Cruciate ligament injuries: The recovery process

Football players are under more strain than ever, and the injuries continue to accumulate.

Some are simple strains due to the intensity of the football calendar, but in others there have been season-ending problems, with Barcelona‘s Ansu Fati and Liverpool‘s Virgil Van Dijk among those to suffer ACL injuries in recent years.

Despite improvements in technology aiding the process cruciate ligament injuries are, unfortunately, still too common an injury in football.

Going back a few decades, such an injury could potentially be career-ending, but advances in medicine and surgery means that many players can make a full recovery and, in the main, return to their former range of movement and ability.

But what exactly is a cruciate ligament injury, how does it happen, and what kind of rehabilitation do players face?

How do Anterior Cruciate Ligament (ACL) injuries happen?

You’ll have seen the footage yourself many times. A player’s foot is planted and he or she tries to change direction. The foot remains in the ground and the knee doesn’t travel with the rest of the body.

It’s the ACL, the anterior cruciate ligament, that takes the strain and if the strain is too much, it gives in, in various levels of severity.

Can you walk on a torn ACL?

You’ll often hear commentators also say that ‘it can’t be too bad because he walked off the pitch’. ACL injuries can be walked on by the sufferer – it’s not like a broken bone. The player would be in pain but it is possible to limp off, with the initial swelling subsiding.

It doesn’t in any way provide an indicator of how serious the injury is, however. Players who walk off the pitch usually have ice applied immediately before they can be taken for surgery.

ACL injury surgery options

There are significant differences in the severity of ACL injuries and also different options that are available in order to resolve the issue.

The fantastic Twitter account Injury Mechanisms outlines this and explains the various options available.

1. Autograft v Allograft

The ‘autograft’ method utilises the players’ existing tendon in order to make repairs. It has a low risk rate but generally the surgery time increases the length of the recovery.

The ‘allograft’ users what is known as ‘donor or cadaver’ tissue to fix the problem. Historically it is a less painful procedure for the player but the risk of failure is higher than the autograft method. The cost of the surgery is also higher, though this isn’t not necessarily a concern for top professional clubs.

2. Patella Tendon Graft

This method uses 1/3 of the patella tendon using bone blocks. It has the lowest failure rate of all the procedures and involves bone-to-bone healing. As Injury Mechanisms points out, this is considered the optimum approach for athletes wishing to return to their very best.

3. Hamstring Autograft

The hamstring autograft uses the same method as the original autograft in terms of taking an existing part of the body to assist with the repair. Taking a piece of the hamstring is an easier ‘harvest’ process and requires a smaller incision, but the graft failure rate is historically higher using this method in younger athletes.

It requires longer integration in order to work and takes longer biological healing, and there are also other issues at play such as the graft stretching or the hamstring suffering weakness afterwards.

4. Quadriceps Tendon Autograft

This is the least common method of repairing ACL injuries. It has a predictable graft size and also requires a small incision, but recent studies have shown the failure rate to be higher, hence the reason that it is less commonly used.

Does an ACL injury require surgery?

Not necessarily. Players are increasingly exploring methods by which surgery isn’t required, but it requires an intense consultation and dedication to the methods of repair to work (rest + likely workload post surgery).

For example, athletes who are not pre-disposed to changing direction regularly of pivoting can see more success in this respect. But for footballers, basketball players or specific NFL positions (like wide receivers), surgery is still recommended.

Different severity of ACL injuries

Not all ACL injuries are equally serious and there are various grades to describe the severity of the injury.

Grade 1 means that the ligament has sustained mild damage and and has been overextended but is still mild and the knee joint has remained stable.

Grade 2 means that the ACL has been stretched and has become loose. In this scenario, the ligament has likely suffered a partial tear but it’s rare for this mid-level injury to happen.

Grade 3 is referred to as a complete ligament tear. It means that the ACL has split into two pieces and the knee itself needs to be stabilised. This is the most common serious injury suffered among football players.

What is the expected recovery time?

This is dependent on many factors. Players are usually walking again after two weeks and this leads them into a false sense of security that everything is ok. They need to be very carefully managed through the rehabilitation procedure to ensure that they are not overextending themselves while the ligament continues to heal.

