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Getting Back Into Sports After Anterior Cruciate Ligament Injuries

Anterior Cruciate Ligament (ACL) injuries are some of the most dreaded injuries among sports professionals and even amateurs. They are usually season-ending and often entail surgery and a prolonged period of rehabilitation. So what exactly are ACL injuries, the causes and treatment options?

What is an ACL?

An ACL connects the thigh bone (femur) with the shin bone (tibia). An ACL stabilises the knee for cutting, twisting, jumping and pivoting activities. This ligament is located in the centre of the knee joint and prevents abnormal rotation of the femur on the tibia.

ACL injuries are common in a wide variety of sports especially where twisting and pivoting are involved such as basketball, netball and football. It affects both men and women and is in fact eight times more common in women than men.

Without an ACL most people have trouble with twisting and pivoting during sports. In severe cases, the patient has trouble even with activities of daily living.

How does the ACL get injured?

Most ACL injuries tend to be a result of a deceleration injury. The foot gets trapped in a tackle or uneven ground and the weight of the body rotates around the knee thereby causing the ligaments to rupture.

When you tear an ACL, you will often feel or hear a pop. You will also feel the knee shift out of place and develop significant swelling in just a few hours. Most people are unable to continue play and some will have severe pain and be unable to bear weight at all.

What should we do immediately after an injury?

Play should be discontinued. The knee should be iced and the leg elevated. A commonly used regime is to ice the knee for 20 to 30 minutes every two to three hours.

Pain killers and anti-inflammatory medication are useful for patient comfort and a sports physician, an orthopaedic surgeon or a phsiotherapist should evaluate the injury. A Magnetic Resonance Imaging (MRI) scan is usually ordered to confirm the diagnosis and to exclude injury to the other ligaments in the knee as well as the articular cartilage and the meniscus.

Who should go for surgery?

If the ACL has been torn, surgical reconstruction of the ligament may be indicated, as the ligament rarely heals by itself. However not everyone who tears an ACL will need surgery.

Individuals who should consider surgery are those who are keen to continue playing sports as well as those who have instability (giving way) during daily or sporting activities. Patients with associated injuries to the other structures in the knee and those who are young should consider surgery.

Current thinking is that recurrent instability in the knee will cause damage to the cartilage and menisci (crescent-shaped cartilage pad between the two joints formed by the thigh bone and the shin bone) and lead to accelerated degenerative arthritis.

The rationale behind surgery is to stabilise the knee for twisting and pivoting activities and to slow down the development of arthritis.

What happens during a surgery?

In surgery, the ACL is recreated by using a “graft” which can be taken from the patient’s own tissue.

The surgery is performed via an arthroscopic or ‘key-hole’ technique. This allows for a rapid recovery and less pain compared to non-arthroscopic techniques. Most times the surgery can be done as a day surgery procedure.

Post Surgical Rehabilitation

The patients’ commitment to a rehabilitation programme is of the utmost importance in determining the success or failure of the surgery. Non-compliance or poor compliance with the rehabilitation programme is a common cause of inability to return to sports.

The rehabilitation programme consists of range of motion, strengthening and finally sports-specific agility training.

Returning to sports will vary from individual to individual but generally nine to twelve months is the norm.

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Singapore’s Oldest Marathon Runner Mr Chan Meng Hui

Mr Chan is an avid marathon runner. To date, he has participated over 80 marathon local and overseas.

Oldest Marathon Runner - Mr. Chan Meng Hui

Oldest Marathon Runner - Mr. Chan Meng Hui

He feels strongly that if he can do it, anyone else can. As he is often asked how he has been able to achieve so much and how he got started, he tells everyone how he could barely run 100m when he first started.

Interview Questions Posed to Mr Chan Meng Hui

What is your age now?
81 years old.

When did you start running?
At the age of 55, after retirement. Before that I was a chain smoker. I was a regular nite club drinker and a bar visitor. I did not engage in much exercise earlier on and I was quite fat with my pot belly out. I was very unfit then, with a height of 1.56m and weight of 65kg.

Why was your reason for taking running as a passion?
Actually, I met some runners who motivated me, especially those from MacRitchie Reservoir, in the past. After meeting them, I took up running as a hobby and over time I was inspired to kick away all bad habits. Thanks to running for giving me the willpower to do this. I also want a new lease of life after my early part of my life. The second part of my life, I wanted my life to be a more meaningful and a healthy one.

Now that you are 81 years old, are you still running?
To date, I am still running. I have done 86 marathons already. The last that I ran was 24th Jan 2010. I ran this in order to remember and celebrate my 80th birthday. The run I did was Khong Kheng (Bangkok) International Marathon. I did the run in a time of 7hr 19min.

How is your running routine per week like?
I usually run half an hour to an hour per day. In one week, I am running around 30km per week. I still find this as not enough and am finding ways to increase my mileage. Can you give me the way,…..ha ha ha …Just joking only.

What is your fastest marathon time ever?
At the age of 56, I took part in the Kuala Lumpur International Marathon, running a distance of 42.195km in a time of 3hrs 26min. This was my best time ever, to date.

How many marathons do you run in the past and now?
In the past, I average my annual marathon runs running 4-5 full marathon per year. However, due to my work commitment I could only do, currently 2-3 marathon per year, both local and regional marathons.

Is your wife supportive in this?
Ha Ha..When I am busy running, I do not give any kind of problem to my wife. She is happy and contented with my calm behaviour. If I do not run, I give problems to my wife…ha ha ha. Over time, I feel that running does relieve my stress. Hence, I get my wife full support in this. Thank God for this, to have a wife who is supportive to my passion.

How about your children’s support in this?
My sons are very supportive of this. My grandson, about 12 years old,  is currently taking up running as a sport. This is good news for me.

What is your goal in life when it comes to running?
My wish is to possibly run at least one hundred marathon. I have 14 marathons left to finish this. Also, I do not forsee any problem in accomplishing this.

What advice would you give to those who want to take up running?
Running is a very good sport to keep the body and mind sound. The strength I have at present, I feel, comes from running. Mentally, I am still alert, like look at me now, I am talking to you with zest..ha ha ha.

What advice would you give to runners after 40/50/60/70/80?
Age is no barrier. Running will keep you fit. Trust me, fellow men…ha ha ha.

Run For Life