Type of paper: Thesis

Topic: Trauma, Sports, Education, Violence, Injury, Anterior, Occurrence, Medicine

Pages: 10

Words: 2750

Published: 2021/02/14

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A thesis submitted to the Department of Physical Education in partial fulfillment of the requirements for the degree of Bachelor of Science

ABSTRACT

At some particular point in an athlete’s career, injuries will strike. Knee injuries are the most frequent injuries in this sport, particularly contact sports. Among the knee injuries, Anterior Cruciate Ligament (ACL) injuries have become more common. In the past, ACL injuries were considered to be career ending. However, the advent of medical technology has gone a long way to ensuring these injuries are largely treatable. These injuries have a greater chance of occurrence in female than male athletes. Regardless of gender, treatment methods are the same, and it takes a long time to fully recover. Athletes who are yet to suffer these injuries can take various precautions to make themselves less susceptible to them.

Chapter 1: Introduction

Introduction
Passive and active joint restraints both have an impact on the dynamic stability of the knee. The Anterior Cruciate Ligament (ACL) is one of the major contributors to the stability of the knee joint. For a long time, the ACL has been considered the main passive restraint to the tibia’s anterior transmission with regard to the femur. Thanks to the very specific orientation of the ACL, it plays a major role in the rotational stability of the knee in both transverse and frontal planes. The ACL is among the most studied structure in the human muscular and skeletal system. The reason for this great interest in the ACL is its significance in sports studies. ACL injuries are among the most commonly suffered injuries among contact sport participants. In addition to being quite frequent, ACL injuries have devastating effects on sportsmen who suffer them. ACL injuries often cause effusion of joints, movement alteration, weakening of muscles, and reduction in performance. Among young athletes, the occurrence of ACL injuries often means that the sportsmen miss a whole season or more of participation. In fact, in the past an ACL injury was considered career ending, particularly in soccer. However, the advent of technology and new treatment methods has helped to reduce the severity of the injury.
A strong relationship between ACL injuries and long-term clinical effects such as meniscal tears and chondral lesions also exists. ACL injuries occur much more frequently among female than male athletes, with figures ranging anywhere between four to six times more. There are various theories that exist and which attempt to explain this difference. ACL injuries generally heal poorly, with a significant proportion of the remedial measures, especially suture surgery, ending in failure. This high failure rate for the injuries results in a preference for reconstruction of the ACL as a method of treatment for ACL injuries. ACL injuries are categorized into three classes or grades, from i to iii, and they usually occur during sections of the game that do not involve contact. Sportsmen who participate in games, which require a lot of physical effort such as soccer are more prone to these injuries. ACL injuries occur during both the contact and non-contact parts of the game. Sportsmen who suffer from ACL injuries are at a great risk of reoccurrence of this type of injury whereas some never even recover from the injury in the first place. There are various factors that precipitate the occurrence of this type of injury and certain preventative measures can be undertaken in order to reduce the chances of occurrence. The study of ACL injuries is important because of their frequency among sportsmen in contact sports and because of the ability. This study also picked ACL injuries since they are among the most serious injuries that a sportsman can obtain and thus it is necessary to identify ways of avoiding them. The study covers the description and definition of ACL injuries. It also investigates the occurrence of these injuries, showing how and why they occur. This study also looks at the preventative measures that may be instituted to reduce the occurrence of ACL injuries as well as their treatment, whether through surgery or rehabilitation.

Research Questions

What are ACL injuries and why do they occur?
How do ACL injuries occur?
What are the preventative measures that can be put in place to prevent ACL injuries?
How can ACL injuries be treated?
Rationale of the Study
ACL injuries are among the most serious and commonly occurring knee injuries because of participation in sporting activities. These injuries lead to loss of livelihood and absence from competition for sportsmen and women. Hence, it is important to study ACL injuries to understand their prevention. This study is also important since it establishes the best treatment measures for this type of injury.