The optimal period of recovery is sixth months but much of the process is in the hands of the player. If they are compliant with the exercises and regimes provided to them then the process can be expedited, but the utmost care has to be taken to ensure that there is no relapse.

There are countless examples of players trying to rush back to finish too soon, and in the most severe cases, it can take a player up to a year to be ready for first-team football once again.



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#Cruciate #ligament #injuries #recovery #process

Cruciate ligament injuries: The recovery process

Football players are under more strain than ever, and the injuries continue to accumulate.

Some are simple strains due to the intensity of the football calendar, but in others there have been season-ending problems, with Barcelona‘s Ansu Fati and Liverpool‘s Virgil Van Dijk among those to suffer ACL injuries in recent years.

Despite improvements in technology aiding the process cruciate ligament injuries are, unfortunately, still too common an injury in football.

Going back a few decades, such an injury could potentially be career-ending, but advances in medicine and surgery means that many players can make a full recovery and, in the main, return to their former range of movement and ability.

But what exactly is a cruciate ligament injury, how does it happen, and what kind of rehabilitation do players face?

How do Anterior Cruciate Ligament (ACL) injuries happen?

You’ll have seen the footage yourself many times. A player’s foot is planted and he or she tries to change direction. The foot remains in the ground and the knee doesn’t travel with the rest of the body.

It’s the ACL, the anterior cruciate ligament, that takes the strain and if the strain is too much, it gives in, in various levels of severity.

Can you walk on a torn ACL?

You’ll often hear commentators also say that ‘it can’t be too bad because he walked off the pitch’. ACL injuries can be walked on by the sufferer – it’s not like a broken bone. The player would be in pain but it is possible to limp off, with the initial swelling subsiding.

It doesn’t in any way provide an indicator of how serious the injury is, however. Players who walk off the pitch usually have ice applied immediately before they can be taken for surgery.

ACL injury surgery options

There are significant differences in the severity of ACL injuries and also different options that are available in order to resolve the issue.

The fantastic Twitter account Injury Mechanisms outlines this and explains the various options available.

1. Autograft v Allograft

The ‘autograft’ method utilises the players’ existing tendon in order to make repairs. It has a low risk rate but generally the surgery time increases the length of the recovery.

The ‘allograft’ users what is known as ‘donor or cadaver’ tissue to fix the problem. Historically it is a less painful procedure for the player but the risk of failure is higher than the autograft method. The cost of the surgery is also higher, though this isn’t not necessarily a concern for top professional clubs.

2. Patella Tendon Graft

This method uses 1/3 of the patella tendon using bone blocks. It has the lowest failure rate of all the procedures and involves bone-to-bone healing. As Injury Mechanisms points out, this is considered the optimum approach for athletes wishing to return to their very best.

3. Hamstring Autograft

The hamstring autograft uses the same method as the original autograft in terms of taking an existing part of the body to assist with the repair. Taking a piece of the hamstring is an easier ‘harvest’ process and requires a smaller incision, but the graft failure rate is historically higher using this method in younger athletes.

It requires longer integration in order to work and takes longer biological healing, and there are also other issues at play such as the graft stretching or the hamstring suffering weakness afterwards.

4. Quadriceps Tendon Autograft

This is the least common method of repairing ACL injuries. It has a predictable graft size and also requires a small incision, but recent studies have shown the failure rate to be higher, hence the reason that it is less commonly used.

Does an ACL injury require surgery?

Not necessarily. Players are increasingly exploring methods by which surgery isn’t required, but it requires an intense consultation and dedication to the methods of repair to work (rest + likely workload post surgery).

For example, athletes who are not pre-disposed to changing direction regularly of pivoting can see more success in this respect. But for footballers, basketball players or specific NFL positions (like wide receivers), surgery is still recommended.

Different severity of ACL injuries

Not all ACL injuries are equally serious and there are various grades to describe the severity of the injury.

Grade 1 means that the ligament has sustained mild damage and and has been overextended but is still mild and the knee joint has remained stable.

Grade 2 means that the ACL has been stretched and has become loose. In this scenario, the ligament has likely suffered a partial tear but it’s rare for this mid-level injury to happen.

Grade 3 is referred to as a complete ligament tear. It means that the ACL has split into two pieces and the knee itself needs to be stabilised. This is the most common serious injury suffered among football players.

