Returning to sports after a knee ligament injury

Anterior Cruciate Ligament (ACL) is one of the four major ligaments in the knee, allowing sports people to perform start-stop movement, pivoting, jumping, and sudden changes in direction. Soccer, netball, tennis, dancing and skiing are sports that exact a heavy toll on this precious ligament - and often result in injury.

Dr Michael Soon, orthopaedic surgeon at Mount Elizabeth Hospital and Parkway East Hospital, navigates the twists and turns of this orthopaedic condition with us.

Case Study: Active Miss Xavier
Miss Xavier was an active young woman who injured her knee during a session of beach volleyball. She had noted instability and swelling of her knee joint when taking part in other sporting activities thereafter. When she found that her ACL was torn, she became visibly upset.

If the ACL remains torn and the knee is unstable, it can lead to further injuries to the knee. Upon a magnetic resonance imaging (MRI) scan, Dr Soon found that not only was Miss Xavier's ACL torn, but an associated meniscal tear had occurred as well. Meniscus is the shock absorber for the knee joint, and it would be impossible for her to return to her beloved beach volleyball without help. As such, an ACL reconstruction surgery was warranted.

After an uneventful surgery, Miss Xavier was able to walk with minimal pain and a good range of motion by the second week. By the sixth week, her reconstructed ACL was 'rock-solid'. Dr Soon advised her to continue physiotherapy and return for review thereafter. Six months after, he asked if she had returned to beach volleyball. She said she had not, but had taken up salsa instead! Needless to say, she had recovered fully and was able to live an active life again.

Case Study: Mr Ahmad and Multiple Ligament Rupture
Another notable case that Dr Soon had handled involved Mr Ahmad. Mr Ahmad had multiple ligament ruptures, having torn three out of four major ligaments in the knee, including the ACL. As he was a Muslim, Mr Ahmad did not want to use donor ligaments for his surgery. Dr Soon had to reconstruct all his ligaments during the same operation using the patient's own knee tendons - making it one of the most complicated surgeries to perform.

As it turned out, Mr Ahmad achieved full range of motion after his knee surgery. He has since returned to sports, running 8 kilometres three times a week. Other patients whom Dr Soon has helped return to pre-injury level activity includes a player from FC Barcelona and Spain.

The silent evolution of ACL reconstruction surgery
Of all the knee surgeries, ACL reconstruction is actually the most common. For what is considered a 'standard' surgery, the ACL reconstruction has undergone much evolution in the last decade. Today, ACL reconstruction surgery is generally successful, with more than 95% of patients noting an improvement.

However, not all patients can return to pre-injury level of sports participation: Only two out of three are able to do so. Surgeons worldwide are constantly striving to improve the success statistics. Along with improving techniques, the implants to fix the reconstructed ligaments have also improved. Together with better physiotherapy protocols, there is hope that more patients will be able to return to pre-injury levels of sports and maintain a healthy lifestyle.

Publication of article by courtesy of Dr Michael Soon, an Orthopaedic Surgeon practising at both Mount Elizabeth Hospital and Parkway East Hospital.