ACL (Anterior Crucial Ligament) injuries are not uncommon when engaged in an intensive sporting regimen. Our friends at Cornerstone Physiotherapy have taken a comprehensive look at what is involved in ACL injuries. For an overview of that, we suggest that you take a look at their post answering questions about ACL injuries.
What we are going to explore further here is the possible secondary complications that can arise after returning to sporting activities after recovering from an ACL tear or reconstructive surgery. The first and most common question that we get from patients is: can I get back to where I was before the ACL tear? The answer to that is almost always an emphatic yes. The reality is that studies have shown that 82% of ACL reconstruction patients returned to some form of sport with63% returning to the sport that they were in before the injury.
There are a number of surgical, rehabilitative, social, psychological and demographic variables that influenced the rates of return to sport. Some of the variables with the strongest impact on the odds of returning to sporting activity included age, gender and interval between injury and surgery.
With the people that did not return back to sports activities after their surgery, the most common reason given for abstaining from sport was fear of reinjury. Given this prevalence of this shared concern, we thought we should explore some of the most common secondary injuries after ACL tears.
Before we look at what secondary injuries can occur, it is important to first explore the timetables for a return to physical activity after a tear of the ACL. There is evidence to suggest that any surgical grafts are most at risk between the 4th and 12th months after surgery. If hamstring tendons are used for the grafts, it is found that this period of vulnerability can extend to 24 months. Each case must be assessed individually but certainly it would suggest that a return to pivoting sports should be monitored carefully within the first 24 months after injury or surgery.
With regards to the types of secondary injuries that can occur after an ACL tear, there are 6 primary injuries that you can expect to see after an initial tear of the ACL.
- Partial tear of the ACL becomes a complete tear: The severity of the tear can become worse if it is aggravated through additional trauma. If surgery was avoided after an initial partial tear, surgery and more rehabilitation will be required if it becomes a complete tear.
- Torn meniscus: A meniscal tear occurs when the cartilage in the knee is compromised and becomes dislodged or non-functional. The motion that triggers ACL injuries is similar to the motion that can trigger injuries of the meniscus. As such, there is an increased likelihood of one becoming more vulnerable after injury to the other.
- Loosening or tearing of the anterior horn of the medial meniscus: This is again a secondary injury involving the meniscus (cartilage) in the knee. This type of injury to the meniscus (both medial and lateral tears) are more common in ACL deficient knees.
- Articular cartilage damage: When the ACL becomes compromised, the amount or direction of the load carried by the ends of the knee bones can be affected which will wear away or fracture the articular cartilage which covers the bones where they articulate.
- PCL, LCL and PLC injuries: When the anterior cruciate ligament becomes less than 100% efficient, the other ligaments and structures in and around the knee (posterior cruciate ligament, lateral collateral ligament and the posterolateral corner) can be forced to accommodate additional workload or a different movement pattern that compensates for the diminished ACL capacity. This undue load can stress the structures and can make them more vulnerable to secondary injury.
- Osteoarthritis: Osteoarthritis is a form of arthritis that manifests itself when the protective cartilage in the knee joint slowly erodes. This is brought on by the secondary damage to the meniscus or articular cartilage which left untreated will contribute to the chronic arthritic pain in the knees.
In light of the secondary injuries that can occur after an ACL tear, it becomes imperative to properly rehabilitate the principal injury. We can help you coordinate your rehabilitative plan with your doctor to ensure that you avoid any secondary damage to the knee and surrounding structures. Give us a call and we will be happy to answer any questions that you may have about your ACL injury.