What is the expected recovery time?

This is dependent on many factors. Players are usually walking again after two weeks and this leads them into a false sense of security that everything is ok. They need to be very carefully managed through the rehabilitation procedure to ensure that they are not overextending themselves while the ligament continues to heal.

The optimal period of recovery is sixth months but much of the process is in the hands of the player. If they are compliant with the exercises and regimes provided to them then the process can be expedited, but the utmost care has to be taken to ensure that there is no relapse.

There are countless examples of players trying to rush back to finish too soon, and in the most severe cases, it can take a player up to a year to be ready for first-team football once again.



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#Cruciate #ligament #injuries #recovery #process

European Golden Shoe 2021/22 standings



The 2021/22 European Golden Shoe race is over after a season in which the continent’s most prolific goalscorers were all vying to win one of football’s most prestigious individual awards.

Bayern striker Robert Lewandowski saw off the challenge of Lionel Messi and Cristiano Ronaldo to finish at the top of the European Golden Shoe rankings last season.

READ MORE: European Golden Shoe 2022/23: Current standings and past winners

Lewandowski scored an astonishing 41 league goals from 29 appearances, giving him 82 Golden Shoe points and the highest winning score since Ronaldo in 2014/15.

Manchester United star Ronaldo and Messi – who has moved from Barcelona to PSG – both entered the new campaign expecting to challenge again in the standings for the most goals in Europe.

READ MORE: Who will be the European Assists King for 2021/22?

Messi’s PSG team-mate Kylian Mbappe and a fellow young star in Erling Haaland were also expected to be in the mix to top the Golden Shoe rankings and take the crown from Lewandowski.

Along with Ronaldo, Romelu Lukaku, Harry Kane and Mohamed Salah started the season as the top Premier League candidates, though surprise winners have also emerged in the past.

This page was updated throughout the 2021/22 season with regular updates on the European Golden Shoe standings, and the final result can now be viewed below.

2021/22 EUROPEAN GOLDEN SHOE STANDINGS

Robert Lewandowski has clinched back-to-back European Golden Shoe titles after another spectacular season.

The Bayern striker scored in his side’s last game of the Bundesliga campaign against Wolfsburg on May 14, with his future at the club looking uncertain amid transfer speculation.

Lewandowski therefore finished the league season with 35 goals to his name from 34 appearances, a total which saw him score the most goals in Europe for 2021/22.

Given the Bundesliga season is shorter than the other major divisions in Europe, Lewandowski finished before many of his rivals had completed their top-flight campaigns, but a huge lead meant his victory never looked in doubt.

Lewandowski secured European golden boot glory once more even though he fell slightly short of his historic 41-goal total last season.

He led the Golden Shoe race for most of the season, but while he was stable at the top, the chasing pack behind him was rotating regularly, right up until our final standings.

PSG sensation Kylian Mbappe, the Ligue 1 top scorer, ultimately claimed second place with 28 goals and 56 Golden Shoe points.

It was a remarkable year for the World Cup winner, who also had 18 assists in the top flight to tie Thomas Muller for the best creative total in Europe’s top-five leagues.

A hat-trick as PSG thrashed Metz 5-0 on the last day of the Ligue 1 season saw Mbappe leapfrog Karim Benzema and Ciro Immobile to finish as best of the rest behind Lewandowski.

It was the second-best goal total of his career, behind only the 33 he scored in 2018/19, and the attacker looks a likely winner of the Golden Shoe in the future.

Benzema (27 goals) recorded the best league goalscoring campaign that he has had in 13 seasons with Real Madrid, impressively beating the 24 goals he netted in 2015/16.

The France forward posted highest Primera Division total and was one of the most prominent challengers to Lewandowski in these standings for much of what was a sublime campaign.

Benzema may have taken second over Mbappe had he not had his schedule carefully managed by Carlo Ancelotti in the final weeks of the season after the domestic title was secured, with a Champions League final against Liverpool in mind.

Lazio forward Immobile, a former winner of this award, superbly scored 27 times in the league this season to top the charts in Serie A.

He has topped 20 goals in Serie A in five of his six seasons for Lazio and remains a prolific striker who consistently features in the Golden Shoe race.

