Munir 1

Auf Munir

Ms. Curtin

Independent Research G/T

1 May 2018

ACL Injury Preventions: The Epidemic Needs to Stop

Laura Soto, an 18 year old star high school soccer player tore her anterior cruciate

ligament(ACL) on the field, and an ambulance took her to the emergency room. For eight hours

a day, she placed her leg in a machine to help it bend. Before the injury, she was division one

bound and received scholarships from multiple schools. This injury affected her, and it can

happen to anybody even if he or she does not play sports (Orr, 28). Since non-contact ACL

injuries happen so often, it is only best to stop the epidemic. Reducing such injuries through the

removal of turf and the switch to natural grass as the main playing surface on athletic fields for

football and soccer while using different balancing and stretching techniques can aid in the

reduction of ACL tears.

An ACL tear can occur from a heavy blow to the knee or a twist in the knee and a

popping sound occurs (Adickes). The injury can even occur without any contact and to

non-athletic people from a quick pivot or cut (“Info Please”). Eighty-five percent of ACL tears

occur on non-contact injuries which is an alarming number (Rouch, 36). The injury is very

common and can even occur in 80 year olds. There were 318 ACL tears in college football in a

span of six years (Cutts, 55-58). Over 1000 knee injuries occur annually (Orr, 28). These

alarming rates are making the injury become an epidemic because of its commonality. If star

players who are well trained and fit can get ACL tears, any random person can get one as well.
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Trying different balancing and stretching techniques can help. Some hospitals have

prevention programs for young kids to help them reduce the likelihood of them getting an ACL

tear in the future. Many trainers also promote different techniques for adults to practice. At the

Cincinnati Children’s Hospital, the director, Tim Hewett, also researches ACL tears and runs a

prevention program where kids start from age six to strengthen leg muscles by doing control,

leaping, and strength exercises. Hewett believes that the program can help athlete performance

by 10% - 100%. For example, single leg balancing four times a week is a good technique.

Improvements will be made within eight weeks (“Info Please”). Stretching is also helpful for

reducing knee discomfort since stressing your knee can cause a tear. As long as you do not

exhaust yourself when stretching, it is a good technique that can be used (Poster, 31).

When walking, biking, or exercising in general, remember to always rest up, use ice, add

compression to legs, and elevate them (RICE) to reduce further injuries (Poster, 31). Working

both legs and hamstrings will support the knees vastly since hamstrings protect the backside of

your knee. Jump roping, hopscotch, and running backwards or in figure eights are good ways to

help keep the knees staying strong because it acclimatizes your knee to awkward cuts and

landings (“No Weak Knees”, 30). To keep leg and knee muscles loose and protected, stretch and

rest. Stressing or tightening leg muscles can provoke further injuries (Karagneas, 117-119).

RICE, can heal minor injuries 90% of the time and can help prevent injuries (Lerner and Lerner).

The main goal in these stretching, exercising, and rest techniques is to prevent knee injuries.

Also, keeping the knee strong will help reduce the risk of future ACL tears. Warming up,

wearing appropriate gear, and exercising the quads, hamstrings, and knees is a good way to keep

the knee strong and its counterparts strong for support (Orr, 28). This improves the odds of
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achieving that main goal of protecting and strengthening the ACL and its surroundings to avoid

injury.

Turf causes more injuries to the anterior cruciate ligament then natural grass does.

Non-contact injuries are on the rise as 85% of ACL injuries are non-contact (Rouch, 36). Pivots,

cuts, and awkward landings can cause an ACL tear (“Info Please”). So acclimatizing to these

situations that one may potentially be in is something athletes need to worry about to prevent an

injury. Turf is very problematic because of the issues it causes. The injury is 1.39 times more

likely to occur if the playing surface is artificial turf than on modern grass. Turf may increase

player performance, which isn’t scientifically proven yet, but it decreases safety (Dragoo,

990-995). A French soccer league, named Ligue 1, banned turf due to safety factors while

ninety-one percent of soccer players interviewed thought that playing surface can increase

injuries (Rouch, 36). Forty percent of college football players suffer knee injuries on turf

compared to natural grass (Cutts, 55-58). This may seem like an unfixable problem but doctors

and researchers are looking for a different technique to fix this: footwear.

