ACL reconstruction

New study finds high level of satisfaction and return to sports after ACL reconstruction

ACL reconstructionA report issued last month from New York’s Hospital for Special Surgery merely confirms what we all knew: that ACL reconstructive surgery has reached an optimum level of patient satisfaction. The study involved over 230 patients – all of whom are active athletes – who underwent ACL reconstructive surgery and the results were a resounding endorsement of the treatment, with 98% of patients claiming that they were ‘highly satisfied’ with the procedure and they would happily undergo it again if they needed to.

The study set out to investigate rates and predictors of return to play, evaluate patient satisfaction after ACL reconstruction surgery, and analyse the relationship between the ability to return to their chosen sport – basketball, football, lacrosse, skiing, American football and tennis – and overall patient satisfaction. The 232 patients involved were on average in their mid-twenties, and an attempt was made to create an even gender split, with 52% of the study group being male.

ACL reconstruction – it needn’t be hell

All study participants had a minimum two-year follow-up after surgery, and were invited to partake in a questionnaire that asked about return to play, sport performance, repeat injury, factors influencing ability or inability to resume a sport, and overall patient satisfaction. The results were fascinating: 201 of the participants surveyed claimed that they had returned to playing their chosen sport at a mean time of ten months and 89% of those claimed that they had returned to their previous level of competition.

Obviously, results varied from sport to sport. The tennis players recorded the highest level of success, with a 100% return to participation: meanwhile, the football and lacrosse players recorded the lowest levels of success. Among those who didn’t make it back to peak performance, the most common reasons appeared to be more psychological than physical: fears about re-injuring the knee or being unable to ‘trust’ the reconstructed knee were a constant factor.

How the ACL works

Located from the back of the femur and running diagonally through the centre of the knee to the front of the tibia, the anterior cruciate ligament is a crucial component in maintaining joint stability. Simply put, the ACL stops your knee from rotating too much and helps keep the shin in place. It can be torn over time by repetitive turning and changing direction: it can also be instantly damaged by any violent impact on the knee.

The symptoms of an ACL tear include mild to severe instability, painful swelling and a long layoff from playing and exercising. Surgery isn’t always a given: ACL tears tend to be treated on a case-by-case basis, and there’s a school of thought that claims that a period of highly structured rehabilitation can repair the damage without surgery. However, in the world of professional sport, those rules don’t necessarily apply: ACL reconstruction surgery (using a strip of the patella tendon as a replacement graft) can get an injured participant back to full fitness in less than six months, if all goes well.

As the study bears out, ACL reconstructive surgery has come on in leaps and bounds: far from being a career-ending situation, the procedure has become an enforced time-out for athletes that could even prolong their careers in the long run – and it seems that the next step is to educate and reassure certain athletes to put greater trust in the procedure.

meniscal tear

Running repairs: when to mend a meniscal tear and when not

meniscal tearThere’s been a fascinating debate in Orthopedics Today about the thorny problem of how to treat a meniscal tear, and the conversation – conducted by a five experts in the field – is something worth commentating on.

Before we get into it, a brief overview. The meniscus is a rubbery, crescent-shaped disc, and their job is to cushion the stress that your knees endure as you walk or run, and help steady the knee by balancing the weight you put on it. Each knee has two of them: one at the outer edge of the knee, and one at the inner edge.

A meniscal tear can be caused by many factors: it can happen when you twist or turn your knee, usually when the foot is planted while the knee is bent. It can happen when you lift a heavy item, or during the rigours or sports participation. Sometimes, amongst older people, it happens while you’re going about your day-to-day routine, as your menisci start to wear over time.

Meniscal tear: one ailment, many symptoms

The symptoms of a meniscus tear can vary depending on the severity of the ailment. A minor tear results in slight pain and swelling, which lasts for a couple of weeks. A moderate tear causes worse pain and swelling, along with knee stiffness and difficulty in bending, but the symptoms will go away and reoccur if the knee is left untreated. A severe tear can result in pieces of the meniscus getting caught in the joint space, leading to the knee locking and catching. Furthermore, the knee can give way without warning on occasion.

