Imagine you’re in the prime of your sporting career: young, kicking goals (literally and metaphorically) and enjoying life. Suddenly, your anterior cruciate ligament ruptures – and so does your career and sense of self.
The anterior cruciate ligament, or ACL, is the knee’s main stabilising ligament. It’s injured most commonly in sport, typically when landing or changing direction, and young, active people are especially prone. In Australia, contact sports and sports that involve pivots and turns wreak the most havoc. Football, netball, basketball and soccer account for 80 per cent of ACL injuries in this country.
La Trobe University researchers have also found that in the under 20 age group, one in three people who’ve had ACL reconstruction surgery will suffer a second injury within five years. That can have a devastating psychological effect on young people, who naturally expect to be active for much longer.
The psychology of sports injuries
At La Trobe, the team headed by Dr Kate Webster is at the forefront of research to reduce ACL injuries. They’re delivering benefits for individuals and sporting communities worldwide by tackling the psychological impact of ACL injury in young people.
When sportspeople sustain a major injury, a whole range of emotions rise to the surface. Among the younger brigade, frustration, fear and anxiety are common feelings associated with ACL injury. ‘Although these feelings can subside during rehabilitation,’ Dr Webster says, ‘we’ve found they emerge again as patients report a fear of sustaining the same injury.’
To determine the extent of the problem, Dr Webster’s team has developed a ‘Return to Sport after Injury’ scale. The scale helps the team understand the psychology surrounding ACL injury and the willingness of patients to return to sport, measuring emotional responses such as anxiety and also confidence. ‘In the literature of sports psychology,’ she says, ‘confidence typically refers to the ability to perform well, but with a serious knee injury, it could also relate to the confidence you have in your knee holding up in a sports environment. We cover both aspects.’
Working out the risk
The team also covers risk appraisal ‘because we’ve found that, post-surgery, patients with concerns delay their return to sport or fail to return’. This is important: if you suffer one ACL injury, you’re more likely to have another, compared with the incidence of injury in people with no prior ACL issues. Their research is based on detailed analysis of targeted cohorts, and the respected American Journal of Sports Medicine has accepted an article for publication based on a study the team conducted of a large group of athletes. The study analysed sportspeople who were under 20 when they had ACL surgery, and discovered 35 per cent went on to have a second injury within five years. That’s of great concern, given the link between recurring ACL injury and knee osteoarthritis. According to Dr Webster, some studies report that as much as 80 per cent of people with ACL injuries go on to develop this condition, a degenerative arthritis of the knee that affects people’s mobility as they age. ‘So seeing multiple ACL injuries in young patients is concerning.’
Why is the younger cohort in the firing line? Is their tender age a factor in increasing risk, with less-developed joints more susceptible to injury? It’s not quite that simple. ‘Age is probably a proxy for a whole lot of other factors, in particular, returning to a sport that puts the knee at risk,’ Dr Webster explains. ‘Our research shows that 88 per cent of younger patients return to high-pivoting impact sports, compared with 50 per cent of older patients. It’s a double-edged sword: you want to return to your sport, but returning to it puts you at risk.’
Adding to the complications is the technique for ACL reconstruction surgery. In Australia, the most common graft used is the hamstring tendon, but Dr Webster points to ‘evidence showing these grafts might not mature for 18 months to two years following surgery. So now we inform young patients just how much at risk they are and advise they might want to hold off on a quick return to sport.’
Research with a global impact
Dr Webster’s motives for working in this field are borne from a desire to improve the quality of life. ‘Any way we can prevent that injury happening in the first place, and to prevent it from happening, has major benefits for the welfare of individuals and also for society by reducing costs.’
That noble pursuit means her research is having a major impact. Dr Webster has presented part of the team’s research at ESSKA, the European Society for Sports Traumatology, Knee Surgery and Arthroscopy, and she’s presented at the Mayo Clinic in Minnesota, an integrated clinical practice, education and research institution that specialises in treating patients. ‘We’re finding there are a number of research groups around the world interested in the same questions,’ she says. ‘And they’re big questions to answer.’
When she undertook a three-month sabbatical overseas, she visited some of the main institutions conducting ACL research. ‘We kept on saying the same thing: that by combining our data, we’re actually going to be able to answer the big questions in ACL. That’s exciting for the future.’
It’s also exciting for sportspeople everywhere, who will be in a better position to continue to enjoy the game they love.
Watch this space.
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