What is an ACL? It’s one of the most important ligaments in the body if you play any kind of sport – crucial for pivoting movement, for moving off to sprint and for landings. These are all key elements in sports like football, netball, rugby, basketball… the list can go on and on!
ACL stands for Anterior Cruciate Ligament, and it is situated within our knees, a short, thick, powerful ligament about the length of a little finger that’s attached to our thigh bone and our shin bone. When it tears or ruptures it is a devastating injury.
And devastating is not an exaggeration. Just over a year ago, I met a couple of orthopaedic surgeons called Nev Davies and Will Jackson. They were fed up. Fed up with operating on teenagers, girls and boys. Fed up with doing ACL knee reconstruction surgery on kids. With the help of numerous other medical colleagues who were also concerned about what they viewed as a “seismic” rise in teenage ACL injuries they crunched the figures and came back with an alarming stat.
Surgeon Nev Davies explains where the anterior cruciate ligament (ACL) is and why surgery is often needed
Compared to just over 20 years ago, for every ACL knee reconstruction operation the surgeons were doing, now they are doing 29 – 29 times more operations to repair an ACL! Davies, a consultant orthopaedic surgeon at the NHS Royal Berkshire Hospital in Reading, said: “Without doubt, every year we seem to be seeing more and more young people coming through with significant knee injuries and primarily ACL ruptures. The numbers are staggering and extremely worrying. For every one person who was having an ACL reconstruction in the late 1990s, there are now 29 children having those surgeries.”
And that is why Davies and Jackson are patrons of Power Up To Play as they try to raise awareness and play catch-up with other countries.
Davies isn’t the only medical professional alarmed by the rise he is seeing. Others have also noticed and at conferences and seminars they have met and discussed their concerns coming together to try and raise awareness.
Professor Stefan Kluzek, an associate in sports medicine at Nottingham University, splits his busy clinical and academic professional career between Oxford and Nottingham. He told Sky Sports: “We increased by 29-fold the number of operations. Devastating injuries that can cause complete change of the life trajectory and the early onset of arthritis.”
The figure of a 29-time increase in teenage ACL injuries is often difficult to comprehend unless you, a family member or friend has been affected. At Ryland Netball Club in Bromsgrove just to the south of Birmingham, ACL injury in teens wasn’t a huge shock. The club is thriving at junior and senior level, well run and takes the care of their members seriously yet many of their players had suffered an ACL injury.
Player and youth coach Caitlin Hillier explained she ruptured her ACL after an awkward landing. “My leg just went back and ‘pop’. Up until then I hadn’t really known much about what an ACL was, but since then I know and I’m trying to be more aware about what the body needs before playing sport, either training or playing. I think as a club we are becoming more aware, but lots of the girls (players) have had ACL injuries.”
Image: Kids training at Bedfont Sports Club in West London where coaches emphasise the importance of warm-ups and injury prevention
Footballers also suffer from ACL injuries, we’ve seen it recently within the women’s elite game with terrible ACL injuries suffered by Beth Mead and Leah Williamson, but ACL injuries aren’t limited to girls and women.
Lee Taylor is an U11s coach at Bedfont Sports Club in west London, he’s an ex-pro having played for Shrewsbury Town and been on the books of Fulham and Luton. Lee’s professional background is a godsend for the grassroots game, he’s so aware of preparing properly for either a training session or a match, but always wary of injury to any of his young players. The rise in ACL injuries among young sportsmen and women wasn’t what he was expecting.
“A little bit surprised because you hope that people look after themselves and actually prepare right to look after their bodies,” he said. “But then football is so popular now with people playing everywhere so I guess the game has never been as big as it is, but it’s not good is it, it’s quite frightening.”
So why is this happening? “People are committing to one or two sports at most it appears at the moment if they are going to play within their local community and they spend less time developing other skills which would be naturally developed when they are participating in multiple sports,” Kluzek explained. “They are also in front of screens a lot more away from (organised) sport so not moving around as other generations had been.”
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Davies added: “They are on screens, sedentary and suddenly they are in very organised, highly competitive sports environments. There is some evidence about sports specialisation, so if you have a child who is good at one sport they might be pushed down that route and only play that sport.
The second biggest reason is that there is a huge knowledge gap in the UK about the importance of injury prevention programmes and the importance of warming up kids. There is this myth in grassroots sport that kids don’t get injured, so they don’t need to warm up, just get on a pitch and off you go. It couldn’t be further from the truth.”
Before I tell you about an easy, simple solution that can reduce the risk of ACL injury, we need to explore further the specific nature of the risk of ACL injury to girls and young women.
As mentioned, ACL injury is quite topical at the moment. The Lionesses will head to the World Cup next month without their captain Williamson and Euro’s star Mead due to ACL ruptures.
Image: England captain Leah Williamson is among many elite athletes who have needed ACL surgery
Sky Sports has already revealed that elite female footballers are six times more likely to suffer an ACL injury than their male counterparts. While the data for the grassroots game isn’t there in data form yet, the medical professionals are in no doubt that girls and young women are at a greater risk of injury.
Dr Kate Jackson is a renowned sports and exercise medicine specialist. She’s worked within football, England Netball and within high performance Olympic sports.
“For 20 years we have known that there is an increased ACL injury rate in women and girls compared with men and boys. The anatomical side of things is what makes it more likely to rupture, the actual rupture is identical whether you’re male or female, it’s been overloaded.
“What other factors impact that ligament? The obvious one to mention first is there’s a menstrual cycle and that appears to have some impact on injury. There’s a fluctuation of hormones through the menstrual cycle, but it’s just not the full picture. It contributes, but we don’t yet understand.
“There’s (also) a nuanced gender issue there which needs more exploring. Is it about attitudes to girls being physically active around that age? Is it accessibility? Opportunity to stay physically active when they become teenagers, we don’t fully understand that yet. It would be correct to say there has been some gender bias, but I do think people are starting to really look at this and try to think how to counteract it and trying to counteract it.”
Image: Dr Kate Jackson explained why girls and women are more likely to have ACL injuries but says more research is needed to explain why
Speaking to Dr Jackson was enlightening. When she mentioned ‘attitudes’ she told me by that it included things like the state of a pitch, a playing surface, changing facilities and kit. But the biggest takeaway was that no-one is 100 per cent sure why female athletes, either grassroots or elite, are more susceptible to ACL injury.
As Dr Jackson says there are so many variables to consider, and the data to help back up the reasons isn’t yet available. What is needed is more research, more studies and more funding to help build a comprehensive picture of the situation that is affecting so many across a huge range of sports.