The anterior cruciate ligament lies hidden within the knee joint, connecting the thighbone to the shinbone. Twisting motions common to sports that involve cutting and pivoting -- including football, basketball, tennis and indeed soccer -- can tear this ligament and require extensive rehabilitation before you return to the game. Top-tier soccer players, including Megan Rapinoe of the U.S. Women's National Team, have returned to the field and made stellar contributions at the World Cup level following surgery to repair the ACL.
Significance
The ACL is one of the most commonly injured ligaments in the knee, states the American Academy of Orthopaedic Surgeons, with about 200,000 injuries recorded annually, and 100,000 reconstructions performed per year. Seventy percent of ACL injuries occur without contact, while 30 percent occur after contact with the ground, another player or another object. Female athletes in soccer and other sports receive ACL tears more than males. Surgical repair involves replacing the torn ligament with a tendon, often taken from the hamstring. Surgical success rates range from 82 to 95 percent, the academy reports.
Post-Injury
As part of greater success in getting players back to play soccer, you start a pre-habilitation program even before ACL repair surgery, orthopedic surgeon Robert Bray of Peter Lougheed Hospital in Calgary, Alberta, told "The Los Angeles Times." You perform simple stretches and exercises to strengthen the leg muscles and get them stronger. Cycling on a stationary bike may be part of the pre-operation routine. The ACL surgery is typically scheduled four to eight weeks after the injury.
Post-Surgery
In the first two weeks after surgery, the emphasis is on working to fully straighten your knee and restore control of it with the quadriceps muscles. Rehabilitation can take four to six months and includes exercises designed to improve balance and control of the leg. Exercises include the stationary bike, stair machines, strength training and bodyweight exercises. You meet periodically with a physical therapist and perform unsupervised exercises on your own. The recovery timeframe for clearance to return to soccer -- which depends on compliance with the program, age, pre-injury fitness and genetics -- can last up to 18 months, consulting physician Mark Heard told "The Los Angeles Times."
Returning to Play
You can return to playing soccer when you have no pain or swelling and a full range of motion, and when muscle strength, endurance and functional use of the leg have been fully restored, the academy indicates. Your challenge in returning to how you played soccer before is partly psychological, given possible apprehension about reinjuring the knee. The challenge is also physical, with special focus needed on strengthening the quadriceps, which receives atrophy during time away from soccer. A survey of the medical literature by Grethe Myklebust of the Oslo Sports Trauma Research Center found that 6 percent of soccer players who received surgery and 1 percent who did not were still playing soccer 10 to 13 years later. Mykelbust also noted a study showing that 30 percent of elite soccer players were still active after an ACL injury after three years, contrasted with 80 percent in a control group.
References
- Academy of Orthopaedic Surgeons: ACL Injury -- Does It Require Surgery?
- "OregonLive.com"; Megan Rapinoe Overcomes Setbacks to Shine in First World Cup; Jamie Goldberg; July 2011
- "Los Angeles Times"; An Injured ACL Isn't a Death Knell for Athletes Anymore; James S. Fell; July 2011
- Science of Soccer Online; ACL Rehabilitation -- Clinically Cleared But Ready to Play?; Jay H. Williams; January 2011
- "The American Journal of Sports Medicine"; Return to the Preinjury Level of Competitive Sport After Anterior Cruciate Ligament Reconstruction Surgery; Clare L. Aldern, et al.; March 2011
- "British Journal of Sports Medicine"; Return to Play Guidelines After Anterior Cruciate Ligament Surgery; G Myklebust, et al.; 2005
