Among professional, amateur, and recreational athletes alike, knee injuries are common. Especially with the quick stops and starts, cutting and twisting of high-speed collision sports — like football, soccer and rugby — “injury occurs when the knee is hit from the side while the foot is planted,” says Dr. Thomas Matelicof the OAM Institute of Sports Medicine. “That results in excessive rotational and bending force on the knee, which could mean an ‘unhappy triad’ injury.” In 1950, Dr. Don O’Donoghue defined the tearing of the ACL, MCL and meniscus as the “unhappy triad” or “terrible triad.” The name stuck for good reason. “Some athletes can never return to their previous level of sport,” says Dr. Matelic. “Even with surgery, six months minimum recovery, and intense rehabilitation, they could develop long-term problems, such as continued instability, pain or arthritis.”

The good news: “More commonly, it’s not the unhappy triad,” says Dr. Matelic. It’s one or two of the three. The MCL, the most common knee injury, can heal quickly and easily, because of its outside location. The ACL however, is a little more difficult. “The ACL is surrounded by synovial fluid which essentially just dissolves the ligament,” says OAM Sports Medicine physician, Dr. Schwab. “We can’t go in there and suture the ACL back together to repair it. So we reconstruct it.” According to Dr. Schwab, most ACL injuries result from running rather than collision and may lead to more problems down the road. “The natural history of the ACL is that when it tears, you then have a much greater chance of tearing the meniscus,” says OAM Sports Medicine physician, Dr. William Schwab. “When that happens, you’re going to get arthritis.” This is why reconstructive surgery is so important. “We want to reconstruct the ACL surgically so the knee becomes more stable to move and play sports and to protect against arthritis,” explains Dr. Schwab. An ACL is reconstructed by taking another tendon — typically from the patient’s own hamstring — placing it in the knee, and holding the graft in position until it heals to the bone. Then comes rehab. Because knee injuries can be serious with long-term consequences, prevention is a  high priority, especially for women. For an unknown reason, ACL injuries occur nearly twice as often in women as in men, according to Dr. Schwab. Practice these five tips from Dr. Matelic, and stay in the game:

  1. Get a pre-season physical exam – No matter your age or skill level, visit your pediatrician or primary care physician before your sport season starts.
  2. Warm up and cool down properly – Practice dynamic stretches that prepare the muscles for sports activity. Dr. Schwab notes, “There’s been some evidence that agility exercises help decrease incidences of ACL injury.”
  3. Condition during the off season – Condition in the summer, so when your fall sport arrives, you won’t experience overuse injuries and stress fractures.
  4. Know when to rest – Don’t do too much too soon. When you’re physically fatigued, be smart, step back and recover. Many injuries occur in game conditions when players are tired.
  5. Wear proper equipment – Often high school athletes wear cleats, made for grass fields, while on turf. Steel-tip cleats create too much friction between the foot and field surface. The foot sticks in the turf, which can lead to injury. For more information on how to prevent sports injuries, go to stopsportsinjuries.org.