To sum up, then, it’s a particularly problematic ailment for a very important part of the knee. As the debate points out, however, making a diagnosis is tricky. Unless it’s a severe tear, the typical symptoms – locking, catching and giving way – aren’t happening. It’s also difficult to pin down what the patient actually did in order to cause the tear, especially when that patient is over 40, overweight, or both.

Meniscal tear: to treat or not to treat?

So why the debate over whether to treat the ailment or not? Because, according to the report; “there is no evidence to support that repairing (degenerative) medial meniscal root tears, knee degeneration will be postponed or stopped”. Past the age of 40, the tears in the menisci tend to be a failure of the cartilage – that is to say, a fragmentation of the cartilage due to repeated trauma. In the case of younger people, the tear is essentially healthy cartilage torn by a single trauma episode. These are more likely to be able to repaired, whereas the failed cartilage is only amenable to being trimmed back to healthy tissue.

It’s worth bearing in mind that meniscal root repairs are a relatively uncommon specific type of tear of the cartilage – the main damage in that area will more usually stem from a tear of the body of the meniscus.

As with any injury to the knee, surgery is not always the automatic option. Knee specialist Mr Jonathan Webb will always take into account the nature of your injury and your personal circumstances and expectations and then advise you on whether surgery is the best solution.

smoking and knee replacement

Quit it: new study finds quitting smoking cuts complications after knee replacement surgery

smoking and knee replacementIf you’re a smoker and were looking for a reason – yet another reason – to give up, here it is: according to a preliminary study conducted by the Department of Orthopaedic Surgery at the NYU Langone Medical Center, smokers who needed a hip or knee replacement fared better in surgical outcomes and experienced less adverse events – including hospital readmissions, surgical site infections and blood clots – if they enrolled in a smoking cessation programme beforehand.

Smoking and knee replacement: the nub of the matter

The study, which included over 500 smokers who had undergone total knee or hip replacement surgery, featured 100 smokers who had gone through a smoking-cessation programme which consisted of four counselling sessions over the phone and the option to receive nicotine replacement therapy if required. The key findings of the study include:

  • Smokers who had undergone the cessation programme prior to surgery had better surgical outcomes
  • The new non-smokers had lower rates of problems post-surgery
  • During total joint replacement surgery, the smokers were 50% more likely to develop complications during surgery
  • The people in the study who continued to smoke within a month of surgery were more than twice as likely to develop a deep surgical infection compared to those who didn’t smoke

The people behind the study are the first to admit the limitations of their study – chiefly, the absence of chemical testing to determine that the ‘non-smokers’ were actually tobacco-free and not just saying they’d given up – but a larger study of 900 people is already underway, and we’ll be following it with interest.

Weight is an issue, too

However, there are other lifestyle factors that need to be adopted by people, especially as they get older, if they want to give themselves the best possible chance of a successful outcome of a joint replacement surgical procedure. In fact, a study presented at the same time in the Journal of Bone and Joint Surgery recommended a procedure of bariatric surgery – either through gastric band surgery or partial stomach removal – for morbidly obese patients who suffered from end-stage osteoarthritis.

Using a computer model to analyse past data on obesity, bariatric surgery and total knee replacement procedures, the study compared the costs and results on morbidly obese people who underwent bariatric surgery before total knee replacement surgery, and those who didn’t. The results? The patients who went through bariatric surgery two years before total knee replacement were more likely to enjoy an improved quality of life post-surgery.

Obviously, this is a no-brainer of a conclusion for a number of reasons, but it adds weight to the theory that if you’re in need of joint replacement surgery, it makes sense to ensure that the rest of your body is in as good a shape as possible to give you a fighting chance of recovery from the procedure – and also delay the need for such surgery in the first place.

runners-knee-prevention

How to beat Runner’s Knee this marathon season

runners-knee-preventionFinally, winter is on the way out and thoughts are turning to the start of long-distance running season. With the London and Boston marathons taking place this month, it is also likely to be a brand-new season of Runner’s Knee.

