Cruciate Ligament Tear in Sports: From Surgery to Compensation

One moment of a wrong twist on the court, an awkward landing from a jump for a rebound, or a sharp stop on a snowy slope, and behind it lie long months of surgery, crutches and rehabilitation. An anterior cruciate ligament tear, known by its abbreviation ACL, is one of the injuries most closely associated with the world of sport, and every year it strikes thousands of people who train in Israel: footballers, basketball players, skiers, and also those who play in a league with friends once a week.

Beyond the pain and frustration, an injury like this raises weighty practical questions. Who covers the costs of surgery and rehabilitation? What happens when income is affected for months? Is a professional athlete whose career was cut short entitled to increased compensation? And what, in fact, is the difference between the rights of a salaried player on a team and those of an amateur injured at an evening training session?

In this article we explain what the injury is and why it is so common in sport, review the three main compensation routes: insurance under the Sports Law, recognition as a work accident and a tort claim, and clarify how orthopedic disability is determined and how it translates into functional impact and compensation.

What the cruciate ligament is and why it tears specifically in sport

The anterior cruciate ligament is one of the four main ligaments that stabilize the knee joint. It prevents the shinbone from sliding forward relative to the thighbone, and keeps the knee stable during rotational movements. Precisely because of this role, it is injured in movements typical of competitive sports: a sudden change of direction in football, landing from a jump in basketball, sharp braking or twisting of the body while the foot is planted in the ground, as happens in skiing when the ski catches in the snow.

In most cases the tear is not the result of contact with another player but of an internal mechanism, and sometimes a pop is heard at the moment of injury, the knee swells quickly and the sense of stability is lost. Diagnosis is made by clinical examination and an MRI, and the accepted treatment for athletes is reconstructive surgery of the ligament using a graft, followed by lengthy rehabilitation of 6 to 12 months before returning to competitive activity. Not every injured person undergoes surgery: for those who do not engage in strenuous sport, conservative treatment may be possible, but for active athletes, forgoing surgery usually means giving up sports that involve twisting the knee.

The consequences: professional athlete versus amateur athlete

The very same injury can produce entirely different damage in two injured people. For a professional athlete, whose entire livelihood depends on physical ability, a cruciate ligament tear means at least a lost season, and sometimes harm to the value of the contract, to advancement and to the career as a whole. Even a full return to fitness does not erase the period that was lost, and medical studies show that some athletes never return to their previous level.

For an amateur athlete the damage takes a different form: absence from work during the period of surgery and recovery, expenses for physiotherapy and equipment, help at home in the first weeks, and harm to quality of life and leisure activity. This distinction matters because it directly affects how compensation is calculated: the loss of earnings of a professional player is measured against salary and potential in the sport, whereas for an amateur the harm to his civilian occupation is examined.

First route: insurance under the Sports Law

The Sports Law, 1988 imposes on sports associations, unions and organizers a duty to insure the athletes active within them under personal accident insurance, as a general rule and subject to exceptions. It should be emphasized that the duty, insofar as it applies, rests on the organizing bodies and not on the athlete himself: a player registered with an association who is injured in the course of its activity, at training or in a game, is entitled to turn to the group policy and claim the benefits set out in it. However, the insurance duty under section 7 of the Law does not apply to every athlete. Among others, the following were excluded from it: athletes who receive at least the minimum wage in return for participating in competitions; participants in sports activity on behalf of the workplace who are in any event insured as work injury victims; students covered by personal accident insurance for students with respect to the covered activity; and athletes participating in activity for which there is no pay or other consideration. It is important to know that exemption from the insurance duty does not prevent the association from taking out voluntary insurance, nor does it rule out a tort claim where the injury was caused by negligence. The organizing body, insofar as the duty applies to it, must check that coverage exists when the athlete joins and at the start of each season.

This insurance is personal accident insurance, meaning it pays according to a table of amounts set in the policy, based on the rate of permanent disability, the period of incapacity and sometimes also medical expenses, without any need to prove anyone's fault. This is a major advantage, but it also has a limitation: the amounts in group policies are limited to ceilings set in the regulations, and they come nowhere near covering the full damage of a serious injury. Therefore the insurance route is almost always one layer, alongside which additional routes should be examined.

Second route: a work accident for a salaried athlete

A professional player who receives a salary from his team is an employee in every respect, and the team is his employer. A cruciate ligament tear that occurred during an official game, training or related activity on behalf of the team may be recognized as a work accident by Bituach Leumi (the National Insurance Institute). Recognition opens a series of rights: injury allowance at a rate of 75% of salary for the period of incapacity, up to the ceiling set by law; funding of medical treatment related to the injury; and later, determination of work disability by a medical committee.

