Anyone who saw Erin Phillips crash to the Adelaide Oval turf last weekend in the AFLW grand final knows it was a moment that will stay in the mind for a long time.
It was heart-wrenching. Both she and we knew straight away that it was likely an anterior cruciate ligament tear.
It felt a little closer to home for me than perhaps most others. Last September my 16-year-old daughter was just starting to shine in open representative netball, but on a Monday night at the Genea Netball Centre in Homebush Bay she changed direction and her ACL snapped. There was also no doubt for her. Her tears at the time weren’t because of the pain so much as they were because she knew what she was going to miss over the next 12 months. For a sporting dad it was hard to watch.
But they are not alone. We hear about ACL tears all the time. Erin Phillips, Alex Rance, Kim Green and Wade Graham are some of the higher profile sporting identities; however, the figures outside the best-known names are simply staggering.
Erin Phillips of the Adelaide Crows (Mark Brake/Getty Images)
New research recently finalised confirmed that there were almost 200,000 ACL reconstructions performed in the 15 years to June 2015. The worrying finding to come out of the numbers were that the annual incidence of reconstructions has increased by 43 per cent for the general population over the 15 years and by 74 per cent for people under 25 years of age. In other words, ACL tears are becoming more and more common.
In 2014-15 the peak incidence for males was for those in the 20 to 24-year-old bracket (283 per 100,000). For females peak incidence was in the 15 to 19-year-old bracket (164 per 100,000). The fastest growth was in the five to 14-year-old age group.
The reasons for this appear fairly straightforward. Despite females being anywhere between two and ten times more likely to rupture their ACL depending on the sport played, the higher male participation rates in AFL explain the higher rates in the male population. With the growth of the AFLW and more female participation, the incidence of ACL tears from AFL will grow. For females the concentration in the 15 to 19-year-old bracket probably represents declining sports participation after that age.
For the younger kids there are no clear-cut conclusions as to why injury rates are growing, but too much screen time followed by intense training and matches may be a factor. There is a lack of free play in today’s society.
A lot of work is being done to try and reverse the growth trend via prevention strategies. Research has shown that the risk of serious knee injury can be reduced by different exercises to increase strength, balance and agility. Sporting bodies are taking it seriously, with Netball Australia, for example, rolling out its extend play (KNEE) program. The same exercises are used in the final stages of ACL rehabilitation.
This education process across a number of sporting codes should reduce the occurrence of ACL tears across the whole spectrum of Australian sport. Erin Phillips and my daughter are currently in different sporting stratospheres but both will be back in their chosen sport soon enough. They will put trust in the rehab and hope like crazy that it doesn’t happen again.
Andrew Ross
Guest
Also the risk of knee osteoarthritis for the ACL sufferer is much higher. I fear a looming knee OA epidemic in older females is likely and will cost the health service a pretty penny. Primary prevention is a must and we should follow Sweden and New Zealand’s national programs!
Internal Fixation
Roar Rookie
Spot on Chris and GB. LARS was essentially recycling ideas that failed 20 years prior - albeit with new technology. Perhaps worth the risk at the end of a career but not a sustainable option for most athletes. There may be some long term data on LARS now - I’ll have to do some research as knee’s are not my sub speciality area.
Greenbeard
Roar Rookie
https://mobile.abc.net.au/news/2018-08-17/whatever-happened-to-lars-acl-the-miracle-cure-that-was-too-good/10129102 I'd have a read of the above article. Was all eventually found to be too risk laden. Malceski if I remember correctly took the risk (at least those that were known at the time) as he believed that Sydney were likely to push for a flag.
Christopher Vertullo
Guest
The enthusiastic promotion of the LARS artificial Ligament for ACL Reconstruction unfortunately resulted in more failure and secondary joint damage to the athletes who received it.
Omnitrader
Roar Rookie
I remember Nick Malceski from the swans doing his ACL twice, he went through the stem cell treatment and returned in the same year it occurred and still had his speed and agility. Why isn’t this method used more often in elite sports?
Internal Fixation
Roar Rookie
A good introduction to a problematic topic. A few things - Even only 10-15 years ago very few players ever regained their pre-ACL injury form (research done by Dr Matt Liptak). Now, modern surgery and probably more importantly, rehabilitating techniques allows the majority of professional athletes to play at the same level again. Contact injuries may be made more risky by the size, speed and weight of the modern day player but I think many of these are luck. Non-contact or minimal contact injuries are the big worry. They are definitely more common in women. There are anatomical factors such as a narrow notch where the ACL inserts on the femur that can not be changed. There are proprioceptive factors as well - some of these can be trained to reduce risk and these form the basis of netball and NCAA programs. I think fatigue and overtraining may also be a big factor. An interesting area even before the best reconstruction technique is discussed!