Is pushing on with a ruptured ACL a good idea?

American skier Lindsey Vonn announced she would still race in the Winter Olympics’ despite a ruptured anterior cruciate ligament, but an expert warns this is not something he advises.

The 41-year-old was injured in a downhill crash in Crans-Montana, in Switzerland less than a week ago but plans to fight it out for an Olympic medal this weekend.

Physiotherapist and Auckland University of Technology (AUT) lecturer Duncan Reid said while an athlete knows their own body better than anyone else, taking part in the race was not something any medical team would advise.

A ruptured anterior cruciate ligament (ACL), was a common injury for athletes and the general public alike – but skiing posed a high-risk due to the high speeds and high levers against the joint, he said.

It was likely Vonn would be wearing a knee brace with strapping tape on race day to help her feel more comfortable.

“[But] her knee could do exactly the same thing.,” Reid said. “The risk is it could do more damage to the knee and tear more ligaments, which would make what’s already there a lot worse.”

Best case scenario, Vonn was fine during the race and was able to win a medal, Reid said.

“Some people have very good balance, coordination and muscle control, with a brace she may have that extra bit of confidence.”

Worst case scenario however, was when she hit the first gate her knee could go one way and her body the other, tearing more ligaments.

Reid said it was “inevitable” – whether she competed or not – that in 10 to 15 years she would develop osteoarthritis in her knee.

For some people, it wasn’t too disruptive, but in some cases a person would end up needing a knee replacement. That’s something Reid himself had at age 55 following an ACL injury at 17.

“Athletes don’t care about what’s happening down the track. She would’ve sat down with her team and made the decision.

“In a normal world, a person would have time for their knee to settle down,” Reid said.

“You do rehab, and then a decision is made to have surgery or see if the knee copes with life and getting strong again.”

It was “50-50” on whether people would need a surgery following a rupture.

In Vonn’s case Reid said at 41, she was nearing the end of her Olympic career and probably felt internal pressure to continue.

“She’s probably thinking, what do I have to lose?”

By competing in such a highly publicised event it was possible Vonn could be giving the message to those watching it was okay not to listen to medical advice, Reid said.

It was something that had been seen time and time again with sports – including when cricketer Kane Williamson returned to the game less than a year after rupturing his, he added.

“He had extensive rehab and was back between the six-to-nine-month mark, but it actually takes one to two years to recover.

“If you go back too soon you can reinjure yourself or get another injury.”

Being patient was the way to go, Reid said.

“But what happens is, the public see things like this and go ‘oh if they can do it so can I’ – so there’s some mixed messages there.”

He fears there would be people who watched Vonn race and, if it went well, would want to speed up their recovery or take risks.

Rupturing an ACL was equivalent to breaking a bone and would be accompanied by a loud crack or popping sound.

“It happened to me during rugby and I heard a loud crack, it’s pretty painful,” Reid said.

“Sometimes there is a typical ‘pop’ sound. There’s a sound, the person falls to the ground and the knee immediately begins to swell.”

About 3500 New Zealanders experience the injury in a year, and while there has been an increase in the number of women sustaining the injury, it was still more common in men, Reid said.

“More women are now injuring their ACL’s than before, but this could be because more women are now playing high level sport. Participation could be driving numbers up.”

There was some evidence, he said, of women being more susceptible to the injury at certain times in their menstrual cycle due to hormonal influences.

A ruptured ACL was still a pretty common injury for people from all walks of life – not just professional athletes – Reid said.

“You have your weekend warriors… sometimes it can happen from just carrying washing out to the line and slipping.

“Even if you just twist your knee the wrong way it can happen. But it’s always the twisting motion that causes it.”

Because of this, Reid said it was important for everyone to work on their balance and keep muscles around the knee and thigh strong.

He said anyone playing sports socially should make sure to prepare their body for what they’re about to do with a warm up before heading onto the field.

“Don’t rush in and do it. Warm up, keep your muscles strong and keep active.”