In the first 2017 AFL final, Adelaide Crows player Brodie Smith suffered the dreaded ACL tear. In this two-article series we discuss the treatment of an ACL injury, where Brodie is in the process and what he can expect next.
On the 7 th of September, 2017, Brodie Smith attempted to change direction at full pace when laying a tackle of GWS midfielder Josh Kelly. This innocuous-looking incident resulted in every
sportsperson’s worst nightmare; a tear of the anterior cruciate ligament, or ACL. This is one of the most debilitating sports injuries, and a full recovery can take up to 12 months.
What is a ligament? What is an ACL?
A ligament is a fibrous tissue that holds bones together, and constrains movement in one direction. Think of ligaments as slightly elastic ropes that allow your joints to move in the directions they should move, while restricting potentially damaging motion. The ACL is one of two ligaments that restrict your knee from buckling forwards or backwards, as well as one of four ligaments that prevent the top half of your leg from twisting relative to the lower half. When Brodie attempted to change direction so suddenly while travelling so quickly, the stress on his ACL snapped it in two.
When an ACL is severed, the knee is no longer fully constrained from rotation (twisting) or anterior translation (buckling forwards). If an ACL injury isn’t treated the risks of knee injury are significantly increased. This can cause osteoarthritis and even require a full knee replacement.
What is the treatment?
Treatment depends on the severity of the injury. In the case of a partial tear, physical therapy and orthopaedic care may be enough. Treatment will rely on the natural healing tendencies of the
human body to repair the ligament, as well as exercises to strengthen the surrounding muscles.
Unfortunately, complete tears are far more common than partial tears, and complete tears require orthopaedic surgery to correct. This was the case with our unlucky Crow.
The first stage of ACL reconstruction surgery consists of taking a graft from a tendon. A tendon is very similar to a ligament – whereas a ligament connects two bones, and a tendon connects a bone to a muscle.
Tendons are very important in ACL reconstruction surgery. The most commonly used tendons are from the hamstring, or the patellar tendon. The prospective tendon can be taken from the patient’s body (an autograft) or taken from a donor (an allograft).
The surgery is arthroscopic, meaning that it’s conducted by inserting a camera through a small cut in the knee. This is most commonly known as “keyhole surgery”. The orthopaedic surgeon removes the damaged ligament, and the new tendon graft is inserted through the knee where the old tendon used to be. The minimally-invasive nature of the surgery means the process itself is quite brief, and the patient often leaves hospital the day after the surgery is conducted. Brodie’s operation took place on the weekend of the 10 th and was a success. Unfortunately, this is where his real battle begins: Rehabilitation.