The Times - UK (2020-10-20)

the times | Tuesday October 20 2020 2GM 63

Sport

ACL can’t heal itself – graft is

needed to grow new ligament

Phil Hayward

Former Wolves head of medical

I

t is virtually impossible for a

footballer to compete at the

highest level without an intact

anterior cruciate ligament (ACL).

The ACL sits within the knee joint

and is one of the four main ligaments

that connect the femur (thigh bone)

to the tibia (shin bone).

It commonly tears when the knee

buckles inwards at the same time as

the tibia rotates outwards. This can

occur without contact from an

opponent when a player’s studs

become stuck in the turf as they try to

change direction. This is how Michael

Owen tore his ACL at the 2006

World Cup for England against

Sweden.

ACL injuries are less frequently

caused by tackles. Jordan Pickford’s

challenge from the side on Virgil van

Dijk forced the defender’s knee

inward into an externally rotated

position, tearing the ligament.

Unlike most other ligaments, the

ACL is unable to heal itself once torn.

Once it tears, the two ends are no

longer in close proximity to each

other and there is no possibility for

scar tissue to bridge the gap.

Ligament reconstruction is the only

option.

Van Dijk will need another piece of

tissue from his body to create a new

ligament where the ACL once was.

Surgeons tend to use either a part of

the patellar tendon, a strip of the

hamstring tendon or, less commonly,

a section of the quadriceps tendon.

The damaged ACL is removed

using keyhole surgery and holes are

drilled in the tibia and femur where

the new ligament will be positioned.

The graft is attached to the joint by

screws.

The surgeon will then examine the

joint and tidy up any cartilage that

may have been damaged when the

injury occurred. This can often add

time to the recovery process.

Depending on the complexity of

the surgery and the extent of the

damage to other structures in the

knee, this will take between six and

nine months.

6 Phil Hayward is the director of

performance and sport science at LA

Galaxy and the former head of medical

at Wolverhampton Wanderers

Patella

Femur

Tibia

Meniscus

Intercondylar

notch

Ptll

What does the ACL do?

The anterior cruciate ligament is one of

the four main ligaments in the knee that

connect the femur to the tibia and

prevents the tibia from shifting too far

forward when moving. It can tear when

landing a jump or making a sudden turn

Quadriceps

Anterior

cruciate

ligament

Tear

season and Villa were the one club

brave enough to go after him. He

looks calm and collected and holds

things together — and it makes such

a difference when you have a

goalkeeper and a back four who trust

each other.

The real problem with the 2019

transfer window was the money

wasted on forwards. Wesley cost

£22 million and managed five league

goals. Villa brought in Jota and

Mbwana Samatta too, and neither of

Aston Villa were heavily criticised for

the way that they spent last summer.

They shelled out nearly £135 million

— including on three new defenders

— and conceded 67 goals, which was

the second-worst total in the Premier

League behind 20th-placed Norwich

City.

Before the Premier League

restarted, Villa were down. They

appeared out of it. It took a serious

upturn in form in July — when they

drew with Everton and beat Crystal

Palace and Arsenal — to save them

from relegation.

Understandably, given the goals

they conceded in the first part of last

season, the back four came in for flak.

In this mad season Villa have the blend to go a long way

But if you look at the team that

started in the 1-0 victory against

Leicester City on Sunday, three of

them were signed last year. They

added Matty Cash from Nottingham

Forest this summer, but Ezri Konsa,

Matt Targett and Tyrone Mings all

joined permanently after Villa were

promoted.

Look at them now. They have

conceded two goals this season —

both of them against Liverpool. It

seems as though Villa worked

tremendously hard during the period

when there was no football — they

were very good at the end of last

season — and the influence of John

Terry on that back four appears to be

growing. He is one of the great centre

halves and since Craig Shakespeare

joined Villa in August as an assistant

head coach, Terry seems to have had

more time to focus on improving

Villa’s defence.

