Helena Frye
An ACL tear is a serious injury that can occur in basketball players, especially when driving through the defense line to shoot the basketball. The injury requires surgery and months of rehabilitation, and while players can return to the sport, their performance may decline. ACL tears are one of the most common knee injuries, affecting between 100,000 to 250,000 people annually, and can be prevented through strength training and exercises that focus on improving flexibility, balance, and proper jumping and landing techniques.
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What You'll Learn
ACL tears are common in basketball
An ACL tear is an injury to the anterior cruciate ligament in the knee. The ACL is like a strap that connects the bones and prevents the knee from bending or rotating too much. The ACL is the most commonly injured knee ligament, with an estimated 100,000 to 200,000 tears occurring each year in the US.
Basketball players are particularly susceptible to ACL tears due to the nature of the sport. The sudden stopping, twisting, and changing of directions inherent in basketball can place a lot of strain on the knee, leading to a higher risk of ACL tears. In addition, basketball players who frequently drive through the defence line to shoot the ball are more likely to suffer ACL tears. The more a player drives to the basket, the higher the risk of a tear.
Research has found that NBA players with high career driving tendencies experienced ACL tears at a rate of 5.2%, compared to 3.8% for those with lower driving tendencies. This means that the playing style of weaving through defences to shoot the basket can increase the likelihood of an ACL tear.
Female athletes are especially vulnerable to ACL tears, with females being two to ten times more likely to suffer an ACL injury than males. The structure of the female knee joint, which generally has more looseness and range of motion, contributes to this increased risk. Additionally, women often have less muscle mass around the knee, leading to greater instability and a higher likelihood of a ligament tear.
To prevent ACL tears, athletes can perform injury prevention exercises that focus on improving strength, flexibility, balance, proprioception, and proper jumping and landing techniques. Some specific exercises include forward lunges, reverse lunges, and squats with explosive jumps. These exercises should be done routinely, ideally three times per week, to help reduce the chances of an ACL tear.
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Recovery and rehabilitation
Most people who experience a torn ACL make a full recovery and resume playing sports with no long-term consequences. The recovery time for a torn ACL is usually six to nine months, but competitive athletes may need a little longer than this to heal fully before they can return to their sport. It takes about 8 to 12 months for athletes to restore their full range of motion and remove all swelling and pain.
Rehabilitation after surgery is the best way to restore the knee's strength and flexibility. The ACL rehabilitation process typically focuses on two main goals: alleviating pain and restoring the knee's range of motion. You will have to work through some pain following surgery, and your physician will likely prescribe painkillers to help you manage the inflammation and swelling. In addition to standard pain relief treatments, you might also work with a sports medicine clinic to speed up healing and decrease pain in other ways, such as shockwave therapy, Platelet Rich Plasma (PRP) injections, or massage therapy. Your physician and physiotherapist may also suggest using a custom knee brace to help stabilise your knee during the rehabilitation process.
To reduce recovery time and lower the risk of re-injury, consult with a sports physician before starting your rehabilitation process. It is important not to rush your recovery. If you need to, you should be able to return to the field or court as soon as your knee has healed. Do not force yourself to use your knee if it is still hurt, and do not return to playing sports or working out before your provider says it is safe.
There are also exercises that can be done routinely, ideally three times per week, to help significantly reduce the chances of ACL tears. These include exercises that improve strength (especially quads, hamstrings, and core), flexibility, balance, proprioception, jumping and landing properly, and having good alignment to protect your knees.
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Surgery and return to play
Surgery is usually required to repair a torn ACL, especially if the patient is an athlete who intends to return to their sport. The standard surgical treatment for ACL tears is ACL reconstruction, which involves replacing the torn ACL with a graft, or a piece of tendon or tissue, from another area of the knee, such as the patient's shin and kneecap (patellar tendon autograft) or the inner side of the knee (hamstring tendon autograft). In some cases, the graft can come from a cadaver. The surgery is typically performed at least several weeks after the injury to allow time for the initial pain and inflammation to subside.
The surgery itself is usually an outpatient procedure, meaning the patient can go home the same day. It is performed using minimally invasive arthroscopic techniques, which involve small incisions and, in some cases, fibre optics and small instruments. The goal of the surgery is to give the patient a fully functional and stable knee, reducing the risk of future meniscus and cartilage injuries. The success rate following ACL surgeries is typically between 85-90%.
After ACL reconstruction surgery, patients typically experience a recovery period of six to nine months before they can return to their sport. During the initial phase of recovery, patients will be on crutches and in a removable knee brace for seven to ten days. They will also begin seeing a physical therapist to discuss rehabilitation goals, which include reducing pain and inflammation, increasing range of motion, strengthening surrounding muscles, and beginning weight-bearing exercises. Isometric exercises are commonly performed during this phase.
As rehabilitation progresses, patients will focus on more aggressive exercises that involve stress on the knee and increasing resistance. Jogging may be introduced after three months, with more intense activities such as running being possible after four months. After five months, light ball work may commence, and after six months, the reconstructed ACL is generally considered to be at full strength, with the patient able to return to activities involving cutting and twisting. However, it is important to note that competitive athletes may need longer than six months to fully heal before they are cleared to return to their sport.
