Buckling knees blow the budget

Panthers have got the ball. Great intercept from Wallace. Oh no, Wallace has fallen. Wallace is clutching his knee. He is not getting up. This does not look good for Wallace.  

Like Peter Wallace, many of our sporting heroes have gone down to an anterior cruciate ligament injury (ACL). This injury plagued Peter Wallace’s career, eventually forcing his early retirement from football.

Alarmingly, Australia has the highest rate of ACL injuries in the world with approximately 10,000 reconstructive surgeries performed annually. The ACL is one of the primary ligaments in the knee, and although very small in size, injury to the ACL can have serious implications.

It is estimated that ACL reconstructive surgeries alone cost the Australian economy $142 million annually, with a further $280 million spent on the treatment of knee osteoarthritis. It’s clear that buckling knees are blowing out the Australian budget.   

Recovering from ACL injuries includes long periods of rehabilitation, with individuals facing 9-12 months away from sport after primary reconstruction surgery.

Injury to an ACL is also associated with significant financial costs to cover medical imaging, specialist fees, potential surgery, hospital fees and post-operative care. Although there is variance between medical providers, it is estimated that the combined cost of medical imaging and specialists can cost upwards of $4,500. In addition there is financial loss for time off work, hospital stay, crutches and physiotherapy after surgery.

ACL injuries also increase an individual’s risk of early osteoarthritis. Approximately 50-70% of cases will experience knee arthritis within 10-15 years after sustaining an ACL injury. Knee osteoarthritis limits an individual’s ability to perform daily activities and those that are symptomatic may require a knee replacement later in life.

New research has shown positive support for the Prevent injury and Enhance Performance (PEP) program, developed by The Santa Monica Sports Medicine Research Foundation. Through injury prevention, the PEP program offers Australia a new solution to our ACL epidemic, potentially saving financial heartache for individuals and the economy.   

What does the ACL do and how is it injured?

The ACL has an important role in the knee, providing stability by stopping the shin bone from sliding forward on the thigh bone. ACL injuries occur when the knee is straightened or twisted beyond its normal limits.

Without an intact ACL, people generally experience instability where the knee will buckle and give way. This often makes sport participation impossible, as the knee is unable to withstand pivoting, cutting and sidestepping movements.

Why does the ACL get injured?

It is estimated that 72% of ACL injuries occur during activities which require jumping and change of direction. In Australia, sports such as soccer (22%), netball (17%) and football (15%) are responsible for the majority of hospital admissions due to ACL injury.

There are many factors which can increase a person’s risk of experiencing an ACL injury. Some factors we can change, such as the strength of our muscles and the way we jump land and move. These are known as modifiable risk factors. Other factors which we have no control over are known as non-modifiable risk factors. These include hormones, skeletal structure, and ligament stretch.

Unfortunately, females are 3.5 times more likely to sustain an ACL injury compared to males. Discrepancies between sexes in the incidence of ACL injuries surface around the onset of puberty. During puberty, the modifiable risk factors of females become more pronounced, due to periods of rapid growth and changes in body composition.

The rate of ACL injuries among children is also on the rise. This is a major concern given the correlation of degenerative disease associated with ACL injury. It is believed that ACL injuries amongst children are rising as a result of children’s sport becoming more professional, reflective through intense training loads, longer sports seasons and higher levels of competition.  

How PEP can help Australians

The PEP program is an exercise program which aims to address modifiable risk factors of ACL injury and trains participants to avoid vulnerable positions and movements which place the knee at risk of injury. The PEP program takes about fifteen minutes to complete and should be performed in place of a regular warm up.

Recent research has shown positive support for the PEP program, showing a reduction in primary ACL injury by up to 70%. The PEP program is also beneficial in reducing the re-rupture rates for those that have already experienced an initial ACL reconstruction.

The results of this research have powerful implications in Australia, given the enormity of ACL injuries nationally. The PEP program is available online and does not require costly equipment. It is therefore an easy solution to protect Australians from this catastrophic injury.

It is estimated that a national program would prevent 3,764 ACL ruptures, 842 cases of osteoarthritis and 584 total knee replacements per 100,000 Australian individuals.

Why does Australia need PEP?

Australia is lagging behind in ACL prevention when compared to the rest of the world. Physiotherapists are working hard to expose patients to the PEP program in their clinics, but the program is yet to gain momentum in Australia.

Despite the efforts of physiotherapists in implementing the PEP program, more is needed to prevent the injury in the public. Given the enormity of ACL injuries in Australia, cooperation is needed between researchers, politicians, and sporting authorities to develop a structured injury-prevention program to address this widespread problem.  

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