Soccer is the world’s most popular sport. Soccer players have a much lower chance of injuries compared to football players and other sports. Injuries do occur at a very low level while players are young. However, the rate of injury increases when soccer players get older.
The most common injuries that occur in soccer are leg injuries (ankle, knee). They have accounted for 65.6% of men’s injuries and 65.3% of women’s injuries. Unfortunately, female soccer players are more likely to injure their ACL compared to their male counterparts. A 2005 study by Angel et al. reviewed ACL injuries in NCAA male and female basketball and soccer athletes from 1990 to 2002 and found that females sustained 67% of all noncontact ACL injures compared with 58% in males.
ACL Injuries and Tears
Anterior Cruciate Ligament (ACL) injuries and tears are common in soccer players. Athletes usually hear or feel a “pop”. Their pain is usually deep in the knee and usually they will have immediate swelling (70%) and sometimes have bleeding into the joint. Symptoms of an ACL tear are usually characterized by generalized knee pain, feelings of instability preventing return to sport, and difficulty putting weight on the knee. ACL tears often happen from a blow to the outside aspect of the knee. ACL tears are commonly seen in activities like basketball, skiing, and football too.
During your doctor’s visit, physicians usually will notice swelling and quadricep avoidance gait (does not actively extend knee). Patient’s knee motion and lack of full extension secondary to meniscal injury or arthrofibrosis is at times noticed. Physicians will do some tests on your knee to confirm an ACL tear, like lachmans and pivot shift tests. They will evaluate for meniscal or concomitant ligamentous injuries (McMurray, Dial test, varus/valgus stress). An ACL tear diagnosis can be suspected clinically with presence of a traumatic knee effusion with increased laxity on Lachman’s test, but it requires MRI studies to confirm the diagnosis. Lateral meniscal tears occur in 54% of acute ACL tears, and medial meniscus tears occur in chronic cases.
Your physician will likely obtain radiography or x-rays. Recommended views are AP, lateral, sunrise/merchant/skyline view. Fortunately, x-rays are usually normal. However, Segond fracture (avulsion fracture of the proximal lateral tibia) is pathognomonic for an ACL tear. This represents bony avulsion by the anterolateral ligament (ALL) and is associated with ACL tears in 75-100% of the time.
Treatment for ACL tears are individualized to each patient based on activity level, age, demands, and other injuries that occurred during the event. Non operative treatment usually includes some physical therapy, bracing and lifestyle modifications. ACL non operative treatment is usually reserved for low demand patients with decreased laxity and recreational athletes not participating in cutting and pivoting activities. ACL non operative treatments are associated with increased meniscus and cartilage damage. Operative ACL reconstruction usually provides the best outcomes for athletes
Can an ACL tear heal on its own?
The ACL cannot heal on its own because there is no blood supply to this ligament.
Can you walk on ACL tear without surgery?
With ACL tears, walking is possible but it can be painful. Patient’s should focus on walking in a straight line and avoid sudden turns or pivots. A knee brace can help stabilize the knee, but with ACL tears, surgery is almost always required.
Is ACL tear serious?
One of the most feared sports and work injuries is a tear of the anterior cruciate ligament (ACL), which has ended or derailed the careers of numerous high-profile athletes. A torn ACL is very painful and can debilitate a person for several months and perhaps for life, although most people with ACL tears recover just fine.
How long does an ACL tear take to heal?
Within the first few weeks after surgery, you should strive to regain a range of motion equal to that of your opposite knee. Recovery generally takes about nine months. It may take eight to twelve months or more before athletes can return to their sports
Do all ACL tears require surgery?
ACL injuries can either be complete or partial. While complete ACL tears almost always require surgery, partial ACL tears may be treated effectively with nonsurgical methods. ACL tears are graded by severity and are called sprains (a sprain is a stretch or tear in a ligament).
What happens if ACL injury is not treated?
Untreated ACL injuries accelerate the development of osteoarthritis. Without proper support from the ACL, the articular cartilage starts to break down at a more rapid pace than normal which leads to osteoarthritis.
Piasecki, Dana P., et al. “Intraarticular injuries associated with anterior cruciate ligament tear: findings at ligament reconstruction in high school and recreational athletes: an analysis of sex-based differences.” The American journal of sports medicine 31.4 (2003): 601-605.
Spindler, Kurt P., et al. “Prospective study of osseous, articular, and meniscal lesions in recent anterior cruciate ligament tears by magnetic resonance imaging and arthroscopy.” The American journal of sports medicine 21.4 (1993): 551-557.
Weiss, K. L., H. T. Morehouse, and I. M. Levy. “Sagittal MR images of the knee: a low-signal band parallel to the posterior cruciate ligament caused by a displaced bucket-handle tear.” AJR. American journal of roentgenology 156.1 (1991): 117-119.
Munk, Bo, et al. “Clinical magnetic resonance imaging and arthroscopic findings in knees: a comparative prospective study of meniscus anterior cruciate ligament and cartilage lesions.” Arthroscopy: The Journal of Arthroscopic & Related Surgery 14.2 (1998): 171-175.