Taking part in exercise, whether it’s playing sport, running or working out at the gym, provides numerous benefits; fitness, physique, current and future health all see gains in a variety of ways. However, injuries during exercise are not uncommon and after sprains, strains and pulled muscles, ligament damage is amongst those most frequently seen. Ligaments are the tissues that connect bones to each other and therefore play an important role in movement.
Those who take part in sport are most likely to tear their anterior cruciate ligament (ACL), one of the ligaments in the knee, which usually occurs when you stop or change direction abruptly. You will soon know if this ligament has been damaged, as besides the “pop” you are likely to hear at the time it occurs, severe knee pain and swelling are accompanied by an inability to straighten your leg or place any weight on it. While some doctors will recommend reconstructive surgery for repair of the ACL, this is not your only option, as non-surgical management is available. Here we consider the treatment options for managing this sports injury.
Discussing your options
Surgery is only carried out when necessary, as complications can occur during and after the operation, which include bleeding, development of a blood clot or infection. However, in certain instances a doctor who specializes in trauma injuries will advise that surgery will be your best chance of regaining full function and preventing further injury to the knee. More conservative management of ACL can leave you vulnerable to knee instability and is usually recommended when only a partial tear has occurred, there are no symptoms of knee instability and in those people willing to give up high-intensity activity or who already undertake light exercise.
The surgical repair of ACL tears has a success rate of at least 80% and in certain subjects may be as high as 95%, while knee instability following this is only seen in around 8% of cases. This provides a greater certainty that you will be able to return to exercise and sport and is nearly always recommended for anyone with a physically demanding job, who has complex or multiple injuries to the knee. If you do decide to opt for surgery, ensure you choose an experienced and competent surgeon who has a good track-record for the procedure.
Besides the management of symptoms with anti-inflammatory drugs and ice packs to reduce swelling, physiotherapy plays an important role in non-surgical management of a torn ACL and consists of four stages of prescribed exercises. Initially the aim is to regain motion while reducing swelling and pain; this is then followed with exercises to strengthen the quadriceps and hamstrings – the muscles that support the knee. By the third stage the strength and range of motion should be equal in both legs, allowing the introduction of sport-specific exercises during the final stage of physiotherapy. The use of a custom-made knee brace will also be important while the knee is regaining its strength.
If ACL tears were merely sutured, there is a high chance that they would rupture again, so instead a graft is made using a tendon – the tissue that joins muscle to bone – which is most commonly taken from one of those of the kneecap, hamstrings or quadriceps. Prior to surgery physiotherapy is often undertaken to improve the range of motion to aid recovery after surgery. At the start of the surgical procedure an examination is conducted to confirm the diagnosis and check for any other damage that requires repair. If the ACL is indeed torn, a tendon is collected and prepared to be the right size. The remnants of the ACL are removed and the tendon graft is attached to the leg bones either side of the knee. After surgery further physiotherapy will be needed to ensure the procedure’s success.
Whichever treatment option you choose, the appropriate dietary intake will help to aid your recovery. The collagen fibers of ligaments are made from protein and for the tissues to recover after surgery adequate is required in the diet. Lean meat, poultry, fish, eggs, low fat dairy produce and soya are all high quality proteins that will aid the healing process. One of these should be included with each meal and snacks such as a low fat yogurt or a small sandwich are good options between meals. It is also important to include complex carbohydrates – bread, cereals, potatoes, pasta and rice – regularly over the day, as these will help to fuel tissue repair, which requires additional energy.
When there is inflammation in the body, substances known as free radicals are produced, which can cause further tissue damage. Antioxidant vitamins A, C and E, which are abundant in fruit and vegetables, can help to counteract these free radicals. The inflammatory process can also be modified by dietary measures; polyunsaturated fats, which are present in high amounts in sunflower, corn and soya oil and their spreads, make inflammation worse, while omega-3 fatty acids that are found predominantly in oily fish can help to minimize this. Choose olive or rapeseed oil and include oily fish twice weekly; omega-3 fatty acids are also found in walnuts, linseeds and green leafy vegetables if you don’t eat fish.
Once free from pain and swelling, and when full movement and function have returned to the leg, you will be able to return to sport and usual activity; though do remember to follow the advice given for how to reduce the recurrence of this injury.See some words or phrases that you don't understand? Check out The Dragon's Lexicon.