Thesis statement

This is a study of the occurrence, prevention, and treatment of ACL injuries.
Chapter Two: Literature Review
A lot of research has been done in the recent past on the ACL. Thus, it is interesting to note that such a large body of information about it exists. As the increase in sports participation in both male and female sportspersons increases, so does the likelihood of ACL injuries. As sports continue to become increasingly demanding, there is an increased likelihood of the occurrence of injuries. In order for sportsmen to improve the odds of having a professional career in future, there is a tendency to focus on playing only one game. This in turn leads to increased hours spent on the training ground and thus to a likelihood of the occurrence of injuries. ACL injuries are among the most common of these injuries.
ACL injuries have been studied in depth with many authors attempting to postulate possible reasons for the increased occurrence of these injuries. The impact of ACL injuries has been studied, as well as the advances made regarding the treatment of these injuries. There has also been great interest shown in possible preventative measures that can be applied to reduce the occurrence of this severe injury.
Like with any injury, the recovery time for an injury is not taken well by the sportspersons. This time is only made worse by the fact that in some sports, an ACL injury is a potentially career-ending injury. At best, it leads to a season on the sidelines, which affects the sportsperson to a great deal. There is a need for a lot of physical strength as well as mental fortitude during the recovery from an injury of this magnitude. However, with the increased commonality of the ACL injuries, there is more research on these injuries. This has ensured that the treatment of these injuries is understood far much better and the procedure for recovery from these injuries is more efficient (Griffin et al., 2000).
The main purpose of the Anterior Cruciate Ligament is the prevention of anterior translation in the knee. The ligament also aims to prevent hyperextension as well as the resistance of the tibia’s internal rotation. The ligament also assists in the stabilization of both the varus and the valgus stresses. The ACL’s length varies in length, width, and thickness. In terms of length, the ligament ranges between 25to 35 millimeters, while its width spans 7 to 12 millimeters. It thickness on the other hand, ranges between 4 and 7 millimeters. The ACL is comprised of two bundles of fibers that begin at the posterolateral femoral condyle. These bundles then cross the notch of the center of the knee and come to an end at the anterior medial tibia.
Injury to the ACL mainly occurs in during involvement that involves no contact. However, when it does occur, it is mainly in contact sports. Examples of these sports are soccer, football, volleyball, as well as basketball. The relationship between these different sports and the occurrence of the injury relates to the activities that participants in each of these sports engage. In all these sports, there is often a lot of jumping involved. With this jumping, there is often a rapid directional change upon landing after the jump. Hence, an ACL rupture most often occurs when the athlete plants a foot with a knee in an extended or hyper-extended position (Spindler, 2008). For instance, an athlete may plant a foot for a pivot and then cut quickly. This would cause an increased knee rotation. The tibia would be rotated towards the inside of the body whereas the knee flexibility would be at an angle above 900 (Besier, Llyod, Ackland, & Cochrane, 2001)
On suspicion of an ACL injury, various factors must be considered in order to make sure that the ACL is actually ruptured. Upon the occurrence of an ACL injury, an individual typically hears a “pop” sound. This is then followed by a reduction in effusion and ability to extend the leg fully. In order for an evaluation on comparison, and also for an understanding of the effects of the injury on the individual, it is important to consider tenderness of the joint line, patellar instability, range of motion as well ambulation and alignment of the knee.
Prior to the use of any form of diagnostic testing, special tests may be performed on the ligament in order to assess it. These specific tests are the Lachman’s test, the pivot shift test, and the anterior drawer test. Other tests that are generally done with the examination include the valgus and varus stress test and the posterior drawer test. Diagnostic testing takes the form of a Magnetic Resonance Image (MRI) scan that shows the ruptured ACL, and may disclose any other damage to the knee.
ACL tears can generally be treated in one of two ways. These are either through surgery, or through rehabilitation, without surgery. In order for surgery to be a successful option, the person must be suffering from minimal effusion and have little pain. The person must also have close to full range of motion. When all these factors are present, there is an increased probability of success of the surgery. Various advancements have been made over the recent years, which have increased the effectiveness of surgery. An ACL reconstruction normally makes use of three types of grafts, a patellar tendon graft, a medial ligament graft, and a cadaver allograft. Where a person chooses not to undergo a surgery, a rehabilitation program can be just as effective. This choice is particularly beneficial for an individual who is still young in age and not fully developed.
Total prevention of ACL injuries is not possible. These injuries will always occur, thanks to the high demands faced by athletes in the present day. However, individuals can reduce the chances of occurrence of the injury. One way of doing this is through plyometric training, which boosts the muscle voluntary reaction time and reduces time necessary for muscles to produce the peak torque. Stability and balance training programs are also crucial in this regard. Game oriented training is another way of preventing primary ACL injuries since it involves drills where players practice making of rapid directional changes as opposed to preplanned cutting tasks.

