Anterior cruciate ligament rupture in field hockey

Although the knee is the second most frequently injured body part among NCAA(1) players and the third most frequently injured body part among NHL(2) players, anterior cruciate ligament (ACL) injuries are uncommon among field hockey players. In fact, the incidence of this injury is higher in sports requiring rapid changes of direction, pivots and jumps(3). The repercussions of this injury can be devastating, keeping an athlete out of competition for a long time, increasing the risk of osteoarthritis 10-fold, leading to concomitant injuries to both knees and a risk of recurrence following surgery (4,5). Its impact on professional basketball and soccer players has been described in several studies (6,7), but what about field hockey players?

Researchers in Minnesota looked into the matter and tracked NHL players from 2006 to 2010 via the NHL Injury Surveillance System(8). They examined the impact of an ACL injury on performance as well as career length. A total of 47 players suffered a complete ACL rupture during the study period. Of these, 5 players (10.6%) did not return to the game. For those who were able to return, the average time to return to competition was 9.8 months (from 6 to 21 months). What’s more, players with an associated meniscus injury saw their careers cut short, which was not the case for those with an associated medial collateral ligament injury, regardless of the grade of the lesion.

By comparing the players’ productivity in the two seasons before and two seasons after the injury, as well as with a control group, we are able to assess the impact of this injury on performance when a return was possible. The players up front have also seen their production of goals, assists, points and games played decline. This trend is not observed among defenders, who seem to be maintaining similar production levels and have even improved their differential (+/-).

Among professional players, it would appear that the vast majority are able to return to play following ACL surgery (8,9). Poor prognostic factors include concomitant meniscus injury and a forward position. However, we must be cautious in interpreting these results, and not assume that this injury has the same impact on other field hockey players. In the younger age groups, such a long absence from competition can have a huge impact on their development. In fact, it would appear that the risk of re-operation increases the earlier the first operation is performed(13). Hence the importance of making every effort to prevent such injuries.

Fortunately, there are various prevention programs that help reduce the incidence of this injury (10,11,12). The biggest challenge in field hockey is the unpredictable nature of the sport. Unlike other sports, most ACL ruptures occur as a result of contact with the opponent or the boards (8). Hence the importance of adapting the prevention program to the type of sport practised, as well as tailoring interventions to the specific needs of each individual.

Written by Maxime Provencher, M. Physiotherapy

References:
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