Patellofemoral pain syndrome, to give it its proper name, is the most common injury amongst the running community – accounting for 16.5% of all running injuries. Essentially, it’s a dull pain that manifests itself behind or around the top of the kneecap and it can flare up whenever the sufferer squats, runs (particularly downhill), walks downstairs and even while sitting. The cause of the problem is the kneecap rubbing against the groove in the femur whenever you flex and extend the knee.

Not surprisingly, developing patellofemoral pain syndrome (PFPS) is one of the most effective ways of throwing a spanner into the works of your season’s training schedule, and has shortened – or ended – many a running career. If you’re female, you’re more likely to experience this particular complaint than men. It’s also possible to confuse it with patellar tendonitis, which is an entirely different complaint with its own specific treatment.

What causes Runner’s Knee?

The general assumption would be to automatically point towards the repeated pressure runners put on the knee, but the development of PFPS is often an indication of a problem occurring either above or below the knee joint.

Above the knee, core strength, ITB tightness and, in particular, glute strength, are all factors in the possible development of PFPS. In a systematic review, published in 2013 in the British Journal of Sports Medicine, growing evidence was found to support the link between gluteal muscle strength and patellofemoral pain syndrome and identified the need for further research into the effectiveness of gluteal strengthening in those affected.

Recent scientific research shows that people with poor quads and calf flexibility are also more likely to develop PFPS. The ailment can also be developed by people with a recent improvement in quad strength.

Often it’s the newly-converted members of the running community that are more likely to develop Runner’s Knee than their more experienced counterparts, who push themselves beyond their abilities or may be wearing poor or incorrectly fitted running shoes.

How to treat Runner’s Knee

In the short term, a period of RICE (rest, icing, compression and elevation) is recommended, along with a period of stretching involving lying on your side with your bad knee on top, bending the leg and them holding your ankle towards your behind, and holding it there for a period of 45 seconds with your knees together – an exercise you should perform for at least six times a day.

It goes without saying that while you’re experiencing pain in the knee area while you go about your day-to-day business, you shouldn’t think about running, but you should be looking at an exercise programme which can stretch and strengthen your quads and lower legs without adding to the problem.

Orthopaedic knee specialist Mr Jonathan Webb often recommends taking up pilates or yoga to improve strength above and below the knee joint. Many runners approach yoga with a great deal of skepticism, but its benefits for the dedicated runner are myriad, whether they are injured or not. Muscles and ligaments are gently stretched, circulation in the tissues is boosted and hip alignment is improved. In fact, strengthening the hips as opposed to focusing on the knees, can be very beneficial for those suffering from PFPS, according to a study published in the Journal of Athletic Training in 2015.

Researchers studied 199 people who’d been suffering symptoms of patellafemoral pain for at least four weeks, stemming from overuse rather than trauma. The subjects were divided into two groups, half that did knee and thigh exercises and half that focused on building up core and hip strength. Although the outcomes were similar, the hip group saw an earlier resolution in pain and greater strength gains, compared to those that followed purely knee rehab exercises.

When can I return to running?

PFPS is notorious for sticking around for weeks or even months, so don’t expect it to instantly go away just because you’ve started doing the right thing. The best-case scenario involves you detecting and isolating the problem as early as possible, taking a few days off to allow it to heal, and cautiously easing back into running – stopping the moment you feel the pain isn’t going away anytime soon.

Rarely does PFPS require surgery, but if symptoms persist you may require referral to an orthopaedic knee surgeon such as Mr Jonathan Webb. He will also be able to rule out other potential causes of the knee pain that may require surgical intervention.

knee-arthritis-in-women

Poor muscle strength linked to increased risk of knee osteoarthritis in women

knee-arthritis-in-womenA recent report from Arthritis Care & Research magazine has come up with an interesting conclusion on the subject of knee osteoarthritis: women with poor strength in their leg muscles are significantly more likely to develop arthritis of the knee, while men with equally poor leg strength aren’t at risk.

