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The walking wounded: the road to recovery

by Shauna Zilversmit March 25, 2014
The walking wounded: the road to recovery

Concordia soccer player recounts her rehabilitation from ACL surgery

On a hot Sunday afternoon, the sun was shining down on the beautiful moss green turf at the Bois-de-Boulogne soccer complex. Sporting the white and green colours of the Laval Conquerants AAA soccer team, Amy Pietrangelo, myself, and our team were doing everything within our power to win. In the first 30 minutes of the first half, Pietrangelo received a tackle from a player on the other team.

As I watched the tackle and saw her go down I remember thinking that she won’t be getting up from that tackle. Yet to my surprise she did.

“I got up from it and continued to play, but my knee felt unstable,” she recalls.

As she played on she realized something wasn’t right and pulled herself off the field.

“I remember that the physiotherapist who was treating me kept on saying it wasn’t an ACL tear.”

Even though Pietrangelo was told she hadn’t torn anything, those comforting words were proven wrong when she got the results back from her MRI, confirming that she had indeed torn her ACL in her left knee.

The ACL, also known as the anterior cruciate ligament, is one of the four primary ligaments around the knee joint and is an important stabilizer of the knee. It’s a band of tissue that connects the femur to the tibia and prevents the tibia from moving out from beneath the femur. ACL tears among young female athletes are becoming very common today, especially in high caliber athletes, like Pietrangelo.

Once it is torn there is no possibility of it healing on its own, but there are many different treatment options available. Most experts recommend an operation, which is exactly what most athletes decide to do.

This type of severe injury generally occurs during high impact sports activities like soccer, basketball, gymnastics, and many others, and seems to be more common in young female athletes. Most female athletes end up tearing their ACL by a simple pivot, the cause of an excessive inward turning of the lower leg or by a hyperextension of the knee, when the knee is beyond its normal 10 degrees, forcing the lower leg excessively forward in relation to the upper leg. It is also possible to tear it by impact.

Immediately after an athlete tears their ACL, their knee may swell, feel unstable and become too painful to put weight on. Most athletes hear a ‘pop’ when it tears, which is a key signal that something is severely damaged. However, it is possible that none of these symptoms occur.

“I didn’t hear any pop and my knee only got a little swollen and felt unstable. When I got home I couldn’t lift my leg, but a week later I was walking on it. I didn’t think I had done any serious damage to my knee,” recounts Pietrangelo.

Researchers are investigating the reason this injury is more common in female athletes. One of the reasons being explored is hormonal difference.

“There has been some research that shows that due to our hormone levels during menstruation, our ligaments become looser.  The body goes through this process in order to prepare for childbirth,” says Michelle Beckles, a Dawson College athletic therapist.

Another possible reason is the anatomic difference between men and women. Women have a wider pelvis, a different Q-angle (the measurement of the knee angle), a different size of the ACL, and the size of the intercondylar notch (where the ACL crosses the knee joint).

Finally, women have different biomechanic movements in the knee area when it comes to pivoting, jumping, and landing.

“It is more common because of the way women’s bodies are formed. We have wider hips, which changes the biomechanics of the knees. These changes cause more stress on the knee in certain positions,” says Beckles.

There are three different possibilities for the ACL to be reconstructed: the hamstring tendon graft procedure, the patellar tendon graft procedure, and lastly the LARS procedure, which is a synthetically constructed ligament.

“The most common procedure that surgeons usually perform for reconstructing the ACL is from the hamstring tendon. This is also the one I would recommend because most athletes who have this surgery have less complications post-op and usually do not require another operation,” says Beckles.

It is extremely hard for athletes to get the news about such a severe injury. I tore my ACL a few years back and I remember the day I found out very clearly. After sitting in the waiting room at the Lakeshore General Hospital for an hour, it was finally my turn to talk with the surgeon.

As I crutched into the room with my mom walking next to me, I felt my heart pounding, fearing what he would tell me. As I sat on the black padded table in the middle of the room watching the doctor look at my file and review my MRI results, I was too nervous to say anything.

“I don’t have good news for you,” he said. “You tore your ACL.”

That was all it took for the tears to come pouring out of my eyes. Everything that came out of the doctor’s mouth after was a blur. I felt like my world had come crashing down; he had just confirmed my worst fear.

When Pietrangelo realized the severity of her injury, she began looking at her options.

“I started looking at every possible option available to me with my family. I knew we had to pick the right one for me at the time because I was in the middle of trying to make the U-17 Canadian national team.”

She ended up choosing to get the LARS procedure.

“Because I was trying to make the national team, I needed my recovery time to be as short as possible. I needed to get back on the field fast and going with this procedure cut my recovery time down tremendously. I didn’t just jump into it though, I sat down with different surgeons, doctors, physiotherapists, and did a lot of research before I made up my mind,” she said.

After discussing it with all the doctors and athletic therapists, it was decided that I would go with the hamstring tendon graft and deal with the long recovery. I chose this because it was the most recommended and because, LARS is extremely expensive and is guaranteed to tear again. I didn’t want to go through another operation.

The road to full recovery after an ACL operation is long and hard. It takes time and commitment on the athlete’s part if they ever want to get back to where they used to be in their sport. As an athlete who went through the rehab process, I can definitely say it is one of the longest processes that I’ve ever gone through. When you get the hamstring or the patellar tendon graft surgery, the recovery can be six to nine months. But, if you follow through and do as you’re told, recovery can be smoother and possibly even quicker. However, you don’t want to rush back either.

“We need to make sure that athletes regain complete mobility and strength in their muscles before easing back into their sport. If they rush they risk tearing it again,” says Andrew Roberts, an athletic therapist at Kinatex West Island.

There are also precautions that athletes can take to try to prevent this injury from happening. They can improve their training conditions, by doing strengthening and stability exercises; aerobic conditioning; jump training; as well as balance training; known to help decrease the risk of a female athlete tearing their ACL. Female athletes also need to strengthen their hamstring and quadricep muscles. Strengthening hip muscles can also decrease the risk of tearing the ACL, according to Beckles.

Furthermore, when the sport involves jumping, athletes need to be taught to use the right techniques and learn how to land safely because if the knee collapses inward upon landing it’s more likely for them to sustain an ACL injury.

If an athlete gets surgery and follows the proper directions, they will be able to get back out on the field quicker. When Pietrangelo got back on the soccer field she was overjoyed and extremely excited.

“It was the greatest feeling. That first touch of the ball came back so naturally, like I hadn’t been off for four months.”

Though this type of injury may seem career ending, the fact of the matter is, with today’s technology, the operation is simpler and effective and allows female and male athletes to get back to their sport and still perform at the level they were before the operation.

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