Keyhole surgery can be a misleading term: while technology, expertise and great skill are involved, it also requires a lot of physical strength.
Sky News reports that surgeon Luke Jones is performing an ACL reconstruction in the operating theater of King Edward VII Hospital in central London.
Mr. Jones (the male surgeon is called “Mr.” rather than “Dr”) didn’t just remove the hamstring: he pulled it out with force.
The drill drills through the bone. The meat will smoke as it is seared. There was quite a bit of hammering: “Use a mallet, please,” Mr. Jones asked his assistant.
The ACL is a small band of tissue that runs through the middle of the knee and keeps the knee stable.
But after watching the surgery, it’s easy to understand why tearing it up can be so devastating. Although the patients only had three tiny scars, their knees were battered.
Mr Jones told Sky News: “I’d be in the theater for 90 minutes and then do a year of rehab with the help of a physiotherapist.”
That’s why ACL injuries are such a concern, especially for one class of athlete: female soccer players.
‘Too many’ female players with ACL injuries
Between 25 and 30 players (enough for an entire extra squad) will miss the upcoming World Cup with an ACL injury. England stars Beth Meade and Leah Williamson have been ruled out. Figures from the ACL Women’s Soccer Club show 195 elite players were injured last year.
It has been described as an “epidemic”. The epidemic affects women far more than men: they are 2.5 to 3.5 times more likely than male athletes to rupture their ACL. We really don’t know why. Even as women’s sports thrive, research lags behind.
One of the players up for the World Cup is England defender Jesse Carter. Before leaving St George’s Park, England’s national football centre, she told Sky News: “Too many women players have suffered cruciate ligament injuries and not enough research has been done on it.
“Why are there so many injuries? How do we prevent them? Why does it happen? One of the questions I sometimes ask is: If this is happening to high-profile male players, is there more that needs to be done to try and improve the situation?”
England’s Leah Williamson.Image: Associated Press
Nature vs Nurture
The problem is that there is more than one answer.
“I made a list the other day and I think 30 causes have been discussed in the literature that I could find,” says Kat Okholm Kryger, a sports rehabilitation researcher and medical researcher at St. Mary’s University, Twickenham. FIFA.
“I think we can break it down into two broad categories. I like to call them nature and nurture.
“So nature is like biology: genetics, body shape and muscle mass and so on … and also the upbringing of the environment that women are in. So, the way young female athletes are managed compared to young female athletes, the way male athletes, the facilities, this the professionalism of the sport, the quality of the staff they have available.”
I ask if research on injuries in the women’s game has received as much attention as it has in the men’s game.
“Attention? No. But in general, with all the research in football and sports medicine. Males have always been the norm,” she added.
Research could eventually benefit men’s game too
Take, for example, a problem in the field of “parenting” that Kate is working on: soccer shoes. Male feet are the norm. Only in recent years have boots designed specifically for women appeared. Even so, we can’t properly understand the differences, which is why Kat took hundreds of feet of 3D scans to map them.
The research will ultimately benefit the men’s game as well, as Kate is also charting differences between races. Because the default foot is not only a man’s foot, but also a white man’s foot.
Males are also the norm when it comes to other environmental factors such as booking pitches.
In Kent on Thursday night, Gravesham Girls and Ladies Football Club, established in 1999, was training before the start of the season. About 20 players in yellow jerseys were doing a shootaround and the ball was flying. A Sky News cameraman shot a police officer in the stomach but bravely continued filming.
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Toni Allen and Keylie Oliver have both ruptured their cruciate ligaments in the past. “I just screamed – everyone thought it was a fox,” Allen said. Both missed a year.
“It’s pretty daunting, especially when you realize it doesn’t just affect football,” Oliver said.
“We have lives outside of football and that also affects that… At the grassroots level, the ladies always kick off at two o’clock. That’s because in our world, men’s football takes precedence over women’s football. We always You have to play after that – so the pitches are always ruined.”
Women’s Soccer: The ACL Epidemic
Importance of factors may change
Another difficulty is not only that there are many factors involved, but that the importance of these factors may vary.
Professor Kirsty Elliott-Sale is Professor of Female Endocrinology and Exercise Physiology at Manchester Metropolitan Institute of Sport.
She works closely with clubs, including Arsenal, on how the menstrual cycle or taking the pill can affect injuries. Research seems to suggest that certain hormones can relax ligaments, increasing the risk of rupture.
So, throughout the season, Professor Elliott Searle has measured the amount of slack in players’ knees, charted its relationship to hormones and cross-referenced it with other factors such as game congestion.
“It’s definitely a puzzle,” she said. “It’s about putting all the pieces together.
“However, once we have all the parts, we don’t necessarily know which factor is going to play a bigger role on any given day. So not all parts are the same size. Sometimes, a particular factor can influence The impact of this injury may be magnified, but one day, it may be denied.”
Biology is still a big part of the answer
But even so, the differences between female and male body types — which in the past have led some to believe women are too “fragile” for traditional male sports — may not be as important as previously thought.
Because in some sports, the ACL injury difference disappears.
“If you compare sports, where men and women start at the same age, train at the same intensity throughout their sporting careers, and perform the same movements in the sport, the rupture rates are, in fact, equal,” said Dr. Dr. Jones said, say.
“A good example is elite dancers. Elite dancers, males and females start training at the same age, they perform the same spins, jumps, twists, and train with the same intensity and intensity. The same conditions. If You compare their rupture rates, and they’re practically equal.”
“This shows that the impact of your training and conditioning is very important in avoiding this type of injury.”
Every expert I spoke to emphasized the role of strength and conditioning training in injury prevention. Lord, nurture affects nature.
“Our attitude is, you know, women do yoga, Pilates and men lift weights in the gym,” Ms Krieger said.
“But the reality is everyone needs to lift heavy weights occasionally to prevent injury and have a healthy body.”
England’s Beth Meade is also out through injury.Image: Associated Press
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The good news is that quantifiable progress is being made here.
Matt Whalan is a sports scientist who works with Australia’s men’s and women’s soccer teams, the upcoming World Cup ‘Matildas’. He spoke to me at the men’s under-23 training camp.
The Australian Football Association has launched a program called “Perform+”, which can be performed during warm-ups and can reduce injuries, including ACLs, by 40%.
Crucially, it’s not just for elite players.
“The idea is so moms and dads coaches can go online and take note of the program and all the videos are there and there’s information on how to deliver the program to athletes from under 7 to 55 to 95 , you can do these exercises if you want,” Mr Whalan said.
“The good thing about working with the national team at a high level for us is if we have players who are doing it all the time because they’re 12, 13, 14 years old, it makes our lives a lot easier.”
This is still a matter of the future. When the World Cup kicks off next week, it won’t be full of stars.
As England striker Chloe Kelly told Sky News: “I’ve suffered an ACL injury myself and it’s very sad when you see so many players suffering from it. Hopefully we can get the research we need. , to prevent these injuries from occurring so frequently.”