ACL microtrauma: healing through nutrition, modified sports training, and increased recovery time

Abstract

Purpose Sports injuries among youth and adolescent athletes are a growing concern, particularly at the knee. Based on our current understanding of microtrauma and anterior cruciate ligament (ACL) healing characteristics, this clinical commentary describes a comprehensive plan to better manage ACL microtrauma and mitigate the likelihood of progression to a non-contact macrotraumatic ACL rupture. Methods Medical literature related to non-contact ACL injuries among youth and adolescent athletes, collagen and ACL extracellular matrix metabolism, ACL microtrauma and sudden failure, and concerns related to current sports training were reviewed and synthesized into a comprehensive intervention plan. Results With consideration for biopsychosocial model health factors, proper nutrition and modified sports training with increased recovery time, a comprehensive primary ACL injury prevention plan is described for the purpose of better managing ACL microtrauma, thereby reducing the incidence of non-contact macrotraumatic ACL rupture among youth and adolescent athletes. Conclusion Preventing non-contact ACL injuries may require greater consideration for reducing accumulated ACL microtrauma. Proper nutrition including glycine-rich collagen peptides, or gelatin-vitamin C supplementation in combination with healthy sleep, and adjusted sports training periodization with increased recovery time may improve ACL extracellular matrix collagen deposition homeostasis, decreasing sudden non-contact ACL rupture incidence likelihood in youth and adolescent athletes. Successful implementation will require compliance from athletes, parents, coaches, the sports medicine healthcare team, and event organizers. Studies are needed to confirm the efficacy of these concepts. Level of evidence V

Overuse Noncontact ACL Injury in Young Athletes: Since We Can’t Completely Fix It, Why Not Prevent It?

“…The native ACL is a vital lower extremity sensorimotor circuitry component serving neuromotor activation and joint position sense functions in addition to helping biomechanically constrain excessive knee joint motion. 16 Although we continue to improve our understanding of the importance of ACL graft type, strength, stiffness, placement location, fixation method, and biomechanical attributes, we have not improved the capacity for graft remodeling or ligamentization to progress to anything that remotely matches the holistic functions of the native ACL. 14,16 At the instant of a noncontact overuse ACL rupture, everything changes as the youth and adolescent athlete unexpectedly enters a world of new medical, surgical, and rehabilitation terminology and experiences that creates a multitude of questions that they are ill-prepared to answer, including, but not limited to, questions about their pain, fear, or perceived function levels.…”

“…16 Although we continue to improve our understanding of the importance of ACL graft type, strength, stiffness, placement location, fixation method, and biomechanical attributes, we have not improved the capacity for graft remodeling or ligamentization to progress to anything that remotely matches the holistic functions of the native ACL. 14,16 At the instant of a noncontact overuse ACL rupture, everything changes as the youth and adolescent athlete unexpectedly enters a world of new medical, surgical, and rehabilitation terminology and experiences that creates a multitude of questions that they are ill-prepared to answer, including, but not limited to, questions about their pain, fear, or perceived function levels. Based on the premise that current ACL reconstruction or repair methods and rehabilitation are poor substitutes for the native ACL, I present a fundamentally different primary ACL injury prevention viewpoint that could be achieved with well-designed, implemented, and monitored programs.…”

“…The youth and adolescent athletes of today experience seemingly endless seasons, with minimal recovery, poor nutrition, and high volume performance and skill training that does not consider the need for ligament healing homeostasis. 16 In the Bob Marley song “I Shot the Sheriff,” 10 the lyrics state that “reflexes got the better of me and what is to be must be, every day the bucket goes into the well, one day the bottom drops out.” In many youth and adolescent athletes, these reflexes represent regular musculoskeletal and cardiopulmonary system or skill training, with little or no consideration for total volume, intensity, or duration. The bottom of the bucket represents the anterior cruciate ligament (ACL), a tissue with a slower extracellular matrix (ECM) and enthesis healing rate.…”

“…The native ACL is a vital lower extremity sensorimotor circuitry component serving neuromotor activation and joint position sense functions in addition to helping biomechanically constrain excessive knee joint motion. 16 Although we continue to improve our understanding of the importance of ACL graft type, strength, stiffness, placement location, fixation method, and biomechanical attributes, we have not improved the capacity for graft remodeling or ligamentization to progress to anything that remotely matches the holistic functions of the native ACL. 14,16…”

“…16 Although we continue to improve our understanding of the importance of ACL graft type, strength, stiffness, placement location, fixation method, and biomechanical attributes, we have not improved the capacity for graft remodeling or ligamentization to progress to anything that remotely matches the holistic functions of the native ACL. 14,16…”