In conjunction with some allied health professionals we are involved with the prevention and treatment of sports related orthopaedic injury. Specifically we have been looking at ACL injuries (Anterior Cruciate ligament) , hip joint related, hamstring and running related injuries.

In the times of increasing health insurance costs, increases in sporting activity related to health and wellbeing,the ability to prevent major injury from occurring is as important as the activity itself.

It is widely known the function of the Anterior Cruciate ligament and its effects on the body after it is injured.

The knee joint is the second most injured joint in the body in sport but the most in soccer with the ACL being the most economically cost related sporting injury. One study showed significant lower number of soccer players having a perceived lower level of function after coming back from rehab for an ACL injury.

In relation to ACL injury, roughly around 80% of the injuries are preventable. Testing in prevention methods have been carried out in both Santa Monica USA and through FIFA in soccer. After these it was found the decrease in such injuries had reduced by up to 80%. Very rarely does one get an ACL in anything that includes straight line exercise or non weight bearing.

There is four different mechanisms of injury that have been identified that relate to ACL injury.
Coming from a jumping position
Changing direction
Contact injury
Supporting leg with the opposite one in motion.

There are also certain types of build that are more susceptible to injury of the ACL. In dancers the rate is only 10% of the knee joint injury in comparison to field sports. ACL injury is also seen in skiing especially with those who go for a holiday as opposed to others that are constantly on the slopes.

One study found six ACL injuries in 253 dancers over a ten year period versus 6-8% ACL injury rate for female university sports participants that involved jumping, hopping, cutting-basketball, soccer, field sports.

The length of time out of activity can depend on anything from 3-12 months based on how the deficits are restored and the mechanical properties return.

COST-to insurers the cost of each ACL injury can be up to €10k and above per injury between operations,rehabilitation,loss of work and medications. This is the short term cost.

In GAA cost terms-35.5% of all insurance claims relate to knee surgeries-2016 figures. Other costs come in the inability to get back properly to pre injury function in about 25-30% of people unless they are at an elite level with access to constant treatment. There is also the psychological cost,the threat of re-injury again within the first 12 months of the first injury. Plus the complication of any additional surgery if complications arise with the joint.

In professional soccer this has been found to be 7% of players who had to go under a second operation for ACL reconstruction. In a Mayo clinic study it was found that about 30% of young active ACL reconstructive people will go on to have a second ACL injury.

Also with the best care in professional ranks 90% return to play within a year but only 66% played at the highest level three years later.

The longer term effects that have been found,come in the form of arthritis within 10-12 years of an ACL injury/operation (detected by radiographer changes in the joint) and also the longer term possibilities this may bring with the joint. Mayo Clinic report stated regardless of the treatment athletes with ACL injuries are up to ten times more likely to develop degenerative arthritis of the knee with a prevalence of between 50%-100%. This is especially seen in radiographic changes up to 90% of cases,when a single bundle technique operation is carried out (main type of operation carried out in Ireland and UK). As well as ACL injury there can meniscus and medial collateral ligament injury and other related knee joint damage.

On a visit to a top 4 senior football county team who had three players out with knee joint injuries (team had 23 players on its panel), out of 18 present,17 were opening themselves up for a knee joint injury based on an assessment of movement. Out of the 3 injured,one will never play again due to the damage of the knee joint.

A statistic from soccer showed that the knee joint is the most affected 35%,followed by the ankle 23% and then the hip 10%. 64% of retired professional soccer players in one study had surgical procedures on joints of the lower extremity during their career and 48% were still under some medical care. However on anecdotal evidence the hip joint in GAA sports looks to be increasing in prevalence in Ireland.

In non-sporting occupations sedentary work return after 2 weeks, driving is only possible after a minimum of 4 weeks, heavy physical or standing it feasible for 3 months due to the slow healing recovery of the transplanted tendon tissue used to replace the ACL. Mechanical properties decrease and only gradually regained.

A ounce of prevention is worth a pound of treatment,this certainly applies in relation to ACL injuries.

Ciaran Fitzpatrick.