Anterior Cruciate Ligament

What is the anterior cruciate ligament?

The ACL is one of the four major ligaments in the knee joint. It plays a crucial role in providing stability to the knee by preventing excessive forward movement and rotation of the shin bone (tibia) relative to the thigh bone (femur). The ACL is located within the knee joint and is crucial for activities that involve cutting, pivoting, and sudden changes in direction.

ACL Injuries in Skiing:

The incidence of ACL injuries in skiing and snowboarding can vary, but studies have indicated that these sports are associated with a notable risk of knee injuries.

Some reports suggest that skiing has a higher overall injury rate than snowboarding, but the risk of ACL injuries may be similar between the two sports.

Twisting and Turning

Skiing involves a significant amount of twisting and turning, especially during downhill descents and navigating through varied terrain. Abrupt changes in direction and quick turns can put stress on the knee, increasing the risk of ACL injuries.

Equipment Influence

Ski bindings are designed to release in certain situations to prevent injury. However, incorrect binding settings or skiing in unfavourable conditions can contribute to ACL injuries. Make sure your release settings are adjusted for the type of snow you’re in whether and whether its on or off piste.

Landing from Jumps

Freestyle skiing or attempting jumps can lead to awkward landings, causing the knee to absorb excessive forces and increasing the likelihood of ACL injuries.

ACL Injuries in Snowboarding

Catching an Edge

Snowboarders are at risk of catching an edge, especially beginners. When this occurs t can lead to sudden twists or falls, putting stress on the knee ligaments.

Freestyle

Similar to skiing, performing freestyle tricks on a snowboard involves jumps and landings.

Stance and Posture

The stance in snowboarding, with both feet attached to a single board, can influence the risk of injury. Improper stance or posture during turns may contribute to ACL injuries.

Gender Differences

Research suggests that female athletes, including skiers and snowboarders, may have a higher incidence of ACL injuries compared to males. This is attributed to differences in anatomy, neuromuscular control, and hormonal factors. Some research has identified that women are 5 X more likely to injure their ACL.

Prevention

We stock a range of protective knee braces at the clinic that you can choose from, as well as some of the newest tech called STOKO, which is legging that you can use as a thermal that hides 90 feet of adjustable high-strength cables that reinforces your body’s muscles and ligaments, providing medical-grade knee bracing that doesn’t hold you back.

Skihab

Sport-specific training programs that focus on strengthening the muscles around the knee, improving balance, and enhancing agility can help reduce the risk of ACL injuries in both skiing and snowboarding. This is crucial and often overlooked when preparing for a ski trip.

Proper Technique

Learning and practicing proper skiing and snowboarding techniques, including controlled turns and landings, can contribute to injury prevention. Just like in any sport, this is why it is important to build a proper foundation and habits when learning. We recommend an instructor or lessons.

Equipment Check

Ensuring that ski bindings are correctly adjusted and regularly checking equipment for wear and tear is crucial to prevent ACL injuries during skiing.

Protective Gear

Consideration of protective gear, such as knee braces, especially for individuals with a history of knee problems or those participating in high-risk activities.

Non-Surgical Treatment

Rest and Protection

Initially, the injured knee may require rest to allow the swelling to reduce. This is crucial.
Using crutches and a knee brace may be recommended to protect the knee from further stress. -Many of our clients also utilise our GameReady ice and compress machine that helps reduce swelling and regain range of movement.

Physiotherapy and Rehabilitation

A physiotherapist will design a customized rehabilitation program to strengthen the muscles around the knee, improve flexibility, and enhance overall knee stability.
Exercises may include range of motion exercises, strengthening exercises for the quadriceps and hamstrings, and proprioception exercises to improve balance.
Depending on time restraints and the need to fly home, we can contact your physiotherapist or doctor back home with an injury and progress report, so you have treatment continuity

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Bracing

Depending on the severity of the injury, a knee brace may be prescribed to provide additional support during activities. A lot of the newest research involves ACL recovery using specialised bracing.

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Anti-Inflammatory Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed by your doctor to manage pain and reduce inflammation.

PLEASE NOTE: swelling is normal after an injury and it is part of the foundation phase of healing, we don’t advise taking NSAIDs immediately. Please talk to your doctor about this for their expert opinion.

Are you a COPER?

Once the inflammation has settled and a patient has regained range of movement, they will begin the rehab journey. When the patient is ready, the physiotherapist can do tests that involve hopping and the success or failure of these tests will give the patient an understanding whether they would be a candidate for non-surgical treatment. Normally patients that have more than one injured structure (ACL + MCL + meniscus), would be advised to get surgery. Obviously there are exceptions to the rule, so check with your health professional team.

Surgical Treatment (ACL Reconstruction):

Surgery Timing

ACL reconstruction surgery is often recommended for individuals with significant ligament tears, high activity levels (especially in pivotal sports) and other structural injuries (such as MCL or meniscus). Delaying surgery may be considered in some cases to allow for initial swelling and inflammation to subside and this will not affect your recovery.

Graft Selection

During surgery, the torn ACL is replaced with a graft, which can be autograft (from the patient's own body, commonly from the patellar tendon or hamstring) or allograft (from a donor). The choice of graft depends on factors such as patient age, activity level, and surgeon preference.

Long-Term Management:

Even after successful surgery and rehabilitation, individuals may benefit from ongoing strength training and maintenance exercises to reduce the risk of re-injury.

Rehabilitation After Surgery

Post-surgery, a comprehensive rehabilitation program is essential to regain strength, flexibility, and functional stability. Physiotherapy will play a central role in guiding patients through progressive exercises to ensure a safe and effective recovery.

Return to Activity

The timeline for returning to sports or high-impact activities varies but typically ranges from six months to a year post-surgery. Running commences sound 4 months and sports that involves pivoting and twisting commence around 9 months. Your physiotherapist will guide you through this process as everyone has different activity levels and goals. Clearance for return to activity is based on the individual's progress in rehabilitation and the surgeon's assessment. NOTE: Rehabilitation cannot make the graft heal faster, that is why 9 months is needed for return to sport to allow the graft time to heal.