It’s not surprising that so many problems can occur with our knees – after all, they’re the largest and one of the most complicated joints in our body, needing to be strong enough to support our weight (and the stress we put upon them through running, lifting, and a welter of day-to-day activities) and flexible enough to allow us to move freely.

Knee osteoarthritis is a condition which damages the surfaces of the knee and causes a range of problems. The cartilage over the main surface of the knee joint and beneath the kneecap thins out and roughens, which causes the bone beneath the cartilage to thicken. Meanwhile, the tissues in the joint react to the changes by going into overdrive, and the bone at the edge of the joint starts to grow outwards and forms spurs. In extreme cases, the synovium – the tissue between the thigh and shin bones – can swell and produce extra fluid.

Bringing your joint to account

All these changes are nothing more than your knee reacting to the inflammatory process and attempting to repair the damage. Sometimes it works, which results in the condition being put right all by itself. Sometimes it doesn’t, which causes instability in the joint and a worsening condition over time. Symptoms of long-term knee osteoarthritis include prolonged pain and stiffness, crepitus (a crunching or creaking sensation in the joint) and swelling. In severe cases, the pain is so intense that sufferers have difficulty sleeping.

There are many factors that can bring on knee osteoarthritis: it can be brought on with age, weight gain, or overwork. You’re more likely to develop it if your parents have suffered from it, or if you’ve had other knee problems in the past, and – yes – if you’re female.

Why are women more prone to knee osteoarthritis?

According to the report, it appears to be an issue with the thighs. Due to their close proximity to the knee, they’re the main provider of stress to the joint – and while female weight gain targets the thighs, male weight gain is generally distributed in the stomach and chest areas, causing the thighs to take the strain and naturally gain more muscle, resulting in less knee stress.

There’s also a case to be made for extra knee stress being brought about by the wearing of heels, which put extra strain on the hips, toe joints and knees.

The solution? Losing weight obviously helps, as does the timely and sensible use of painkillers when needed, but if all non-surgical interventions fail to improve pain and mobility levels adequately, then a surgical solution in the form of knee replacement surgery may be your best option.

Artificial knee joint

The debate: partial v total knee replacement

Total Knee ReplacementThere’s been an argument raging amongst the medical community for a while now, and I’ve been following it with interest. It’s been a long-held view that a total knee replacement is better than a partial one – for reasons we’ll go into later – but recent high-profile developments may suggest that the tide is beginning to turn back to the partial side.

The case for total knee replacement

While total knee replacement – the replacement of both ends of the bones in the knee with metal and plastic – is most commonly used on older patients, who have usually already undergone less drastic (and ultimately less effective) treatment. It has been viewed for a long time as the cure-all procedure, as it theoretically eliminates any further problems in that area, especially when the client suffers from severe three-compartment (inside, outside and front-of-knee) arthritis.

It’s also a much easier procedure for the practitioner to perform: after all, taking the entire engine out is a lot less hassle than extracting a few valves and cogs. There has also been a greater reliability rate with the total knee replacement over the years, despite the longer recovery time.

The case for partial knee replacement

However, the tide may be turning towards the partial approach. Despite its undeniable success rate, there are many downsides to total knee replacement: the loss of feeling, the long and arduous recovery period, the fact that half of all patients experience pain in the knee area after a decade or so, and the sheer cost of the procedure. Consequently, as developments in knee repair technology are starting to catch up, the decision to go partial or full is starting to get trickier.

There have been huge advances in pain and bleeding control, risk management and physical therapy of late which suggest that partial knee replacement is making a comeback. The most newsworthy non-sporting knee surgery of the decade so far – George W Bush’s unicompartmental procedure on both knees in 2014 – allowed him to take up his cycling hobby again within a few months, something that would have been difficult at best with a total knee replacement. Once seen as a bit of a punt in the hope that further deterioration won’t happen and some feeling will remain – or the delaying of the inevitable for a few years – the partial procedure has developed a new lease of life.