The return-to-play guidelines after ACL reconstruction surgery vary depending on the individual's progress and specific sport. Some criteria that indicate readiness to return to sport include no pain or swelling in the knee, full range of motion, stability, normal knee function, and psychological readiness. Additionally, isokinetic hamstring and quadriceps strength should be symmetrical, and jumping and running movements should demonstrate symmetry in vertical and horizontal values. A formal return-to-sport test is recommended, especially for pediatric patients, to ensure that the individual has regained the necessary strength and agility to safely resume their sport.
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Prevention exercises
An ACL tear is a common injury, especially among athletes. The anterior cruciate ligament (ACL) is like a strap that connects your bones and prevents your knee from bending or rotating too much. A tear can be caused by anything that puts enough force on your knee to bend or twist it beyond its natural limit.
Basketball players are particularly vulnerable to ACL tears, especially when weaving through defences to shoot baskets. The more often a player drives the ball toward the basket to score, the higher the risk of an ACL tear.
To prevent ACL tears, athletes can perform specific exercises that focus on improving strength (especially quads, hamstrings and core), flexibility, balance, proprioception, jumping and landing properly, and having good alignment to protect the knees. These exercises should be done routinely, ideally three times a week, to help significantly reduce the chances of injury.
- Stand upright with your feet hip-width apart and your toes pointing forward. Raise your heels off the floor and squeeze your calves. Slowly lower your heels and return to the starting position. Repeat this process several times.
- Begin on your back with your knees bent, arms straight beside you, and feet flat on the ground. Engage your core, press your heels to lift your hips until your body forms a straight line from your knees to your shoulders. For a more challenging variation, try lifting one leg at a time. Hold this position for two seconds before slowly lowering your hips back down.
- Forward lunge: Take a big step forward with your right leg. Lower your body so that your right thigh is parallel to the floor and your right knee is positioned over your ankle. Your left knee should be bent at a 90-degree angle and pointing towards the floor, with your left heel lifted. Return to a standing position by pressing your right heel into the floor and bringing your left leg forward. Alternate legs.
- Reverse lunge: Similar to the forward lunge, but take a big step backward with your left leg. Lower your body so that your right thigh is parallel to the floor, with your right knee positioned over your ankle. Your left knee should be bent at a 90-degree angle, pointing towards the floor, and your left heel lifted. Press your right heel into the floor to return to a standing position, bringing your left leg forward. Alternate legs, stepping back with your right leg.
- Regular squat: Start with your feet hip-width apart. Engage your core and squat down, then jump up explosively.
- Plyometric and strengthening exercises: These exercises help athletes retrain their muscles to fire in sync. For example, the FIFA 11+ program is a free 20-minute warm-up routine that includes running, jumping, strength, and balance exercises, with a focus on practising landing skills.
- Cross-training: Incorporate a variety of exercises such as strength training, swimming, and cycling into your regimen to keep muscle groups balanced and strong, leading to better and safer performance.
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Symptoms and diagnosis
An ACL tear is an injury to the anterior cruciate ligament in the knee. The ACL is a band of tissue that connects the thigh bone to the shin bone and is crucial for knee stability. It prevents the knee from bending or rotating too much. When an athlete goes down with a suspected ACL tear, it usually means surgery and months of rehabilitation.
The symptoms of an ACL tear include difficulty walking or an increased risk of falls. Some people can walk with a torn ACL, but it is important not to force yourself to move or use your knee if it hurts. If you have difficulty walking, you can use a cane or walker.
If you suspect you have torn your ACL, you should visit a healthcare provider as soon as possible. They will likely recommend imaging tests such as a computed tomography (CT) scan or magnetic resonance imaging (MRI) to diagnose the injury and determine its severity. Treatment can vary depending on the grade of the tear and any other damage inside the knee.
It is important to follow the RICE method as soon as you notice any symptoms:
- Rest: Avoid the activity that caused the injury and any other activities that put stress on the knee.
- Ice: Apply ice packs wrapped in a thin towel to your knee for 15 minutes at a time, several times a day.
- Compression: Wrap your knee in an elastic bandage to help reduce swelling.
- Elevation: Prop your knee and leg up above the level of your heart as often as possible.
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Frequently asked questions
The ACL is the most commonly injured knee ligament, and ACL tears are very common among athletes. In basketball, ACL tears are especially prevalent in players who weave through the defence to shoot. It is estimated that there are 250,000 ACL tears annually, with between 100,000 to 200,000 occurring in the US each year.
An ACL tear can be extremely painful, and the injury can cause your knee to give out, feeling unstable and weak. The recovery time for a torn ACL is usually six to nine months, and surgery is often required. However, most people who tear their ACL make a full recovery and can resume sports with no long-term consequences.
To diminish the risk of ACL tears, there are several exercises you can do to improve strength, flexibility, balance, and proprioception. These include forward lunges, reverse lunges, squats, and exercises that target your calves and core.
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