Looking into the crystal ball of ACL injuries

Sometimes I wish I had the ability to just look at an athlete and tell them exactly when and how they will injure themselves, and then be able to prevent it (of course).  Not only could I prevent  a TON of injuries, but I could probably make a TON of money!  Imagine getting hired by all the professional teams and just pointing and telling them who they need to work with, who they need to cut, or who needs to play more.

But unfortunately I can't tell the future.  It's not as easy to look at someone and predict an injury.  There is good news though- I do have statistics on my side!  That sounded cooler in my head, but I'm also a huge nerd.  What I mean by that was that I have data that people a lot smart than me have compiled over the years that can statistically show who is MORE LIKELY to be injured and how we can possibly prevent them.  The big injury we are gonna talk about today is the big A- ACL tears.  It is one of the most common injuries, especially in athletes, so let's break down what it is, how common it happens, and can we prevent it.

all-knee-ligaments.jpg

The ACL (anterior cruciate ligament) is an important ligament within the knee capsule.  It begins on the posterior aspect of the intercondylar notch on the femur and attaches onto the anterior tibial plateau.  There are actually two parts that arise from the femur and come together to attach into the anterior aspect of the knee capsule and medial meniscus.  Like the image to the left shows, many texts and images will show the ACL is separate from the meniscus, but this is a fairly inaccurate representation, as there are very few structures within the musculoskeletal system that are completely isolated.

The primary function of the ACL is to provide stability within the sagittal plane (think front to back) and helps keep the tibia from sliding forward.  It works with the PCL (posterior cruciate ligament) to provide complete stability of the knee joint within the sagittal plane.  Without these ligaments, your knee would just slide forward and backward (see our Instagram post from March 22nd, 2018 to see what it looks like when your ACL is torn).

There are approximately 200,000 ACL injuries per year in the US, with 95,000 of those being complete tears.  100,000 ACL reconstruction surgeries are performed annually with an average cost of $5,000-$17,000 per patient (out of pocket cost), and some research actually puts the societal cost at $38,000 per ACL surgery.

I'm going to put those numbers together... the number of ACL surgeries within the US costs somewhere between $500 million to $1.7 billion, and that doesn't include what the insurance companies pay!  Ok, so we've established there are a lot of ACL injuries and they're expensive... but who's at risk of getting them?

Allan et al performed an epidemiological study on high school ACL tears from the 07/08 year to 11/12.  I could literally spend 2-3 hours breaking down this study (because that's what I did to write this blog... and enjoyed every minute of it), but I'm just going to throw out the highlights-

  • ACL surgeries account for 60% of sports related surgeries among high school athletes
  • ACL injuries account for more than 50% of all knee injuries
  • Across 9 sports surveyed (Football, boy's and girl's soccer, volleyball, boy's and girl's basketball, wrestling, baseball, softball), girl's soccer accounted for 14.9% of all ACL injuries, with football coming in second and 11.5%
  • The rate of ACL injuries in high school is 6.5 per 100,000 athletic exposures (this includes every practice and game)
  • 42.8% of ACL injuries were during an athlete/athlete contact, 37.9% were non-contact

This is important information to digest.  We can talk about each point of these, but the main thing to focus on is that if you play a sport, you have a higher chance of an ACL injury.  I focus on high school athletics because roughly 50% of all high school aged adolescents play sports, but this does not include club sports, which probably increases that number fairly significantly.

One thing I observed during this study though was the ratio of contact vs. non-contact.  I've read some studies where the ratio is 30/70 (contact vs. non-contact), and the definition of contact to me is not well defined.  I don't believe the contact is defined as contact directly to the knee, just contact with another individual of any means, which I believe changes these numbers.  Also, the numbers from football really skew the numbers in favor of contact, as 61.2% are contact related.  Almost every other sport had a higher rate of non-contact ACL injuries than contact.

Why are we talking about this?  Well, summer is approaching shortly, and despite the doom and gloom I just presented, there is hope!  The National Athletic Training Association released a position paper on ACL prevention programs in January, showing some of the efficacy of these programs.  While we are limited on the information of what actually causes ACL tears, programs that include strength, plyometrics, agility, balance, and flexibility seem to help reduce the risk of ACL tears, especially in females.

All that being said, Victory will be introducing it's first ACL Prevention program this summer!  While most people know us for helping recover from injuries, we want to make sure we offer programs to help prevent injuries in the first place.  This is important to help athletes stay on the field, but also reduce health costs, as a prevention program will be much cheaper than an ACL injury.  We will be releasing the finalized program within the next week, so keep your eyes peeled on when, where, and how much.  Don't let the summer fly by without making you or your athlete a better, healthier athlete.