Often with knee injuries the Anterior Cruciate Ligament (ACL) is damaged or torn. In fact, this is one of the most common knee injuries.
Most ACL injuries occur during sports or activities that require sudden pivoting, change of direction or rotation of the knee.
Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.
If you have injured your anterior cruciate ligament, you may require acl surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.
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Symptoms of an acl injury may include a sudden giving way of the knee, a “pop” at the time of the injury or a sudden swelling of the knee joint and pain in the knee when walking. When an acl injury occurs, the knee becomes less stable, and this instability will make sudden pivoting movements difficult. This type of damage to the knee may also make you prone to developing arthritis and cartilage tears. While you still may enjoy daily activities with little discomfort, pivoting activities or sports may prove difficult.
The anterior cruciate ligament can be injured in several ways:
Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.
Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.
Collateral Ligaments
These are found on the sides of your knee. Medial collateral ligament and lateral collateral ligament control the sideways motion of your knee and brace it against unusual movement.
Cruciate Ligaments
These are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.
The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the shinbone from sliding out in front of the thighbone, as well as provides rotational stability to the knee.
Normal knee anatomy
ACL Tear
The knee is made up of four main things: bones, cartilage, ligaments, and tendons.
Description;
Injured ligaments are considered “sprains” and are graded on a severity scale.
Grade 1 Sprains
The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains
A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains
This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.
Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.
During your first visit, your doctor will talk to you about your symptoms and medical history.
During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.
Other tests which may help your doctor confirm your diagnoses include:
Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a broken bone.
This study creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL.
Treatment for an ACL tear will vary depending upon the patient’s individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level and Grade 1 torn. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.
Bracing
Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.
Physical therapy
As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.
Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as scaffolding for a new ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Finally, cadaver graft (allograft) can be used.
Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.
Surgery to rebuild an anterior cruciate ligament is done with an arthroscope using small incisions. Arthroscopic sugery is less invasive. The benefits of less invasive techniques include less pain from in recovery times.
Your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.
If you had surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete’s sport.