Another factor is Emiliano

Martínez, the goalkeeper. He was

excellent for Arsenal at the end of last

them performed. Managers rarely get

big money twice if they haven’t

delivered the first time but Dean

Smith has had that luxury. It is

difficult to know how much say Smith

has in transfers — Villa sacked their

sporting director Jesús García Pitarch

in July and replaced him with Johan

Lange — but the owners seem to

have backed him, or at least the

team, again. Smith worked with

Ollie Watkins at Brentford and

they bought him for nearly

£30 million, as well as Bertrand

Traoré, Martínez and Cash.

Smith now has a lovely

blend of players. Jack

Grealish is given free rein

to create and exploit

space, then he has the

pace of Watkins and

Ross Barkley driving

forward, which will

continue to cause

problems. He also has the advantage

of having no European commitments

and few players leaving on

international duty. With no

substantial break for pre-season, that

could be crucial. So, too, could having

players such as Grealish, Cash and

John McGinn, who probably think

that they have a point to prove —

that is always excellent for

motivation.

It is early days for Villa, but in

38 years involved in the game I

have never seen a season like

this. The volume of goals,

deflected goals, the

general madness — it’s

difficult to say exactly

what has caused the

chaotic results, because

on every level so

much has changed.

Villa have adapted

nicely to it — and in

this mad season, who’s

to say that cannot take

them a long way?

Tony Cascarino

How Villa have improved

This

season

Villa PL stats per

game

Last

season

3 Goals 1.1

0.5 Conceded 1.8

14.5 Shots 12.1

11.3 Shots faced 16

45.9 Possession (%) 43.3

14.3 Tackles 13.8

13.5 Interceptions 11.1

Martínez has brought

calmness and security

Van Dijk’s potential return. “He will be

out for a pretty long time and that’s

what the situation is. I expected it pret-

ty much on Saturday after the game

immediately, especially when I saw the

challenge back. I saw it the first time

only from the bench, and when I saw it

back I was pretty clear that he will be

out for a long time.We are there for him.

He knows that and we will wait for him

Everton players threatened online

like a good wife is waiting when the

husband is in jail.”

The absence of Van Dijk, 29, for what

is likely to be at least seven months

leaves Liverpool’s defensive resources

stretched. Joël Matip underwent a scan

on Saturday but no serious issue was

detected. Klopp will, however, have a

decision on whether to play the centre

back in the Champions League against

Ajax tomorrow.

Liverpool play Sheffield United on

Saturday and Matip has not played

three games in a week for more than a

year because of injury problems.

The FA has yet to clarify whether the

Liverpool captain Jordan Henderson

will face sanctions for suggesting VAR

officials “bend the lines” to disallow

goals deliberately. Henderson had seen

a late winner ruled out after Sadio

Mané was adjudged to be offside and

spoke out in a television interview.

Meanwhile, Merseyside police have

said they will take action against

the perpetrators of abusive and

offensive tweets sent to two Everton

players, believed to be Pickford and

Richarlison.

Richarlison, the Brazil international,

was sent off for a foul on Thiago Alcân-

tara in the closing stages of the game

and later apologised for the incident.

A police spokesman said the

language used in the social media posts

directed at the duo was “totally

unacceptable” and they were taking the

reports “extremely seriously”.

Detectives are continuing with their

inquiries and the spokesman added:

“Those who use the internet to target

others, and who commit criminal

offences such as making threats or

committing a hate crime in doing so,

are not beyond the law.

“Where we identify offences, we will

take action to bring those responsible to

justice.”

continued from back

JOHN POWELL/LIVERPOOL FC/GETTY IMAGES

Van Dijk is ruled offside and no

further action is taken. At no

point do replays show the

tackle is checked for a red card

David Coote, the VAR, checks

if Van Dijk was onside and

therefore if a penalty should

have been given to Liverpool

Van Dijk is felled by Pickford

but referee Michael Oliver

blows his whistle for offside

as Liverpool players protest

Did officials

only check

for offside?

Referee

Van Dijk