The Injury that is the Excruciating Cruciate
It is one of the most feared of all football injuries – the dreaded cruciate ligament – and the initial agony endured by the player is painful to witness. The lengthy list of those tearing the anterior cruciate ligament (ACL) in their knees this season include Zdenek Grygera, of Fulham, Michael Essien, the Chelsea midfielder, Bebe, of Manchester United, and even Quade Cooper, of the Australia rugby union team.
A club can usually expect at least one of these per squad per season and implementing strategies in preventing them from happening can be time well spent. This can be from simply ensuring players fully recover between games and are not playing fatigued to working on their jumping and hopping technique (plyometric training).
The ligament is situated inside your knee going from the front of the shin bone (tibia) to the back of the thigh bone (femur) and basically stops the shin bone from moving forward when you twist and turn on the knee. Nowadays, the recovery period is about six months for a footballer as they will need an operation to replace the ligament with a grafted tendon, usually taken from their hamstring or the tendon on the front of their knee.
ACL Surgery and rehabilitation has come along way since the early 1990s when Paul Gascoigne infamously injured his in the FA Cup Final tackling Gary Charles. He was out for 16 months! A six-month period is also just a guide as the reconstructed graft is, in fact, strong enough to cope with the stresses of football at three-and-half months but it is usually the strength and control of the knee that takes longer to fully recondition. Some players have complications such as infection after surgery, which can take you back months.
When the rehab goes well, I have rehabilitated some players back in four to five months, especially if they have had the injury before and know what to expect. This can be quite common as, once you have injured one knee, you have a much higher risk of injuring the other one.
The period following reconstruction can be long and painful, both physically and mentally, for players and keeping the rehab varied and interesting is one of the physio’s main challenges. Many clubs ship their players out to specialist clinics in the United States, Qatar or France just to break up the monotony.
Also the harsh reality is that, when a treatment room is full of four or more injured players that may make the next game and a long-term injury, such as an ACL, that won’t, it is the latter that usually suffers and is not seen as the priority. The bigger clubs have more than enough staff and facilities to avoid this but many clubs only employ one physio.
Not all sports people need to have surgery after rupturing their ACL. The decision will depend a lot on their level of activity and type of sport they play. The ACL is essentially a supporting strut that stabilises the knee when you twist and turn so, if you participate in a sport where you run in straight lines or your body weight is supported, such as cycling, as long as you regain full knee flexibility and undertake a thorough strengthening and reconditioning programme, you won’t need surgery, be able to do your sport sooner and with no long-term implications.