The NBA postseason could not have begun any worse for the Chicago Bulls and New York Knicks on Saturday afternoon. Reigning NBA MVP, Derrick Rose, suffered a torn ACL while driving to the basket in the last 90 seconds of the first NBA postseason game with the Philadelphia 76ers, while Knicks’ rookie sensation, Iman Shumpert, tore his ACL when dribbling down the court and attempting a sudden change of direction, in the middle of the third quarter of their match up against the Miami Heat.
Unfortunately, within recent years, the increase in anterior cruciate ligament (ACL) tears has been more common, specifically in sports involving sudden changes of speed and direction, such as basketball and soccer. In fact, women are 6-8 times more likely to tear their ACL as compared to men, which has sparked the recent “injury prevention” push from many medical professionals. But, many questions as to the etiology and risk factors of such a devastatingly rising injury rate continue to present themselves.
Recent evidence shows that 70% of serious knee injuries involve the ACL, while 80% of these injuries occur without any contact from another player, which is the same mechanism of injury that Rose and Shumpert suffered on Saturday. Typically, non-contact ACL tears occur because of the excessive internal rotation of the knee as the foot is planted, such as what happens with sudden changes of direction or pivoting, decelerating when running, or landing from a jump. Contact ACL injuries also occur when the knee is violently hit from the side, also while the foot is planted, causing a valgus force, or twisting motion, to the knee.
There are other factors that compromise an athlete’s risk to suffering an ACL tear. Biomechanically, poor muscular control during dynamic activities such as landing from a jump with stiffer knees, or landing with knees collapsed inward, increases the risk for ACL tears. Similarly, a wide array of anatomic risk factors exists, such as larger Q angles, increased genu-valgum, increased genu-recurvatum, or hyper-pronated feet. Most recent literature suggests that poor trunk sway or trunk control during dynamic activities of cutting, pivoting, jumping or landing has a high correlation to ACL tears.
Needless to say, professional athletes put a lot of demand on their bodies, during their respective seasons. Specifically, the NBA placed a lot more stress on their players by shortening their season to 66 games in less than 125 days, leaving little time to practice, recover from minor aches or pains, and rehabilitate more serious conditions. Players, old and young, suffered injuries that either kept them out for a week or the remainder of the entire season, begging the questions: Did these injuries have anything to do with the shortened preseason preparation time and strength & conditioning camps that they typically attend? Did they try to squeeze too much basketball in too little time? Did the minor aches, minor pains and general fatigue suffered throughout the year set the players up for a serious injury later on in the season because of the lack of recovery time?
Although we cannot definitively answer these questions, we do know that these risk factors play a role in many injuries, specifically ACL tears. As medical professionals, we must do our part in ACL injury awareness through injury prevention programs, patient-specific training programs, and education seminars to all athletes. Ultimately, prevention of the problem will help reduce the ACL injury rate and keep athletes, like Derrick Rose and Iman Shumpert, in the game, and not on the sidelines.