The ACL

The anterior cruciate ligament commonly known as the ACL is the most important of the four ligaments that connect the bones of the knee. The ACL has two important functions: It provides stability to the knee and minimizes excessive stress to the knee joint. The ACL performs these functions by limiting excessive forward motion of the lower leg bone, and by restricting rotational movements of the knee.

About 80,000-100,000 ACL tears occur annually. They are most common in the following activities:

• Skiing
• Football
• Soccer
• Gymnastics
• Hockey
• Basketball
• Rugby
• Wrestling
• Lacrosse
• Volley Ball

Torn ACL's are usually considered “non contact” injuries. They often occur during:

• Planting and Cutting Moves
• Straight Leg Landing from Jumps
• Pivoting with Hyperextension

Women tend to be susceptible to ACL injury, due to a number of factors. Women have a wider “Q” or quadriceps angle. This means that the knee cap is more prone to sliding. Since women have less androgen, they are less apt to develop the large muscles responsible for protecting the knee. When landing from a jump, women are less apt to bend their knees. This increases the pressure on the knee joint. Some experts also believe that the joint laxity caused by estrogen can also make women more susceptible to ACL injury.

In addition to being female, anyone with a hamstring/ quadricep muscle imbalance may be prone to ACL injury. Lack of neuromuscular coordination, poor balance, insufficient proprioception and faulty technique and equipment may also be the culprits. Many sports medicine professionals also believe that some specific foot factors contribute to people’s susceptibility to ACL injuries. These may include excessive pronation, limited dorsi flexion and being flat-footed.

If you are a skier, The Vermont Ski Safety Association has outlined the key technical faults that make a skier more susceptible to injuring their ACL

• Attempting to get up while still moving after a fall.
• Attempting a recovery from an off-balance position.
• Attempting to sit down after losing control.
• Uphill arm back .
• Skier off-balance to the rear .
• Hips below the knees.
• Uphill ski unweighted.
• Weight on the inside edge of downhill ski tail. Upper body generally facing downhill ski.

Each sport has its own specific guidelines for injury prevention. For a safer game, educate yourself on these guidelines. ACL surgery is an expensive and painful procedure. Therefore, it behooves you to pay careful attention to all preventative measures.

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