Chapter Three: Methodology & Findings

This study was conducted in order to investigate Anterior Cruciate Ligament injuries among athletes. In order to gather the required data, the writer made use of a descriptive method, which integrated both quantitative methods. The research made use of secondary data with the application of relevant literatures order to justify the findings. The credibility of the findings a well as the conclusions, is reliant upon the quality of data collection, management and analysis and of the research design. This chapter describes the methods and procedures utilized to obtain the data, as well as the analysis and interpretation of the data and the subsequent conclusions.

Methodology

This research utilized the descriptive method of research, which aims at describing a condition and its nature and exploring the occurrence, as well as the causative agents of a certain condition. The descriptive research method aims to gather information about an existent condition. Since this study is about the Anterior Cruciate Ligament injuries and their occurrence, the descriptive method of research is the most appropriate.
This method utilized the secondary data obtained from all findings detailed in published literature and documents that relate to the problem. The research was conducted in the United States and it covered athletes participating in various contact sports such as soccer, volleyball, football and basketball. Regarding the approach, the study utilized the quantitative approach that concentrated on obtaining numerical information and this was dome over a three-month period.

Findings

ACL injuries are among the most severe and dreaded injuries by athletes all across various disciplines. ACL injuries in contact sports are commonplace and they have grave short and long-term effects on players’ careers. ACL injuries usually require surgical intervention, and hence they are invalidating and keep players out for a long period. Ligaments refer to tough bands, made up of fibrous tissue, whose role is to connect bones. The anterior and posterior ligaments maintain the knee’s rotary support. The terms anterior and posterior are used to describe their respective attachments to the tibia. The injury is called a “cruciate” injury since the two ligaments cross with one another through the intercondylar notch. The ACL is small yet it provides around 90% of the overall stability of the knee.

Occurrence of the injuries

ACL injuries are frequent, occurring about 250,000 times in the USA annually. Injuries to the ACL occur most commonly in sports that require athletes to perform activities such as jumping, deceleration, as well as changing directions. These sports include soccer, volleyball, and basketball. These injuries occur in both the contact and non-contact phases of pay. An ACL ruptures or tears when it stretches to a point beyond its normal elasticity. Non-contact ACL injuries occur when the foot touches the ground or during the performance of cutting or landing moves in these games. Women are more likely than men to suffer these injuries and this is attributed to the fact that women train for shorter periods than men and hence they have lower levels of fitness. Women are also more likely to lose control when jumping and hence land more awkwardly which results in injury.

Treatment of ACL injuries

In consideration of the treatment of ACL injuries, it is important to understand the diagnosis of these injuries. The primary physical test normally used for the diagnosis of an ACL injury is the Lachman test. This test is considered to be the most reliable test .The other physical test used is the pivot shift test which is also a reliable indicator of the injury. A third physical test that can be used is the anterior drawer test. Where the patient is in a lot of pain such that physical tests cannot be used, an MRI scan, which is between 70 and 100% accurate, can be used. ACL ruptures or tears can generally be treated in two ways. The first way of treating ACL injuries is through surgery whereas the other is through non-surgical means. One of the surgical means of treatment is primary repair and in this case, it involves suturing of the remaining tissue after the tear (Shelbourne, 1994). However, this method is rarely effective and it leads to a tear later on. The other type of surgery normally done is reconstructive surgery where a part of a tendon can be obtained either from the patient himself or from a cadaver. The reconstructive surgery mainly aims at the restoration of knee stability and motion (Shelbourne, 1994). For patients who do not favor surgery, such as very young or old patients, non-operative methods such as knee braces and rehabilitation of muscles are applicable.