Footwear designs are also being worked on to help athletes cut and pivot safely on turf

since the footwear for natural grass is different than the ones on turf. Doctors are working on

shoes that help with control and grip on the surfaces. It could potentially prevent future injuries

(Dragoo, 990-995). In another interview, 64% of soccer players thought that their injury was

caused by the playing surface (Rouch, 36). If athletes believe that turf is a problem, than trainers,

doctors, and researchers must find ways to prevent the epidemic.

Another surfacing idea has been ACL products. These products are placed on the knee to

help protect the ACL. This has only worked in specific sports like skiing. They have been tested
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as well. These KneeBinding products stabilize ligaments and the knee (Cutts, 55-58). But these

products have only been tested on skiers and not football players. Another device, called the

ExoShape ACL Fixation System, is used for surgical procedures and helps the process of

rehabilitation go smoothly after the injury occurs (“ConMed Buys ACL Product”). However, this

doesn’t prevent the injury in the first place. Getting the ACL tear will require a lot of hard work

and patience to recover.

The last thing that anybody on Earth wants to do is go through a year long rehabilitation

to get their knee back. It is long, hard, and grueling. Many people take their knees for granted but

if it is injured, it could be placed in a machine for eight hours a day just to help it bend. Rehab

takes 12 months (Adickes). Motion exercises are done throughout that time to help the body

(Lloyd, 60). According to many doctors, it is an athlete’s “worst injury” (Karagneas, 117-119).

Rehab is something many people who obtain an ACL injury have to go through. But

before that, they must get surgery. Surgery could also be done in the LCL, PCL, or MCL. These

are the lateral, medial, and posterior cruciate ligaments. These other three ligaments are around

the ACL. They are on the sides and the back and are less common to tear but still possible. They

are less exposed to big hits so are torn less. An allograft must be done to repair an ACL which is

when a cadaver’s ACL is taken to put into the injured person’s knee. Chemists and professors are

still looking for ways to strengthen the bones artificially to reduce injuries. Artificial ligaments

are not an option yet because they break easily (“Artificial Bone”). Therefore, surgery is the

most likely option after a tear.

Unfortunately, surgery is not always successful as X-rays may be done before surgery

(Lerner and Lerner). It has a 95% success rate which is really good but if it does not go as
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planned, an infection may occur (Adickes). It is also expensive to do since a cadaver’s knee is

used (Cutts, 55-58). A cast or brace must be worn after an ACL is torn and when rehab occurs

(Davidson). Arthroscopy can also be done which is when a camera is put into your knee so that

the surgeon can use the images to guide them when performing surgical tasks (Lloyd, 60). After

the surgery, much rest is needed with ice, compression, and elevation of the knee (“Sports

Injury”). The injury cannot heal on its own which is why surgery must be done in order for the

person to get back to full form (Redmond, 106-108).

There are many different stretching and balancing techniques that can help prevent the

ACL tear. Also, removing turf from soccer and football fields and implementing natural grass

will help reduce the amount of ACL tears that occur annually. A follow through on these two

ideas will help prevent people from going through grueling rehab, a potential surgery, and a year

long wait on the sidelines before a full recovery. This is a serious injury that needs to be

prevented. Taking steps forward to stop this epidemic would be a impactful deal in the sports

world and the lives of many people.

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Works Cited

“Anterior Cruciate Ligament (ACL) Reconstruction.” ​Mark Adickes, MD, Mark Adickes, MD
Orthopaedic Surgeon Sports Medicine Knee Surgery Houston TX, ​www.aclreconstruction
houston.com/anterior-cruciate-ligament-acl-reconstruction/. Accessed 6 Nov. 2017.

"Artificial Bone." ​World of Invention​, Gale, 2006. ​Science in Context​, link.galegroup.com/apps/

doc/CV1647500047/SCIC?u=elli85889&xid=3e101b08. Accessed 23 Oct. 2017.

"Conmed Buys Exoshape ACL Product Line from Med Shape." ​Business Journal (Central New
York)​, vol. 31, no. 28, 17 July 2017, p. 9. EBSCO​host​, search.ebscohost.com/login.aspx?
direct=true&db=f5h&AN=124240713&site=ehost-live. Accessed 2, Jan. 2018.

