How (Knee) Injuries Can Be Eradicated

As someone that has undergone multiple surgeries, spreading a better understanding of the biomechanics of injury will hopefully reduce injuries in the next generation and preserve the well-being of countless people.

Jean de Villiers was one of many rugby players that were forced to miss crucial games, & in his case, several World Cups due to injury; the deformation of tissues beyond their failure limits, which results in damage of anatomic structures or alteration in function.

There are actually three principal mechanisms of an impact injury:

1. Compression of the body and injury when the crush exceeds elastic tolerances.
2. High-speed impact with injury when violence exceeds the viscous tolerance.
3. Body acceleration when internal organ motion lags the skeleton with injury due to organ inertia.

The most common exercise-related injuries globally are:

• Sprains: injury to ligaments (the tissues that connect bones to one another)
• Muscle strains: injury to muscles or tendons (the tissues that connect bones to one another)
• Tendinitis: inflammation of a tendon (often due to overuse)
• ACL & meniscus tears of the knee: a rip in one of the ligaments that helps stabilise the knee or cartilage that cushions the knee joint
• Rotator cuff tears: rips in the group of muscles and their tendons that hold the arm in the shoulder socket

The pain of tearing my ACL in both legs on multiples occasions (both mentally and physically) has left me driven to try and find ways to prevent others having to go through this injury in the future; especially as the majority of ACP repairs that occur each year are done on young athletes, under the age of 25. The majority of ACL injuries occur when an athlete misses a landing from a jump, pivots quickly while changing direction, or decelerates abruptly. These movements may cause the ACL to stretch to the point of tearing.

Principle factors that contribute to ACL injuries:

1. Ground hardness
2. Grass type
3. Shoe/Boot type

Interestingly, most ACL injuries are non-contact. One of the major findings is that women are nearly three times more likely to have ACL injuries than men (female football players up to eight times more likely than their male counterparts). This is due to the differences in hormone levels on:

• ligament strength and stiffness,
• neuromuscular control,
• lower limb biomechanics,
• ligament strength,
• and fatigue.

Across the pond in the US, the injury is even more common - every year, approximately 400,000 people tear their ACLs in the United States.

Are there ways to reduce the likelihood of having this injury or even eradicating this all together?

PREVENTION

Injury prevention programmes in your training schedule for athletes who participate in start-and-stop sports are key to staying injury free.

Performing drills that require balance, power and agility are important. Here are some links to great sessions:

• Plyometric Exercises
• Strengthening Exercises
• Neuromuscular Training Programmes
• Warm Up & Agility Drills (Line-to-line jog, shuttle run, backwards running)
• Dedicated Stretching & Cool Downs (Calf, Quadriceps, Hamstring, Inner Thigh & Hip Flexor)

Teen athletes who have poor alignment should be tested for muscle weakness or imbalance. Strengthening programs should be designed to correct any weaknesses.

They should also be encouraged to take a break from sports during the year or perform some cross-training that emphasizes different movement patterns. For example, a teen who plays on the football team may benefit from cycling or swimming in the off-season. This will help prevent overuse injuries, which can also lead to ACL tears.

Now, all of these exercises and tactics will drastically help prevent ACL injuries but with the technological advancements of our time, it has lit a fire in me to find out if there are ways in the future that we could completely eradicate injuries whether that be through wearables, biological enhancements or surgical treatments.

ERADICATION

In this section, there will be an assessment of the current developments in science and tech to help with ACL and knee injuries as a whole.

1. Stem Cell Treatment

Surgeons have pioneered a new knee operation that could prevent the development of arthritis and extend sporting careers.

The procedure, which is being trialled at Southampton general hospital, involves coating damaged cartilage with stem cells, taken from a patient's own hip, and surgical glue.

Known as Abicus (autologous bone marrow implantation of cells University Hospital Southampton), the technique, if successful, will regenerate the remaining tissue and create a permanent "like-for-like" replacement for the first time.

Cartilage is a tough, flexible tissue that covers the surface of joints and enables bones to slide over one another while reducing friction and acting as a shock absorber.

(Israel Dagg had stem cell therapy to save his All Black Career and make the World Cup)

Currently, the most commonly used procedure to repair the injury – microfracture – involves trimming any remaining damaged tissue and drilling holes in the bone beneath the defect via keyhole surgery to promote bleeding and scar tissue to work as a substitute.

However, the technique has variable results, with studies in the US suggesting the procedure offers only a short-term benefit (the first 24 months after surgery), and does not lead to the formation of new cartilage.

Patients who undergo the Abicus operation have the cartilage cut and tidied and undergo microfracture, but their cartilage tissue is then coated with a substance made up of bone marrow cells, platelet gel and hyaluronic acid.

During the 30-minute procedure, the bone marrow sample is spun in a centrifuge in the operating theatre to give a concentrated amount of the patient's own stem cells.

These cells are then mixed with the gel and acid to create a "glue" substance which is placed over the cartilage defect and allowed to set.

2. Microsoft Kinect's Motion-Sensor Technology

Dr. Aaron Gray, a sports medicine doctor at the University of Missouri is looking at software for the platforms that they are able to go out to high schools and gyms and test young athletes and the way they jump and land, revolutionising the way they can detect their risk for knee injuries.

3. Wearable Technology

Often an injury will occur due to the fatigue of the body and a change to the normal bodily movement whilst playing a sport. Wearable technology can gauge and quantify the player fatigue that leads to bad biomechanics and injuries—a winger suddenly taking many more strides to achieve the same speed, for instance. It can measure the loads on knees and joints, forces that lead to the abduction and adduction that lead to ACL tears. It is essentially used as an early-alert system for soft-tissue injury risk.

4. Shoes/Boots

Athletic therapist Melanie Fiala says the wrong soccer cleat increases the tension on knees and ankles and can lead to damaged ligaments like the ACL. 

Study of the boots that the players of all ACL injuries were wearing in 2015

Choose safety over style and if you need any more advice on the structural makeup of your body that may lead to an injury such as this, please seek out help from an orthopaedic surgeon such as Dr Mark Drakos.

If anyone else has any information or insight into the ACL injury itself or knows of new technology emerging that could really help with this injury, please could you share in the comments :)