Anterior Cruciate Ligament (ACL) is present inside the knee joint within the capsule and it prevents excessive anterior translation of tibia over femur.
Anterior Cruciate ligament injury or ACL tear is relatively common problem of knee in athletes and is the most debilitating knee ligament injury compared to other ligament injuries.
Sports that require frequent tackles, pivot and sudden change in directions like football, rugby, basketball, tennis, volleyball, hockey, dance, and gymnastics have high incidences of ACL injury.
An ACL injury is a sports-related knee injury. Most often ACL tears occur when pivoting or landing from a jump. The knee starts gives way from under surface following ACL tear.
(pic- ACL injury while pivoting)
Female athletes are more prone to ACL tear. Theories for females being more prone suggests recruitment pattern paradoxy of quadriceps and hamstring muscles, hormonal and biomechanical difference to male counterpart.
Pain around anteromedial region of knee, swelling and ecchymosis, joint giving way from under surface are common complaints of the patient.
Clinical examination will reveal signs of ACL ligament instability. The common special ACL tests are Anterior Drawer Test and Lashman test.
An MRI may be needed to find the extent of injury (grade) and if any associated injury within the knee which is common.
The symptoms of ACL tear may start settling within a few weeks, but as patient starts to feel better there are chances that the knee joint may start giving way at this point of time.
All ACL tear doesn’t need reconstruction surgery. The factors that decide whether a patient with ACL tear is a suitable case for ACL reconstruction-
- Age of the patient
- Grade of ACL tear.
- Regular participation in sporting activity which needs a functional ACL.
- Feeling of knee instability
- Future plans
NOTE: If a person with ACL tear doesn’t participate in a multi-directional sport which requires a functional ACL and doesn’t have feeling of unstable knee, he doesn’t need to undergo ACL reconstruction surgery.
A patient can undertake a comprehensive ACL – Rehabilitation Program to avoid ACL reconstruction surgery. This involves leg strengthening, proprioception and high-level balance training plus sport-specific agility and functional training.
The aims of physiotherapy treatment are:
- Reduce pain and inflammation.
- Normalise joint range of motion.
- Strengthening the knee muscles.
- Strengthening the lower limb muscles.
- Improve patellofemoral (kneecap) alignment.
- Normalise muscle lengths/ stretches.
- Improve proprioception and balance
- Improve functionality e.g. walking, running, squatting, hopping and landing.
- Minimize re-injury.
We at pain free help diagnose your problem and efficiently treat it. Contact an expert at our clinic for the best advice.
A knee surgeon is the best person to discuss whether ACL reconstruction is advisable or not.
The surgery that is usually undertaken for an ACL tear is called ACL reconstruction. A repair of the anterior cruciate ligament is rare and thus the ACL is reconstructed using another tendon or ligament to substitute for the torn ligament.
Post-Surgical ACL Rehabilitation
Post-operative ACL rehabilitation is one of the most important, yet too often neglected, aspects of ACL reconstruction surgery. One must undergo physiotherapy rehabilitation post-surgery for quicker and better outcome.
Post-surgery ACL rehab focuses on restoring full knee motion, strength, power and endurance, balance and proprioception and agility training which should be individualized to one’s specific sporting or functional needs.
Return to Sports after an ACL Injury
The return to sports after ACL injury is quite difficult even after reconstruction surgery and at times athlete/ individual have to give up the sporting activity.
The best chance of returning to sports post-ACL tear is to undergo intensive post operative physiotherapy rehabilitation.
A knee strengthening, agility and proprioceptive training program is the best way to reduce the chance of a knee ligament sprain. Premature return to high-risk activities such as sport may increase the chance of reoccurrence.
For more information, please contact us.