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INSIDE JAMES STEWART’S KNEE: THE RAMIFICATION OF A TORN ACL

January 18, 2013
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If James is like most riders with torn or injured knee ligaments he will not stick his leg out as far as he used to.

Now that James Stewart has revealed that he suffered a torn ACL ligament at Anaheim I, it’s time to look at this very common motocross injury. It should be noted that the MXA wrecking crew doesn’t have any medical degrees (and Jody’s PhD studies were in Gerolotology, nor orthopedics), so we aren’t offering medical advice.

The knee is strung together with four thick bands of tissue, called ligaments, that stabilize the knee:

The medial collateral ligament (MCL) and the lateral collateral ligament (LCL) stabilize the sides of the knee.

The anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL) form an X on the inside of the knee joint and prevent the top and bottom of the knee from sliding back and forth.

WHAT IS A TORN ANTERIOR CRUCIATE LIGAMENT (ACL)?

The ACL rises from the front of the medial femoral condyle and passes through the middle of the knee to attach between the tibial spine. The ACL is small, only 1-1/2 inches long and 1/2 inch wide, but it is vital in preventing the thigh bone from sliding backwards on the tibia (or the tibia sliding forward on the femur). The ACL also stabilizes the knee from rotating when the foot is planted and the leg pivots? Without a normal ACL, the knee becomes unstable and can buckle, especially when the leg is planted and attempts are made to stop or turn quickly.

WHAT CAUSES A TORN ACL?
 
Most anterior cruciate ligament injuries occur from trauma. The rider plants his foot and the ligament gets stretched or tears when the knee locks and twists at the same time. This is a common motocross injury, where a sudden changes in direction, propelled by an internal combustion engine, put stress on the knee. Most ACL tears aren’t cause in ramming incidents or crashes, but from simply putting your foot in the wrong place at low speeds?typically while braking for a corner.

WHAT ARE THE SIGNS OF A TORN ACL?

In basic terms, a loud pop and intense pain in the knee. The pain makes walking very difficult. Swelling will be the next symptom?making it even harder to walk.

WHAT IS THE TREATMENT FOR A TORN ACL?

The major decision in treating a torn ACL is whether or not the patient needs to repair the injury. Little old ladies and shut-ins can lead sedentary lives with torn ACL’s. However, athletes need to function at 100 percent. Obviously the best cure is to address the injury medically, but in many cases the rider doesn’t want to take the time off. The patient and the surgeon will not always agree. But many riders have raced with torn ACL’s or even without an ACL. If surgery is indicated, the anterior cruciate ligament can be reconstructed using arthroscopic surgery. Each type of tear has it own surgical complications.

HOW LONG DOES IT TAKE TO RECOVER FROM ACL SURGERY?

The book says nine months before a return to normal activity, but motocross racers always push the envelope to around six months.


James faces a long season of worry and will most likely skip the AMA Nationals to get it fixed in time for 2014.

CAN YOU RACE WITH A TORN ACL

Yes, with a good knee brace, some tape and a cautious approach to corners it is possible for a rider with a torn ACL to race. This past season, GP rider Steven Frossard had his ACL removed and raced five GPs before throwing in the towel. If you choose to race, your doctor won’t like it, but it is often done, with the caveat that you have to suffer through the pain. But many riders, with less on the line than James Stewart, have done it, so it isn’t heroics time. Every knee injury is different and the ACL tear that stops one rider, may only be an annoyance to another. Most riders take the approach that the ligament will have to be operated on anyway, so they might as well take the chance and race, then get it worked on after the season. After all, it’s already injured, so it can wait.

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