THE anterior cruciate ligament (ACL) rupture is the bane of skiers everywhere and we diagnose over 100 a season at Niseko Physio.
The ACL is the main stabilising ligament of the knee, wholly contained in the knee-joint capsule. It’s primary role is in twisting. If you don’t need to twist you don’t need an ACL.
As it is deep inside the capsule it does not receive blood supply, and blood supply = ability to heal,
so once you tear an ACL its career is pretty much over. Although many people have been diagnosed with a partially torn ACL by MRI, the smart money will tell you that tearing an ACL is like being pregnant, you’ve either done it or you haven’t; it’s either fully ruptured or it’s fine.
Once you’ve ‘done it’ you will need to decide whether to have an operation to replace it or to live your life without an ACL. Your age, future sporting goals, life situation, spare time for the operation and extensive rehab, and your level of instability will all influence your decision to have surgery and replace your ACL.
Of the 100 ACLs we see, about 95 are skiers, 4 are snowboarders and one lucky person who has slipped on Niseko’s famous icy footpaths! The snowboarders invariably have done theirs either by hitting a strong thin tree just below the knee or landing badly from a big jump, we almost never see snowboarders doing their ACLs from a normal stack. The best way to avoid one is to get your legs strong and agile before your ski holiday.
If you decide to go for an ACL replacement (generally known as a knee reconstruction), I’d advise finding a surgeon who specialises in knees, rather than a general orthopaedic surgeon who may only do a few ACLs a year. If you have the surgery done in Japan you’ll be incarcerated in the hospital for about three weeks. In other developed countries the operation is only day surgery. Wait about four weeks after the injury before the operation so the swelling reduces and strength improves. Many people get into bad habits of over-protecting their injured knee, so we always tell people that their ACL is as torn as it can be so try to keep using the knee where possible.
By Bevan Colless