Consultant Orthopaedic Knee Surgeon, Mr Alexander Dodds, explains what to do if you injure your ACL Skiing.
As the weather starts to get colder and the nights longer, here in the UK many will be looking forward to their winter skiing trip. Hardened skiers will be used to taking a tumble on the slope but what happens if you’re the unlucky one who sustains a more serious injury?
The knee is a complicated and delicate structure between the end of the femur (thigh bone) and tibia (shin bone), held together by an array of soft tissue ligaments which allow its complicated movements. Injury to the anterior cruciate ligament (ACL) is one of the most common ski injuries. It’s usually caused by the extra rotational force applied to the knee on impact, as the knee joint twists beyond its normal range of movement during a fall or simply by crossing skis. The role of the ACL is to act as a central stabiliser in the knee, preventing instability in both the front to back plane (antero-posterior) and also prevents the knee rotating around itself (called the ‘pivot’). Other structures such as the mensiscus (‘shock absorbers’) of the knee or other ligaments can be damaged at the same time and may contribute to the instability.
Patients who have torn their ACL maybe aware of a ‘popping’ sound, the knee will tend to swell up immediately after, and the knee may feel ‘wobbly’ to walk on. In this instance seek medical help locally, normally the will advise rest with crutches and a knee brace to decrease swelling, followed by early physiotherapy to maintain range of movement and maintain muscle strength. The torn ligament will not be seen on an Xray and an MRI is needed to aid diagnosis.
When the ACL is torn it often is torn from the femoral (thigh bone) insertion, and whilst some surgeons in the continent in skiing areas are attempting to repair (stitch the injured ACL back into place immediately after injury), results for this procedure are mixed and it is not generally advocated in the UK. Surgical reconstruction using tissues from elsewhere around the knee is now relatively common place following an ACL tear in the UK, and normally this involves taking a piece of tissue from around the knee, commonly some of the hamstring tendons or patella tendon at the front of the knee. Surgery will normally take 60 to 90 minutes and you can normally be fully weight bearing after but will be followed by an extensive period of physiotherapy led rehabilitation – which at least means you can get ready for the following years ski season!
Alexander Dodds is a specialist Knee and Hip Orthopaedic Surgeon. For more information go to www.alexanderdodds.co.uk