Real California FC

What is ACL reconstruction?

The letters ACL are as common in soccer as GAA, MLS and NCAA are.

It seems every team has someone either tearing it, repairing it, or rehabilitating it. As you enter your teenage years, it's important to learn about what the ligaments in your knee are, how to strengthen them and what a teammate might be going through after surgery.

What is the ACL?

There are two cruciate ligaments in your knee, the posterior and anterior. The cruciate ligaments in your knee joints crisscross to give you stability on your feet. They connect your femur (thigh bone) to your fibula (shin bone). You may remember from ninth grade biology that a tendon is the end of a muscle that attaches a muscle to bone. There is a tendon at each end of a muscle. A ligament is a soft tissue structure that connects a bone to a bone. There are both ligaments and tendons in your knee. The ACL lies behind the patella (knee cap) in front of the PCL and runs diagonally from the femur to the fibula. When stretched, it's about 1-2 inches long, but at rest, it's about half the size.

What does it do?

The ACL is not the only ligament holding your knee together, but it's most important role is stabilizing the knee joint against sudden movements. As it applies to soccer, it keeps the knee in place when making side to side turns or stopping short after a sprint. Any quick movement to the knee can affect the ligaments and tendons in it.

How do I keep from tearing it?

Short of creating a force field around you that stops people from tackling you or never playing on astroturf, there are a few things you can do to strengthen your knee. The consensus in the medical community is that people who are more prone to tearing their ACL's have a difference in strength between the quadricep muscle (lies on top of the femur) and the hamstring (tendon running down the back of your leg). If the hamstring is weaker than the quad, there is a higher risk of tearing the ACL. There are many exercises you can do which can improve hamstring strength. This is particularly important for women who doctors are finding have a much greater risk of tearing the ACL. The American Academy of Orthopedic Surgery has some good guidelines for how to prevent ACL injuries in women.

Why does astroturf increase the risk of ACL tears?

Don't be mislead. You can hurt your ACL on grass or even by slipping on the kitchen floor. Yankees centerfield Mickey Mantle was taken out by stepping on a hidden sprinkler head in the outfield. Astroturf has been victimized in the past 20 years due to the fact that it can lead to injuries without any physical contact whatsoever. Quick sharp turns on an artificial surface can lead to your foot being caught in the turf. The resulting torque can twist or strain your knee. Remember artificial turf is often laid on top of concrete, not the most giving surface.

The worst thing about turf is that it has seams where players have gotten their foot caught in. That can do the damage. Turf is often laid out in large strips and then it is sewn together. Newer technologies in artificial surfaces are coming into vogue that are softer and more like grass. Chicago and Dallas both play on Fieldturf at their stadiums, and FIFA is finally approving artificial turf for use at international level.

How will I know I have snapped my ACL?

Oh, you will know. You might hear a popping noise when your ACL tears. Your knee gives out and soon begins to hurt and swell. It's highly recommended you ice your knee immediately to prevent the swelling and see a doctor as soon as possible to evaluate your condition.

OK, I snapped my ACL - now what?

If you are going to continue in competitive sports, you are going to want to have your ACL reconstructed. The ACL can be rehabilitated with strength and conditioning exercises, but if you are going to be active in any sport, you are going to want to have it reconstructed.

How do they reconstruct the ACL?

Your doctor replaces the damaged ACL with strong, healthy tissue taken from another area near your knee. A strip of tendon from under your kneecap (patellar tendon) or hamstring may be used. Your doctor threads the tissue through the inside of your knee joint and secures the ends to your thighbone and shinbone, usually with small steel screws. In a few cases when the ACL is torn cleanly from the bone, it can be repaired without using other tissue. Less active people may be treated non-surgically with a program of muscle strengthening.

How long am I out for?

Players in every major sport are constantly pushing the envelope to get back on the field faster these days, but the medical consensus though is nine months. You will begin rehabilitation two or three days after your surgery to increase your range of motion. Walking and strengthening the muscles around your knee can begin 7-10 after surgery. Even after you are given a clean bill of health, it is normal to wear a knee brace to further stabilize your knee for up to a year afterwards. The good news is that surgically repaired ACL's are often stronger than they were before surgery.

Which players on the National Team have torn their ACL's?

It's such a common injury these days that this is only a short list. Claudio Reyna, Chris Armas, Tab Ramos, Steve Cherundolo and Juergen Sommer have all done it. U.S. Women's National Team player Shannon MacMillan is currently trying to rehab her knee to be a part of the U.S. World Cup squad in September even though she hurt her ACL four months ago.