In India, traditional surgery methods to reconstruct the Anterior Cruciate Ligament (ACL) or the knee ligament causes most players to quit sports, doctors say.
In October 2023, Brazil’s star football player, Neymar’s club Al Hilal announced that he had torn his ACL (Anterior Cruciate Ligament) and meniscus in a World Cup Qualifier match against Uruguay. It was further announced that his trip to India for a match against the Mumbai City FC had been held off, owing to his injuries. Neymar’s ACL injury which came as a disappointment for many Indian football fans is the most common sports injury in India.
The number of football and cricket players from India suffering knee and ankle injuries has increased by 500 percent over the last 20 years, according to a 2023 report by UnivDatos, a market research and insights firm. Within the same time period, the number of players suffering from ACL injuries has increased by 400 percent, according to the report. Authors of the report have accessed the data from Prohealth Asia Physiotherapy and Rehab Center.
Doctors and sport coaches attribute the limited number of playgrounds, gaps in training periods due to academic pressure or too rigorous training sessions as reasons for increase in sports injuries in India. Additionally, traditional methods of treating ACL tears and expensive modern surgeries render players incapable of returning to sports, they say.
Aishwarya B, coach at the Karnataka State Football Association said the lack of playgrounds in the city leads children to play on narrow streets, making them more vulnerable to injuries. She further said the lack of adequate fitness training, which improves flexibility of muscles and endurance is detrimental.
Dr. Santoshkumar Hakkalamani, an orthopaedic surgeon from Bangalore said once a player sustains an ACL tear, their career is often cut short. Due to lack of infrastructure, equipment or money, most orthopaedic surgeons in India perform a traditional type of ACL reconstruction surgery in which a graft is created to replace the torn ACL, he said. “The graft has the potential to damage the growth plates around the knee, thus prohibiting recovery and reducing the functional ability of the knee like before,” he said.
Sonal Sanjit Rout, a 23-year-old athlete who had been practising football since his childhood said he had to give up sports completely after he sustained an ACL injury during a practice session in August last year. Doctors had recommended surgery but he didn’t undergo one because three months of post-op bed rest would hamper his studies, he said.
Avirup P, a former football player who was part of his school football team said he tore his ACL when he fell hard during practice one day. He said that he had excruciating knee pain and had to undergo surgery only a day after. However, he said he has still not recovered fully after two years, and has discontinued football. “Back then, I wanted to play football throughout my life, but now my knee and leg hurt even when I run a little fast,” he said.
A physiotherapist at the Centre for Sports Science, Karnataka Department of Youth Empowerment and Sports agreed that ACL was the most common sports injury among sports persons part of the centre as well. “About 90 percent of injuries we see are ACL tears. Unfortunately, all of them required surgeries and very few players who underwent the surgery could continue their sport,” he said.
Football coach Aishwarya said established players, who represent the city or state and are training under the government, are in a much better state than those who are not. Entry-level players from backward and poorer communities lack the adequate nutrition required for a growing body which is also engaged in sports or physical activity. “This makes bones and muscles weaker and prone to injuries,” she said.
Dr. Hakkalamani explained that the ACL consists of strong bands of tissue that connect the thigh bone or femur to the shinbone or tibia. ACL injuries, in most cases, are sports related injuries caused from sudden stops or changes in direction. “It occurs when the knee gets hit hard; or when the knee moves more than it naturally can,” he said. He added that most ACL tears require surgery and cannot heal on their own, even over time.
Boxer Mary Kom endured an ACL tear during the trials for the Birmingham Commonwealth Games in 2022. The 40-year-old sports enthusiast underwent a surgery soon after, but is yet to compete in any event since.
The commonness of ACL injuries is not limited to India. A 2023 study by the Journal of Athletic Training found that 215,628 ACL injuries occurred in nine sports studied during the 2023-24 academic year in the US, which was higher than what was recorded the previous year.
Recent news reports note that the sports injury centre at the Safdarjung hospital in New Delhi has been upgraded by the government and now includes rehabilitation in hydrotherapy pool and underwater treadmills. There are several privately owned sports rehabilitation centres in Bangalore. The government General Hospital, Jayanagar (Department of Physiotherapy) is a state owned sports rehabilitation and sports medicine center.
Dr K.B Ghosh, an orthopedic surgeon from Kolkata, said that proper safety gear, equipment and adequate training can help prevent ACL injuries. “In sports you cannot avoid an injury, but proper medical treatment of the injury, which can bring the player back to the field after the recovery period, is important,” he said. He suggested that government intervention and attention towards sports injuries should be increased and the sports infrastructure of the country at all levels should be bettered.
