Injury has hit England’s World Cup hopes yet again, after an MRI scan today confirmed that striker Michael Owen has sustained an Anterior Cruciate Ligament (ACL) injury to his right knee.
Owen twisted his knee in the first minute of the match against Sweden and was clearly distressed. He was replaced by Peter Crouch and stretchered to the physio room, where England team doctor Leif Sward examined the knee. The initial instability suggested ACL damage and this has been confirmed on the MRI scan.
A disappointed Owen, who will return to England for treatment, said, "Obviously it's a massive blow to suffer the injury and be out of the World Cup. As soon as it happened I knew I was in trouble. My main objective is now to get fit as quickly as possible for Newcastle United."
Owen’s ACL injury completes a nightmare 2006 for the striker. He had only recently returned to action after recovering from a foot fracture that had ruled him out of Premiership action for Newcastle United since last Christmas.
The Anterior Cruciate Ligament lies deep within the knee joint, connecting the thigh bone with the shin bone. Its function is to prevent excessive forward movement of the shin in relation to the thigh and also to prevent excessive rotation at the knee joint. It is usually damaged by a twisting force on a planted boot. Because of the amount of force that is required to damage the ACL it is not uncommon for other structures within the knee such as the meniscus (cartilage) or medial ligament to also be damaged.
ACL injuries lead to a feeling that the knee is unstable or giving way. This instability is no good for a top level football player, so reconstructive surgery will be essential for Michael Owen. The aim of reconstructive surgery of knee ligaments is to restore stability and normal joint motion. ACL injuries used to be career threatening, but medical advances mean that most ligament reconstruction surgery gives good results in the short term with most football players returning to action in around six months, although up to 25\% of reconstructed knees may suffer longer term instability that can cause damage to other structures in the knee and lead to longer term degeneration.
ACL surgery is delayed for two or three weeks, until the knee swelling has been resolved, otherwise there can be complications during the rehabilitation. Rehab time can be greatly reduced with the expert treatment provided by the England and Newcastle United physiotherapists. This consists of protecting the injured part from further damage by using a knee brace; rest from activity; ice and compression using a Knee Cryo/Cuff device and the administration of anti-inflammatory medication prescribed by a doctor.
The pre operation stage and first two weeks after surgery are considered to be the most important with regard to rehabilitation. The key to success is to prevent a bleed within the joint. Physiotherapists accomplish this with the use of a Knee Cryo/Cuff iced water device for compression and cold therapy. This limits knee swelling and allows the rehabilitation to be accelerated.
By preventing bleeding within the joint (a haemarthrosis) the patient has an easier time of obtaining full range of motion and has less pain. Depending on the opinion of the surgeon, obtaining full hyperextension (straightening) equal to the opposite normal knee is accomplished as early as possible (Day 1 after surgery) and is monitored and maintained throughout the rehabilitation process.
Some surgeons insist on the use of a Continuous Passive Motion (CPM) machine and bed rest during the first 5 days after surgery. This machine bends the knee and straightens it continually during the early stages. This helps to disperse fluid from the knee and prevents stiffness.
Following an accelerated rehabilitation protocol, flexion (knee bending) to about 100° can be accomplished by 1 week after surgery and flexion should be around 135° (full) by 1 month after surgery. Aggressive leg strengthening exercises can begin once full range of motion has been achieved. This strengthening is continued in the gym from one month after surgery and three months after surgery.
The other aim of physiotherapy during this period is to regain proprioception in the operated knee. Knee ligament injuries and surgical procedures can cause damage to nerve endings which convey signals to the brain to allow us to subconsciously calculate body position in a process known as proprioception. Enhanced proprioception helps to make the knee joint feel stable and is an essential component of knee injury rehabilitation. Intensive proprioception training under the supervision of a physiotherapist is essential prior to a return to functional football training.
Running and football related exercises can normally begin around three months following surgery and are gradually progressed up until the four month period. This is followed by a period of intense physical training and the player will normally return to match play after five or six months.