As Mother Nature blankets the mountains with the cold white stuff, hundreds of thousands of ski enthusiasts head out to the slopes. For most skiers, a day of fun on the slopes is followed by a relaxing evening by the fire or a night about town. Unfortunately, injury cuts the day short for some and ruins the evening and ski year entirely for others. One of the most common injuries is the torn anterior cruciate ligament(ACL).
Ligaments are strong connective tissues that help connect bones at the joints. The ACL is one of four ligaments that provide stability at the knee joint. It extends from the top of the lower leg bone (tibia) to the bottom of the thigh bone (femur).
ACL can be damaged in any physical activity but it is a common injury among skiers. Here are some of the actions associated with ACL damage:
Now you know more about how your knee can be injured. How do you know for sure if you have suffered a torn ACL?
Damage in the ACL can range from a minor tear to a full rupture. Symptoms will vary by the degree of injury to the ACL, but may include:
These symptoms are usually good indicators of an ACL injury but doctors will usually x-ray the knee to rule out a fracture to the bone. The doctor will also examine your knee to see if there is instability. If a definitive diagnosis is still unclear, an MRI scan may be ordered. This scan can provide detailed pictures of the interior of the knee. In other cases, an arthroscopic exam of the knee may be performed. The doctor will insert tiny cameras into your knee. The cameras will show any damage inside the knee joint.
If you do suffer a torn ACL, your treatment will depend on your age, activity requirements, and the extent of your injury. Here are the most common treatments:
Most of these remedies can be done at home:
If these methods do not work for you, or you are more active, other treatments may be used to help repair your knee and get you back on your feet.
Surgical treatment involves repairing and rebuilding the ligament. In the past, this surgery required opening the knee to reconstruct the ACL. It was performed with success, but the rehabilitation process was slow. Today, doctors most often perform surgery arthroscopically utilizing small incisions. It can lead to a faster recovery. Here is what to expect during surgery:
This procedure is very effective because it uses your own tissue and allows the knee to retain its normal range of motion. The knee can heal back to its original degree of strength with a low risk of infection or graft rupture. The reconstruction usually lasts a lifetime, but repeat tears can occur with sufficient stress.
This type of surgery may require an overnight stay at most, but in many cases, you can leave the hospital the same day.
Physical therapy programs will help to restrengthen the knee with both conservative and surgical treatments. These programs will help you:
An ACL brace is generally prescribed for use with any physical activity for some time after the surgery. It will help stabilize the knee while it continues to strengthen.
Treatment can be effective but considering the pain, inconvenience, surgery, and the lengthy recovery, your best bet is to prevent ACL injuries from happening in the first place. Some prevention tips below might help you avoid injury on the slopes.
The best way to do this is to strengthen the muscles surrounding the knee, specifically the hamstrings and quadriceps. The reason? These two sets of muscles are crucial in giving a skier the ability to regain balance and control (such as catching an edge during a snowplow). This will help you to prevent the twisting and hyperextension of the knee that can cause the ACL to tear. The hamstrings also control forward motion of the shin bone on the thigh bone, so strength in this muscle group is essential.
Strength training is one important way to help prevent injury. Here are some others:
Strengthening the leg muscles is particularly beneficial in the months prior to the start of ski season. Consider consulting a sports physician or trainer to try out other exercises and stretches designed to strengthen your knees and the rest of your body. These can improve your performance and lower your risk of injury.
American Association of Orthopaedic Surgeons
The American Orthopaedic Society for Sports Medicine
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Anterior Cruciate Ligament Injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what.php. Updated November 3, 2012. Accessed November 15, 2012.
Anterior Cruciate Ligament Injuries. Orthoinfo from American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00549. Updated March 2009. Accessed November 15, 2012.
Anterior Cruciate Ligament Injuries. Teens Health website. Available at: http://kidshealth.org/teen/sports_center/injuries/acl_injuries.html#Updated October 2012. Accessed November 15, 2012.
Anterior Cruciate Ligament Injuries: Treatment and Rehabilitation. Encyclopedia of Sports Medicine and Science website. Available at: http://www.sportsci.org/encyc/aclinj/aclinj.html. Accessed November 15, 2012.
Skiing Injuries. American College of Sports Medicine website. Available at: http://www.acsm.org/docs/current-comments/skiinginjuries.pdf. Accessed November 15, 2012
Smith, CM. Anterior Cruciate Ligament Injury. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 2010. Accessed November 11, 2010.
Last reviewed November 2012 by Brian P. Randall, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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