Anterior Cruciate Ligament (ACL) INJURY
Dr Mohan Kumar J FASM,FSA
Consultant Orthopaedician & Arthroscopy Surgeon
An ACL injury is a tear or sprain of the anterior cruciate ligament (ACL) — one of the
major ligaments in your knee. ACL injuries most commonly occur during sports that
involve sudden stops or changes in direction, jumping and landing — such as
basketball, football and road traffic accidents.
Many people hear or feel a "pop" in the knee when an ACL injury occurs. Your knee
may swell, feel unstable and become too painful to bear weight.
Depending on the severity of your ACL injury, treatment may include rest and
rehabilitation exercises to help you regain strength and stability or surgery to replace the
torn ligament followed by rehabilitation. A proper training program may help reduce the
risk of an ACL injury.
Signs and symptoms of an ACL injury usually include:
· A loud "pop" or a "popping" sensation in the knee
· Severe pain and inability to continue activity
· Rapid swelling
· Loss of range of motion
· A feeling of instability or "giving way" with weight bearing
When to see a doctor
Seek immediate care if any injury to your knee causes signs or symptoms of an ACL injury. The knee joint is a complex structure of bones, ligaments, tendons and other tissues that work together. It's important to get a prompt and accurate diagnosis to determine the severity of the injury and get proper treatment.
During the physical exam, your doctor will check your knee for swelling and tenderness — comparing your injured knee to your uninjured knee. He or she may also move your knee into a variety of positions to assess range of motion and overall function of the joint.
Often the diagnosis can be made on the basis of the physical exam alone, but you may need tests to rule out other causes and to determine the severity of the injury. These tests may include:
· X-rays. X-rays may be needed to rule out a bone fracture. However, X-rays don't show soft tissues, such as ligaments and tendons.
· Magnetic resonance imaging (MRI). An MRI uses radio waves and a strong magnetic field to create images of both hard and soft tissues in your body. An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee, including the cartilage.
Prompt first-aid care can reduce pain and swelling immediately after an injury to your knee. Follow the R.I.C.E. model of self-care at home:
· Rest. General rest is necessary for healing and limits weight bearing on your knee.
· Ice. When you're awake, try to ice your knee at least every two hours for 20 minutes at a time.
· Compression. Wrap an elastic bandage or compression wrap around your knee.
· Elevation. Lie down with your knee propped up on pillows.
Medical treatment for an ACL injury begins with rehabilitative therapy. A physical therapist will teach you how to do exercises that you will perform either with continued supervision or at home. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee.
The goal of rehabilitation is to reduce pain and swelling, restore your knee's full range of motion, and strengthen muscles. This course of physical therapy may successfully treat an ACL injury for individuals who are relatively inactive, engage in moderate exercise and recreational activities, or play sports that put less stress on the knees.
Your doctor may recommend surgery if:
· You're an athlete and want to continue in your sport, especially if the sport involves jumping, cutting or pivoting
· More than one ligament or the meniscus in your knee is also injured
· The injury is causing your knee to buckle during everyday activities
During ACL reconstruction, the surgeon removes the damaged ligament and replaces it with a segment of tendon — tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft.
Your surgeon will use a piece of tendon from another part of your knee
After surgery you'll resume another course of rehabilitative therapy. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee.
There's no set time frame for athletes to return to play. In general, it takes as long as a year or more before athletes can safely return to play. Doctors and physical therapists will perform tests to gauge your knee's stability, strength, function and readiness to return to sports activities at various intervals during your rehabilitation. It's important to ensure that strength, stability and movement patterns are optimized before you return to an activity with a risk for ACL injury.