Which knee replacement surgery is best for you?

The short answer, as always: it depends on many factors. If you’ve kept your weight down, are in good health and are still physically active, you stand more chance of a successful partial replacement. If you’re overweight and inactive, you may be pointed towards a full replacement. My job is to assess the requirements and expectations of the individual patient and recommend the best option for them.

Rugby Knee Injury

Six Nations puts spotlight on knee injuries – again

Rugby Knee InjuryLike every other rugby fan – and especially as an English Rugby fan – my heart went out to George Kruis when I heard of his knee ligament injury, which he suffered in training in the run-up to England’s first Six Nations game. Not only is he ruled out for the rest of the Six Nations, but it’s also pretty certain that his chances of making the British and Irish Lions squad is now slim to none.

It’s a shocking blow for the Saracens forward, who was really starting to establish himself as a major part of the England squad, but not an uncommon malady. As we’ve pointed out before, knee injuries account for the most number of missed days in the rugby world – and out of all the things that could go wrong with that part of the body, the most common injury occurs with the ligaments – the ailment that George has succumbed to.

So is the constant array of knee injuries that crop up during the season nothing more than an unavoidable part of a very physical contact sport, or are there preventative measures that can be taken? Well, let’s start by taking a look at other sports that closely resemble rugby and see what their statistics are…

It’s not just rugby union

We can argue all day – usually with Americans – about the ‘toughness’ of rugby compared to American football, but despite all the padding and protection, the most common injuries in gridiron also occur around the knee area, especially to the cartilage. And while NFL players are allowed to wear knee braces that are much sturdier than the ones allowed in rugby, the problems remain the same – enormous pressure on the knees, which are magnified by the extra weight carried by the players. Not to mention the problems caused by artificial turf.

When it comes to the other sports that come close to rugby – Gaelic football and Australian Rules football – there’s an interesting divergence. Both are vaguely similar, with their heavier reliance on kicking, but while the Irish sport has ACL injuries as its most common malady, Aussie Rules’ most regular injury involves hamstring strain. Pitch size might be the key factor here: the Australians cover much more ground, and there’s far more space to cover, meaning the grind-it-out methodology of rugby doesn’t apply – however brutal the tackles are.

Different league

Finally, we come to the obvious comparison: rugby league. You may be surprised to learn that knee issues aren’t even in the top three most common injuries: in reverse order, it’s dead legs, ankle damage and shoulder dislocations. Maybe it’s because of the six-tackle rule: maybe the faster pace and the higher impact of those limited tackles has something to do with it.

So, after taking all these facts on board, what does that tell us the spate of injuries to the knee in the Union code? It’s clear that an expanded pitch, a greater emphasis on kicking and the introduction of a limit on tackles would greatly reduce strain upon the knee – but then again, it wouldn’t be rugby union anymore, would it?

Preventing Skiing Knee Injury

Ski injury prevention: beware the 5 B’s

Skiing is often thought as a highly risky sporting activity – something about sliding down a mountain at great speed strapped to two boards – but in an evaluation of most dangerous sports, Forbes magazine found that skiing fell significantly behind a whole host of other pastimes. Furthermore, technological advances and the use of helmets has meant that ski injuries have declined in recent years.

However, even with this decline, the knee is still very prone to incurring trauma when skiing, accounting for a third of all ski injuries. The most common cause of these knee injuries is rotation and I have identified the five Bs to watch out for:

1. Bindings

The introduction of bindings – the device that connects the boot to the ski, which releases when certain force limits are exceeded, such as a spill or collision – was a huge development in on-piste safety which addressed the two main dangers of the era: ankle injuries and lower leg fractures. The ‘downside’ of that was an increase in the rise of anterior cruciate ligament injuries and the knee sprain becoming the most common injury in skiing.