Disability rates are translated into payment according to tiers set by law: permanent disability at a rate of 9% to less than 20% entitles the injured person to a one-time grant, disability at a rate of 20% or more entitles him to a monthly pension, and permanent disability at a rate lower than 9% does not entitle him to work disability benefit. An athlete whose disability prevents him from returning to his occupation may petition for the application of Regulation 15, which allows the disability degree determined to be increased by up to half of it, taking into account occupation, age and the ability to return to work. For a professional athlete, whose knee is his work tool, such an argument carries added weight. Bear in mind that a rejection of a claim by the National Insurance Institute is challenged by filing a claim with the Regional Labour Court, within the time limit set by law.

Third route: a tort claim where there is liability

Alongside the insurance and Bituach Leumi there is the tort route, which is relevant when a negligent party is responsible for the injury. Not every ligament tear gives rise to such a cause of action: competitive sport carries inherent risks, and someone injured during proper play has to a large extent assumed the ordinary risk of the sport. But the picture changes when the injury was caused by a factor external to the inherent risk, for example:

• A defective playing surface, a hole in the field or synthetic turf that was not maintained as required

• Faulty equipment, such as studded boots supplied in defective condition or a facility that collapsed

• Negligent instruction or a training program that ignored a known limitation of the athlete

• An early and reckless return to activity after a previous injury, contrary to reasonable medical judgment

• A violent or exceptional act by an opposing player, clearly exceeding the rules of the game

In a tort claim, compensation is derived from the full damage: past and future loss of earnings, medical and rehabilitation expenses, third-party assistance, pain and suffering. On the other hand, negligence and causation must be proven, and the proceeding is longer. In many cases the three routes combine, taking into account the rules on deduction and coordination between the various benefits.

Orthopedic disability and functional impact

The disability rate is determined according to the disability criteria in the National Insurance regulations, which also serve as a reference point in tort claims and insurance policies. In knee injuries, the factors examined include joint stability, range of motion, damage to the cartilage and meniscus that often accompanies a ligament tear, and signs of degenerative changes. A tear that was successfully operated on may leave a relatively modest disability rate, whereas a knee that remained unstable or developed early wear will receive a higher rate.

But the medical number is only half the picture. The decisive question is the functional impact: what that disability does to the injured person's life and earning capacity. An orthopedic disability of 10% in a lawyer who sits in an office is not like the same 10% in a striker in the Israeli Premier League or in a ski instructor. The courts recognize that for those whose livelihood depends on their body, a moderate medical disability may embody a severe functional loss, and this directly affects the amount of compensation. Therefore the medical opinion, and the way the functional impact is worded, are of decisive importance in handling the case.

Rehabilitation, documentation and return to competition

Rehabilitation after reconstructive surgery is a graded process: reducing swelling and restoring range of motion, building muscle strength, stability and coordination training, and finally a gradual return to running, jumping and contact. The decision to return to competition should be made on the basis of fitness tests and not on the basis of the calendar alone, since returning too early significantly increases the risk of a repeat tear.

From the legal angle, the rehabilitation period is also the period of building the case. It is worth keeping every document: the surgery summary, the orthopedist's follow-ups, the physiotherapy records, receipts for expenses, incapacity certificates and correspondence with the team or association. A real-life scenario illustrates this: an amateur football player injured on a neglected municipal pitch struggled a year later to prove the condition of the surface, until photos taken on the day of the game were found. Documentation collected in real time saves entire evidentiary battles later on.

Why it is important to act early

Each of the routes has its own time limits. Insurance policies set a duty to notify the insurer within a fixed period, and a claim against an insurance company becomes time-barred 3 years after the insured event. A tort claim generally becomes time-barred after 7 years. Applications to the National Insurance Institute also have time limits set by law, and delay may prejudice the rights involved. Beyond the deadlines, early action makes it possible to choose the right sequence of steps between the routes, a decision with real consequences for the final outcome.

Summary

A cruciate ligament tear is an injury that begins in one moment on the field but stays with the injured person for long months, and sometimes changes the course of an entire career. The legal rights are spread across the association's insurance policy, the Bituach Leumi work accident system and a tort claim against whoever was negligent, and each route operates according to its own rules, deadlines and ceilings. Choosing the right path and aligning the medical opinion with the injury's true functional impact are what determine the outcome.

If you were injured on the field and are unsure where to start, Yaniv Gavish Law Office accompanies professional and amateur athletes through every stage, from the first notice to the insurer to the judgment. To schedule a call: 4 Berkowitz St., Tel Aviv, telephone 076-5385862.