What is ACL (Anterior Cruciate Ligament)?
Sports and physically active people have often heard of an ACL (Anterior Cruciate Ligament) injury or perhaps experience this injury personally. The injury is the tearing of one of the major ligament in the knee, the anterior cruciate ligament. This injury happens in the knee during physical activity that involves jumping, a sudden stop or change in direction. Many athletes who play tennis, volleyball, basketball, football or downhill skiing experiences the tearing of the anterior cruciate ligament.
People that have experienced an ACL injury describes hearing or feeling a ‘popping’ at the moment of the injury. The knee will almost immediately swell and will not be able to bear any weight; the injury is also painful.
The treatment or rehabilitation program to follow will depend on how severe the injury experienced. Treatment actions often involve rehabilitation exercises to regain stability and strength in the knee. A knee support brace could also be worn to stabalise the knees. In severe cases, surgery may be needed to replace the ligament which is then followed by physiotherapy. The risk of experiencing an ACL injury is lessened with proper training and stretching.
ACL Injury Symptoms
People that have experienced an ACL injury describes the following symptoms at the moment of injury:
- A “popping” sensation at the moment of injury
- Instant swelling of the injured knee
- Severe pain in the knee
- Unable to straighten the injured knee and limited movement
- Feeling as if the knee is unstable and unable to bear any weight
- Heat emanating from the knee due to bleeding or inflammation in the knee joint
The feeling of instability in the knee will be felt more when placing any strain on the knee, for example climbing or going downstairs. An ACL injury is not a progressive one, meaning an injury that manifests symptoms sometime after the moment of injury, rather the tear is sudden and felt almost immediately.
The pain and swelling in the knee will subside with home treatment and therapies over a few weeks. However, the feeling of instability and weight bearing pain will remain until proper treatment and care are administered. People with the injury will experience difficulty or have limited movement, for example, they may experience standing up from a seated position painful and difficult.
A medical practitioner will conduct a series of physical exams to eliminate any other potential causes of the discomfort and to determine how severe the injury is to the knee. The tests conducted are the following:
• MRI (Magnetic Resonance Imaging): An MRI will allow a doctor to see hard and soft tissue of the knee. The scan will show any injury and damage to the knee.
• Ultrasound: The sound waves will show any injuries to the tendons, muscles, and ligament of the knee.
• X-ray: Although an X-ray will not show any damage to the soft tissues, it will show if there are any damages to the bone in the knee.
A series of tests to check the movement and weight bearing ability of the knee joint will also determine the type and extent of the injury.
As soon as you suspect a torn ACL, it is advised to see a medical professional as soon as possible. You will need to determine the nature and severity of the injury, as well as consult an orthopedic surgeon should you need surgery.
As with any injury to a joint, the immediate care to apply would be the P.R.I.C.E therapy principles. P.R.I.C.E. stands for Protection, Rest, Ice, and Elevation. A cold compress must be applied for the first 72 hours or until you see a doctor. A cold compress will help ease the swelling and inflammation.Severe swelling may make proper diagnosis difficult for a medical practitioner. Should the swelling be very bad, the doctor will refer you for X-rays, Ultrasound or an MRI, and then refer you on to an orthopedic surgeon.
The decision to operate or not is always a controversial one. There are many factors to take into consideration when deciding on surgery. The surgeon will need to consider factors such as the age of the person, their lifestyle, occupation and the level of instability and injury. The orthopedic surgeon will be best to advise on the course of treatment to follow. Surgery is usually done as soon after the injury as possible or when the swelling has subsided, and the knee has settled.
Cruciate Ligament Surgery
Surgery involves repairing the tear by stitching the ligament together, or by grafting where new tissue is attached to the torn ligament. A reconstruction process involves removing the torn ligament and using a tendon from another area of the body to replace the ligament. For sometime, after surgery, the knee will still have limited movement as it heals and you may still experience some instability and pain. Surgeons advise a recovery period of six months that includes physiotherapy sessions to restore normal mobility to the knee.
Recovery time after surgery
Recovery time will differ in each case, as well as with surgery and reconstruction. It is advised that normal functionality and mobility will return to the knee within 4 to 5 months. It is possible not to have your knee return to the way it was before the injury even one year after surgery. You may still experience some minor issues with the knee joint.
Do not be alarmed if you experience some bruising, swelling or pain after surgery as this is normal due to an accumulation of fluid in the knee. All post surgery symptoms are temporary and will start to reduce after a week.
Physical therapy rehabilitation
Treatment for an ACL injury will also involve several weeks of physical therapy. You will need to follow a set of exercises that aim at improving mobility and strength of the knee joint. The therapies will also help to lessen the swelling and pain post-surgery. Physical therapy is useful for those that are not very active and only engage in recreational sports.
An ACL injury is a severe injury that is easily treatable with immediate and proper medical care. Be sure to seek medical attention as soon as you suspect a torn ACL.