So, what have bindings got to do with knee injuries? Well, a common occurrence is when someone is travelling too slowly for the bindings to release, and falls – resulting in the ski going one way and the body weight going the other, resulting in an unnatural rotation of the knee. This incident is usually prevalent amongst beginners, but more experienced skiers can come a cropper when they set their bindings too tight.

2. Bad snow

Snow quality is a huge factor in skiing injuries and for obvious reasons: if it’s too hard-packed or icy, it’s harder to grip the surface with your ski edges and can cause more severe injuries if you take a spill. On the other hand, if the snow becomes sticky and slushy, the danger of slow-turn injuries and failures in binding releases increase dramatically.

Make sure you keep tabs on the quality of the snow as the day wears on, and adjust your style accordingly – or call it a day if you’re not comfortable with it. Early season skiers usually encounter more hard and icy surfaces: late season skiers are usually forced to contend with slushier snow. Wherever you are, it makes sense to consult local knowledge and weather reports. Here’s a more detailed guide to the complexities of snow quality.

3. Bottom of the run

By this, I mean towards the end of the day, when too many skiers are more fatigued than they realise and start to lose concentration and consideration for others.

Obviously, unless you happen to live in the Alps, skiing is not a hobby one can pursue whenever you like, and the whole point of your holiday is to get on the slopes, but there’s a fine balance between getting the ski time you desire and giving your body the chance to recover for the next day. After a day on piste, you are strongly advised to partake in a ten-minute cool-down session (simply walking on the spot will suffice), followed by a routine of stretching exercises, such as lunges, calf raises, and groin and calf stretches.

4. Boredom

It can’t be stressed enough: not only is skiing an incredibly strenuous physical activity, it’s also a hugely taxing mental experience. Furthermore, the short and exciting bits are punctuated by queuing for ski-lifts, dealing with skiers of varying experiences and skill levels, and distractions such as low sunlight.

Simple solution to this: if you feel your concentration waning, remember the latter half of the words ‘skiing holiday’ and do something else that you’d normally do on a break. Which leads to the fifth ‘B’…

5. Boozing

Preventing Skiing Knee InjuryThere’s no getting around it – the temptation to push the boat out in a nearby chalet bar and get stuck into the Glühwein can be overwhelming, but there’s a price to pay when you overdo it. The dulling of reactions, loss of concentration and the removal of inhibitions can be a recipe for disaster when on skis and the French have recently introduced stiff penalties for those caught drunk skiing, claiming that one in five ski accidents in France are due to drinking.

Surgery is not always necessary after a knee injury – modern skis can allow the recreational skier to continue their favourite pastime. My rule of thumb is always whether the patient is willing and able to adapt their lifestyle to the reduced capability of their knee joint or if the knee needs to be adapted to suit their requirements.

New-treatment-for-meniscus-tears

Stem cell ‘bandage’ has been trialled in meniscus tears

New-treatment-for-meniscus-tearsA potentially interesting development has recently been announced in the treatment of one of the most common knee injuries. Utilising the still burgeoning technology of stem cell research, the practice of harvesting stem cells from patients’ bone marrow and using them to knit together tears in the meniscus area has been trialled at Liverpool and Bristol universities – with encouraging results.

The menisci are the C-shaped discs of tough, rubbery cartilage which act as shock absorbers around the knee. Each knee has two of them: one at the outer edge of the knee and one at the inner edge, and they undergo a lot of stress throughout the day as they balance and evenly distribute weight and force and provide stability across the knees.

When a tear of the meniscus occurs, it can therefore cause significant problems. It’s usually caused by twisting or turning quickly, often with the foot being planted while the knee is bent. As time goes on, the cartilage becomes less supple and pliable, increasing the risk of meniscus damage.

How will you know when you’ve suffered a meniscal tear?

