones are not closed so he thinks she will grow more. He studied in London so I asked him what the pro players use and he said mostly hamstrings but he thinks Quad for her. She has 2 more years of competitive travel and school soccer left but is good enough to be a squad player in Collège at least if it goes well and she has the drive and passion left . Any thoughts on ACL repair methods would be appreciated .Thanks again
I tore my left ACL in 2001 playing football on a soggy pitch. Just felt a ping in my knee trying to change direction. Tried to carry on but couldn't run without limping. I tried just resting the knee but after two periods of approx 3 months trying to run again without severe pain, went to GP's who sent me for a scan. They found that i had torn my cartilage so i was booked in to have it shaven by keyhole. After approx 6 weeks i tried full on running again, but the pain was still there. Went back to GP's and was booked for another scan, this time they found a tear on my ACL. Also cartilage was torn again. This was cleaned up and a date set to have the full reconstructive surgery of having strips of hamstring taken out and then grafted to the torn ACL. I was warned I would be in a brace for approx 3 months and then intense rehab afterwards. So i warned work and had arranged cover for at least 4 months. Date came and went in for the op. When i woke up i thought this doesn't feel too bad. The doctor then explained that on physically seeing the tear they did not think it warranted a full reconstructive procedure and that i would have to have an intense physio programme to strengthen the muscles around the knee. At the time, I think not long after 2003, Raul from Real Madrid had the exact same diagnoses that he had torn his ACL but a full reconstructive procedure was not recommended. I was 35 in 2003 and did not return to playing 11 a-side after that. Played the odd 5 a side for a mates team but I have learned to live with it. I was told that i would be susceptible to arthritis in the knee later in life. I feel it every now and then when walking up stairs or cycling. Overall i am glad i did not have the full surgery with hindsight.
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