THE RISE OF THE ACL INJURY
Megan Dickinson | Senior Physiotherapist and Clinical Pilates Insturctor
Top Knee surgeons in Australia are seeing a rise in the numbers of ACL reconstructions in children under the age of 15, leading to a rise in knee replacements later in life. A recent publication in the MJA revealed the annual incidence had increased by 74% among people under the age of 25 with the highest being in the youngest group aged 5-14 years.
Professor Julian Feller one of Melbourne’s top orthopaedic surgeons outlines the possible reasons for such a high incidence in Australia may be down to one or more of the following…
- Type of sports we are playing
- Australian children are participating in sports that require a lot of stop/start, change of direction and pivoting movements such as AFL, netball, touch rugby & soccer. These movement patterns required for the demands of the sport put increased pressure on the structure of the knee and integrity of the ligaments.
- Sedentary children
- Children of 2018 are far more sedentary than the children of the 70’s and 80’s. The children of today are spending far more time in front of a screen than the likes of our parents who were forever outdoors mucking around climbing trees and jumping from self-made obstacles. Feller makes a valid point, that our playgrounds now days are almost constructed so that nothing can happen and parents are so worried about their kids getting hurt that they’ve stopped them from learning balance and landing skills that kids of earlier era’s thrived upon.
- Increasing weight
- The average weight of children has increased which has placed an added load on the knees. This combined with the way children’s sport has evolved over the years plays a large role in the overall incidence of ACL repairs.
- Intensity of sport
- The intensity of sport has increased, there’s far more pressure on winning, which has also lead to a higher training intensity. Children of today are not prepared for such intensity. Previously sport was just one component of an active day for the average child, now it’s a specific intense period on a far less active day.
So how can we slow down the stats….?
Although cultural factors may be hard to change, prevention is always better than a cure. Specific preventative training programs need to be included in our change of direction sports such as netball, football and basketball. Feller points out that Football Federation Victoria has set the example by designing a specific warm up program to improve strength, awareness and neuromuscular control of the core and lower limbs throughout the specific movements required for the sport. This type of program needs to be made part of a standard warm up undertaken 2-3 times a week to ensure the behaviour carries over into the sport without practice.
The other preventative tactic lies in the professionals of today identifying possible contributing risk factors and guiding a safe return to sport within adequate timeframes. Due to the requirements of elite sports, timeframes are always being pushed to the limits to return a player back to game play as soon as possible. Whereas Feller points out ACL graft ruptures can happen within 18months post-surgery, therefore we should be waiting a couple of years before returning to sport, but some may wonder if that’s counterproductive. A lot more research needs to be done on understanding WHEN IS SAFE and if that means a longer time then it’s something we need to accept.
To read various related articles you can access more online at the Medical journal of Australia where many of the top knee specialists have done further research on the topic.
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