One word: pain. And lots of swelling. In minor cases, the swelling will get worse over the first three days before receding, but flare up again whenever you flex your knee. There’ll be prolonged stiffness of the knee after a week or two, which will fade away. The meniscus has a limited blood supply, meaning the tear – no matter how minor – can be incapable of healing itself, and the pain can come and go for years if left untreated.

In more extreme cases, when the tear is large, a piece of the torn meniscus can lodge in the hinge mechanism of the knee. This can cause anything from irregular catching and popping in the knee to a prolonged locking of the knee, which will typically require surgery to correct.

How a meniscus tear is treated

Your knee specialist will want to know about your regular physical activities, any past injuries in the knee area and what you were doing when the pain began. This will be followed by a physical exam which will involve X-rays and/or MRIs and checks for tenderness, range of motion and stability in both knees.

Treatments for a meniscus tear can range from a simple course of RICE (rest, isolation, compression and elevation), icepack treatment and anti-inflammatory medications to surgical procedures to repair or remove part of the meniscus. Rehabilitation programmes usually concentrate on maintaining muscle strength in the quads, hamstrings, calves and hips.

Previously, the menisci were routinely removed when torn, but now we know how important their contribution is to a healthy knee, so the aim is to repair if possible. If the ‘stem cell bandage’ trial continues to produce such encouraging results, we could see a new and more effective alternative to surgery and reduce the chances of developing debilitating symptoms such as osteoarthritis in later life.

Ohio-State-University-study-into-brain-and-ACL-injuries

Beyond the body: new research looks at the full impact of an ACL injury

A recent study in the Journal of Orthopaedic & Sports Physical Therapy has claimed that to regain full function after an injury to the ACL, or anterior cruciate ligament, goes beyond the physical and actually requires ‘retraining’ the brain.

According to a controlled laboratory study by the Ohio State University Wexner Medical Center released in November 2016, it was determined that parts of the brain which controlled leg movements went into a lag during the recovery period during an ACL injury, particularly when extending and flexing the knee. In other words, instead of relying on movement and spatial awareness, recovering patients had started to over-rely upon their vision when they didn’t need to before. One researcher compared it to walking in the dark: moving with less speed and confidence, with a strong mistrust in their natural instincts.

While it’s only natural to have your confidence knocked after an injury, the idea that you can’t trust your natural instincts adds a huge mental knock to an equally debilitating physical setback, particularly to a sportsperson. So, what’s causing this – and how can it be avoided?

Where seeing is more important than believing

The study, involving 15 people who had undergone ACL surgery and 15 who hadn’t, put participants through repeated cycles of knee flexion and extension, and surmised that the half of the study group that had been through ACL surgery displayed increased activations in the contralateral motor cortex, lingual gyrus, and the ipsilateral secondary somatosensory area (in other words, the parts of the brain that dealt with processing visual stimuli), and diminished activation in the ipsilateral motor cortex and cerebellum – the part of the brain which regulates and coordinates muscular activity. In other words, they were placing more emphasis on what they saw over how they felt.

Could strobe glasses help?

Ohio-State-University-study-into-brain-and-ACL-injuriesOn the surface, there’s a simple explanation for this: when it comes to the human body, you tend not to miss something until it’s gone, or at least stopped working. In the case of ACL injury, there has been a long layoff period: the wait to get treated, the two weeks of zero movement after surgery, and a period of slow rehabilitation that can last up to six months. That’s a long time to be away from the use of a part of your body that you largely took for granted.

Factor in the statistic that sportspersons who have experienced an ACL injury are anywhere between 30 to 40 times more likely to suffer a second injury in that area compared to an equivalent athlete who hasn’t had one, and it’s clear that an element of doubt will be at the back of the mind of anyone who has undergone ACL surgery.

The scientists at Ohio State are trialling an interesting technique to remedy the overreliance on sight: strobe glasses. The idea is to visually distract clients whilst they work out, in an attempt to re-wire their brain back to its pre-injury state and forcing them to rely on instinct once more.