Prevention of ACL injuries

Treatment of ACL injuries is very costly, with estimates giving a figure of $17,000 per patient. Thus, in order to mitigate against such costs, preventative methods are encouraged. Such methods include training for example neuromuscular training methods like pylometrics. This type of training focuses on landing after a jump, which is one of the most likely occurrence periods for an ACL injury.

Chapter Four: Summation

Application of the Study
The study of the Anterior Cruciate Ligament injuries is important since it helps us to understand one of the most serious injuries affecting athletes in the country. This understanding is beneficial to both players and coaches. For players, ACL injuries are very costly, both in terms of treatment, and income lost when off the pitch. An understanding of ACL injuries, and how they arise, enables the players to make changes in order to protect themselves. The other benefit may accrue to coaches, who lose continue to lose key players during vital periods to this injury. Coaches can apply the findings of the study about preventive measures to prepare training programs that will enable them to succeed.

Conclusion

In conclusion, it is evident that the prevalence of ACL injuries is rather high. The existent body of knowledge on these injuries has developed greatly. The increased medical research has contributed significantly to the treatment of these injuries. From being considered as career ending, these serious injuries are now treatable. This represents the great strides that continue to occur in the area of health and physical education.

Indications for further research

Whereas this study has looked at ACL injuries from a broad point of view, in both male and females, it is evident that differences exist in prevalence of these injuries in both genders. Hence, the reasons for the increased prevalence of these injuries in women over men represent an area for further research. Further prevention strategies can hence be developed to minimize the occurrence. This study also looks at the occurrence of ACL injuries in both contact and non-contact areas as a whole. Further research into the occurrence of these injuries in each individual area also represents an area for further research.

References

Besier, T. F., Llyod, D. G., Ackland, T. R., & Cochrane, J. L. (2001). Anticipatory effects on knee joint loading during running and cutting maneuvers. Medicine and Science in Sports and Exercise, 1176-1181.
Dorizas, J. A., & Stanitski , C. L. (2003). Anterior cruciate ligament injury in the skeletally immature. Orthop Clin North Am, 34(3), 355-63.
Griffin, L. Y., Albohm, M. J., Arendt, E. A., Bahr, R., Beynnon, B. D., & Demaio, M. (2006). Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II meeting. January 2005. Am J Sports Med, 34(9), 1512-32.
Hakkinen, K., & Komi, P. V. (1986). Training-induced changes in neuromuscular performance under voluntary and reflex conditions. European Journal of Applied Physiology., 55, 147-155.
Harmon, K. G., & Ireland, M. L. (2000). Gender differences in noncontact anterior cruciate ligament injuries. Clinical Sports Medicine, 19, 287-302.
Hewett, T. E., Myer, G. D., & Ford, K. R. (2006). Anterior Cruciate Ligament Injuries in Female Athletes: Part 1, Mechanisms and Risk Factors. American Journal of Sports Medicine, 34, 299-311.
McNair, P. J., Marshall, R. N., & Matheson, J. A. (1990). Important features associated with acute anterior cruciate ligament injury. The New Zealand Medical Journal, 103, 537-539.
Spindler, K. P., & Wright, R. W. (2008). Anterior cruciate ligament tear. New England Journal of Medicine, 359(20), 2135-2142.
Griffin, L. Y., Agel, J., Albohm, M. J., Arendt, E. A., Dick, R. W., Garrett, W. E., & Wojtys, E. M. (2000). Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. Journal of the American Academy of Orthopaedic Surgeons, 8(3), 141-150.
Shelbourne, K. D., & Rowdon, G. A. (1994). Anterior cruciate ligament injury. Sports Medicine, 17(2), 132-140.

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