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The Fabled “Pop” – Can We Prevent More ACL Injuries?

by Jeff on March 3, 2009

ACL knee surgery

The story is always pretty much the same. “I was skiing. I fell. It didn’t seem that bad at all – but then I heard the popping sound everyone always talks about.” That dreaded “pop” may as well be your season being pricked and deflated by an orthopedic drill. You, my friend, have likely just blown out your anterior cruciate ligament, or ACL.

X-Ray of a torn ACLIf there is one dreaded injury in skiing, it’s the fabled ACL rupture. The ACL is a large, strong ligament that runs through the very middle of the knee joint. It’s the main connection between the femur and the tibia, so it’s easy to see how a complete tear can leave the knee about as strong as a house of cards. Without the ACL, the bottom half of the leg is essentially a bag of bones connected to the rest of your body only by skin. Not a pleasant thought.

The pain is intense for only a short time immediately after the accident, but the recovery can be a long and painful road of surgeries, physical therapy, and hits to the wallet – at least if you ever want to be able to ski again. But therein lies the good news… less than a decade ago, ACL repairs were in their infancy, and positive results meant no permanent disability or weakness. Skiing again was simply out of the question for all but the most athletic of people.

But a lot has changed in the last decade – a variety of surgical techniques have appeared on the horizon, including arthroscopic repairs, replacement with durable materials second only to the real thing, and even grafts from cadavers and other muscle on the patient’s body. All of these advances have led to an extremely high success rate, and for most people, an eventual return to skiing.

Map of the human ACLBut surgical techniques and recoveries aside, shouldn’t we be asking if anything can be done to prevent the injury before it occurs? Hard shell high boots have virtually eliminated ankle injuries, and since the advent of the modern releasable binding in the 1970s, lower leg fractures have been dramatically reduced. But as technology has evolved, the stress of a hard fall has been translated straight up the leg. The next weak link in the chain is the ACL, as 20,000 skiers find out each year.

This isn’t an issue that has gone unnoticed in the marketplace. Just in the past couple of years, the number of body armor (and specifically, preventative knee braces) on display at industry trade shows has exploded. I, personally, am a fan of the Asterisk Cell – it’s tough, lightweight, and protects against the kind of twisting injuries that cause ACL ruptures. Another new advent in the past couple of years is the KneeBinding, which features a releasable heel that protects against the majority of ACL related injuries.

But the real question is, will these pieces of equipment find their way into the mainstream as helmets have in the past few years? I, for one, am not willing to roll the dice every time I head out. I have heard that story about the popping sound a few too many times. What do you think? Let us hear your responses below.

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