Cutts, Joe. “A Safer World for ACLs?” ​Ski Magazine​, vol. 79, no. 4, Dec 2014, pp. 55-58. http://
web.a.ebscohost.com/ehost/detail/detail?vid=0&sid=68bc10d7-496c-4608-9c15-b17d4a1
b75c5%40sessionmgr4007&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d%3d#AN=995772
82&db=f5h. Accessed 4 Dec. 2017.

Davidson, Tish. "Sprains and Strains." ​The Gale Encyclopedia of Medicine​, edited by Jacqueline
L. Longe, 5th ed., Gale, 2015. ​Science in Context​, link.galegroup.com/apps/doc/LHFICE
123651383/SCIC?u=elli85889&xid=94848d38. Accessed 16 Oct. 2017.

“Football Knee Injuries Likelier on Turf Than Grass.”​ Reuters Health Medical News​, 1 May
2012. ​Science in Context​,link.galegroup.com/apps/doc/A288187577/SCIC?u=elli85889&
xid=7ac981e2. Accessed 6 Oct. 2017.

Karageanes, Steven J. “Avoiding ACL Injuries .” ​American Cheerleader​, vol. 10, no. 3, June
2004, pp. 117–119. web.a.ebscohost.com/ehost/detail/detail?vid=0&sid=becbde19-a35e-
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N=12871052&db=f5h. Accessed 27, Nov. 2017.

“Knee.” ​The Centers for Advanced Orthopaedics.​, 2017. ​Potomac Valley Orthopaedic
Associates​, www.pvoac.com/specialized-care/knee. Accessed 6 Nov. 2017.

Lerner, K. Lee and Lerner, Brenda W. "Lower Leg Injuries." ​World of Sports Science​, Gale,
2007. ​Science in Context​, link.galegroup.com/apps/doc/CV2644830276/SCIC?u=elli85
889&xid=a71f61a6. Accessed 30 Oct. 2017.

Lerner, K. Lee and Lerner, Brenda W. "Thigh and Upper Leg Injuries." ​World of Sports Science​,
Gale, 2007. ​Science in Context​, link.galegroup.com/apps/doc/CV2644830459/SCIC?u=
elli85889&xid=4743cd68. Accessed 30 Oct. 2017.
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Lloyd, Janice. "ACL Tear is no Longer a Big Game-Stopper." ​USA Today​, 8 Apr. 2009, p.
06D. ​Science in Context​, link.galegroup.com/apps/doc/A197458139/SCIC?u=elli8588
9&xid=fb40d1b2. Accessed 16 Oct. 2017.

N.A. "Information Please." ​USA Today​, 2003. n.d.EBSCO​host​,search.ebscohost.com/login.aspx?

direct=true&db=f5h&AN=J0E118831932003&site=ehost-live. Accessed 2, Jan. 2018.

"No Weak Knees." ​Prevention​, vol. 48, no. 8, Aug. 1996, p. 30. EBSCO​host​, search.ebscohost.
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Orr, Tamra B. "Needing Your Knees." ​Current Health 1​, vol. 25, no. 3, Nov. 2001, p. 28. EBSC
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-live. Accessed 9 Jan. 2018.

Poster, Carol. "Knee-Deep in Trouble. (Cover Story)." ​Backpacker​, vol. 21, no. 9, Dec. 1993, p.
31. EBSCO​host​, search.ebscohost.com/login.aspx?direct=true&db=sch&AN=94022359
63&site=scirc-live. Accessed 9 Jan. 2018.

Redmond, Jennifer Hogan. “ACL and MCL Tears and Repairs.” ​Cincinnati Magazine​, vol. 49,
no. 7, Apr. 2016, pp. 106–108. HealthWatch Orthopaedics, http://web.b.ebscohost.com
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sionmgr101. Accessed 27, Nov. 2017.

Rouch, Philippe "Influence of playing surface on ACL injuries for non-contact sports." ​Sports
TURF​, Feb. 2017, p. 36+. ​Student Resources in Context​, go.galegroup .com/ps/i.do?p
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“Sports Injury.” ​Gale Student Resources in Context​, Gale, 2016.​ Student Resources in Context​,
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Accessed 26 Sept. 2017.
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