Leading surgeon points to alarming number of injuries here as competitors push their bodies further

This article was published in the Irish Independent on 20th February 2023.

A leading surgeon has said the incidence of anterior cruciate ligament (ACL) injuries in Ireland is among the highest in the world, as sports popular here have a high risk for the injury.

Brian Devitt, a consultant orthopaedic surgeon at the UPMC Sports Surgery Clinic in Santry and Professor of Orthopaedics and Surgical Biomechanics at Dublin City University, said he is also seeing more ACL injuries as the number of women taking part in sport is on the rise.

“In GAA, hurling and rugby, the ball is often played overhead, above a player’s eye-line,” Prof Devitt said.

“When a player is fielding a high ball, landing, and trying to avoid an opponent by pivoting, there is a lot going on which requires huge co-ordination. Unfortunately, when this co-ordination fails, even momentarily, it can put the knee at risk of giving way, and that’s why there’s a high rate of ACL injuries here.

“There are lots of times during a match when players aren’t aware of how they are landing when trying to catch the ball. An injury can happen in a microsecond, and that’s especially true for the sports we love in Ireland,” he added.

“The ACL controls the forward motion of the knee and also, most importantly, rotation. If you are changing direction, such as side-stepping, then your ACL is working. In the majority of cases – roughly 70pc – ACL injuries occur without contact with an opponent.

“A rupture typically happens when a player is pivoting, or changing direction at speed.

“The other reason we are seeing such a high incidence of ACL injuries in Ireland is because the level of female participation in sports is surging, which means we are seeing comparable ACL numbers now in women.”

The source of the trouble, the ACL, is a 3.5cm piece of connective tissue which links the shin bone to the thigh bone, located in the middle of the knee.

When the ligament pops or snaps, it may require surgical reconstruction as it has a limited capacity to heal. This is especially recommended in young, active individuals returning to a pivoting sport.
ACL reconstruction surgery is reasonably routine, but it can be complex if there is additional cartilage damage.

There is no guarantee of success, particularly in young patients, who are high-risk.
“It is tragic when an ACL reconstruction fails, and, unfortunately, we do have higher failure rates than we would like in our younger population,” Prof Devitt said.

‘In GAA, hurling and rugby, the ball is often played overhead, above a player’s eye-line,’ Prof Devitt said.

“We understand some of the reasons for this, but not all. This is one of the questions I would like to address in my clinical research.”

Prof Devitt went to school at Belvedere in Dublin’s north inner city, where he excelled academically and in sport, playing rugby for the school team. He studied medicine at UCD, and continued to play rugby.

“Given how much I was involved with sport, it seemed like a natural progression to head for a career that would involve sport, and orthopaedic surgery was the ideal speciality for me,” he said.
After UCD, he completed his orthopaedic training at the Royal College of Surgeons in Ireland, before heading overseas on a fellowship in the US, Canada and Australia.

My research is looking outside the knee for new solutions – not simply doing a reconstruction of the ACL, but a procedure outside the knee.

He also found time to raise a family with his wife Marina, with whom he has three children, aged 10, eight and six.

“We have the unique distinction of having three children, all born on different continents. As such, our children all have at least three passports,” he said.
He decided to return home last year, when he accepted a role where his time would be divided between clinical work at the Santry clinic and research at DCU.

Since returning he has been staggered by the number of ACL injuries coming through his clinic door.

“I worked at a hospital in Melbourne for a number of years, and saw a lot of ACL injuries – which was not a surprise given how devoted the Aussies are to sport,” he said.

“Ireland though is totally bonkers about sport, and the volume of ACL injuries I’m seeing in Santry certainly surpasses the numbers I experience in Melbourne.”

He sees injury reduction as a big part of his new role, and he does not want to be a surgeon interested only in treating injuries.

“An ACL injury is traumatic for the person who suffers it, and it can increase the risk of earlier onset of arthritis,” he said. “A successful reconstruction of the ligament can get someone back playing sports and perhaps delay the onset of arthritis later in life, though we can’t prevent it.

“A big research question for me is how we can reduce ACL injuries as we will never be able to totally prevent them from happening.

“My research is looking outside the knee for new solutions – not simply doing a reconstruction of the ACL, but a procedure outside the knee. We want to improve our surgical techniques, and also to use biomarkers, which can hopefully inform us about who is at great risk for arthritis.”