Monaco’s Wissam Ben Yedder challenged Mbappe in Ligue 1 for much of the season and he finished with 25 goals to claim an impressive fifth-place finish in the Golden Shoe, boosted by a hat-trick against Brest in the penultimate game of the season.

Ohi Omoijuanfo, who played for Molde and Red Star Belgrade over the course of the campaign, came sixth and was the highest-placed finisher outside Europe’s fop-five leagues.

Leverkusen forward Patrik Schick and Juventus’ Dusan Vlahovic finished level on 24 goals. Both of those players were fast starters this season which made them a permanent fixture on the leaderboard.

Completing the top 10 were the two payers who ultimately finished level in the Premier League golden boot race with 23 goals. They were Liverpool forward Mohamed Salah, who was the leader for most of the campaign in England, and his Tottenham rival Son Heung-min.

Strikes on the last day of the EPL season for that duo meant outgoing Dortmund star Erling Haaland, who will be joining them in England with Man City next season, finished 11th after racking up 22 strikes despite an injury-hit season.

So Lewandowski once again finished top of the prestigious Golden Shoe standings and the major league seasons across Europe have now come to a close.

Lewandowski becomes the 10th player to win the Golden Shoe twice – a total only bettered by Lionel Messi and Cristiano Ronaldo, who were unable to challenge this season.

After not producing a winner since 1972, the Bundesliga has now come out on top for two straight campaigns, and the stage is set for another intriguing battle in 2022/23.

2021/22 European Golden Shoe

Who are the previous European Golden Shoe winners?

Lionel Messi has won the most European Golden Shoe titles.

The PSG forward has triumphed on six occasions, most recently in 2018/19 for Barcelona.

Cristiano Ronaldo is his closest challenger with four career wins, though the Man Utd attacker has not come out on top since 2014/15 when he was at Real Madrid.

Nine players have two awards apiece, including Luis Suarez and Thierry Henry.

Messi holds the record for most goals and points in a season as well. He remarkably scored 50 goals in 2011/12, earning himself 100 points.

Ronaldo has come closest to breaking that, scoring 48 goals for 96 points when he last won the crown more than six years ago.

Argentina forward Messi is the only player in European Golden Shoe history to win the title three years in a row, doing so from 2016/17 until 2018/19.

Ronaldo, though, is one of only four players to have won the title with different clubs. The others are Luis Suarez, Diego Forlan and Mario Jardel.

Robert Lewandowski became the first Bundesliga winner since 1972 last season, with his 41 goals being the best tally for six seasons.

That came after Ciro Immobile won the 2019/20 European Golden Shoe, scoring 36 goals for Lazio in a tremendous Serie A season.

It was his first title, with the striker becoming the first Serie A player to have the most goals in Europe since Francesco Totti triumphed for Lazio‘s rivals Roma in 2006/07.

Ligue 1 has not produced a winner since Josip Skoblar in 1971, a statistic the likes of Messi and Mbappe are hoping to change soon.

What are the European Golden Shoe rules and weightings?

Only league goals are eligible for the European Golden Shoe, with each strike earning points in a weighted system depending on the quality of league.

The five elite leagues – Premier League, La Liga, Bundesliga, Serie A and Ligue 1 – all carry a weighting of 2, meaning that a player will be awarded two points for every goal they score in these competitions.

For the leagues ranked sixth to 21 in Uefa’s coefficients rankings – which includes the top-flights in Portugal, Netherlands and Russia – goals scored are given a weighting of 1.5, and goals scored in a league outwith the top 21 are given a weighting of 1.

That was not always the case in the European Golden Shoe. From 1968 until 1991, the award simply went to the highest goalscorer on the continent, regardless of the strength of league.

Awards were not initially handed out between 1991 until 1996, when the new system came into force. Since then, only two players playing outside what were the five highest-ranked leagues at the time have ever won the Golden Shoe – Henrik Larsson (2000/01) and Mario Jardel (2001/02).

The Golden Shoe has been tied in the past, most recently when Suarez and Ronaldo shared the honour in 2013/14. Going forward, though, the award will be given to the player who has played the fewest minutes if two of them end up on the same number of points.

This page covers the 2021/22 European Golden Shoe race.

Last season’s standings can be found here and if you want to see the final results for the 2019/20 European Golden Shoe, follow this link.





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