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Anterior Cruciate Ligament Injuries-Treatments and Rate of Success

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Anterior Cruciate Ligament Injuries-Treatments and Rate of Success

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One of the ligaments present in the knee joint is the anterior cruciate ligament (ACL). Injury to the ACL may affect life’s quality. Read to learn more.

Medically reviewed by

Dr. Ranvir Sachin Tukaram

Published At July 21, 2022
Reviewed AtDecember 26, 2023

Introduction

The anterior cruciate ligament is an essential structure of the knee joint, playing a vital role in stabilizing and maintaining joint integrity and function. Torn ACLs are common in athletes and other sports persons who are involved in high-impact games. This article explores the causes, symptoms, diagnosis, and treatment of anterior cruciate ligament injury.

What Is the Anatomy of the Knee Joint?

The knee joint is a complex joint. It is a hinge joint that connects the femur (thigh bone) to tibia (shin bone) and also the smaller bones that run alongside the shin bone. The knee joint is the largest in the body and helps in supporting the weight of the body, doing movements, and stability. The key components of the knee joint are

  • Bone Part:

    • Femur (Thigh Bone): It is the upper leg bone. It is the top part of the knee joint.

    • Tibia (Shin Bone): It is the lower leg bone and is located below the femur bone.

    • Fibula: It is a smaller bone that runs along the tibia and gives lateral support.

  • Cartilages:

    • Articular Cartilage: The ends of three bones, namely the femur, patella, and tibia, are surrounded by a smooth substance called articular cartilage.

    • Meniscus: It is a C-shaped wedge located between the femur and tibia.

  • Ligaments:

    • Anterior Cruciate Ligament: It is present at the center of the knee.

    • Posterior Cruciate Ligament: It is also present at the center of the knee.

    • Medial Collateral Ligament: It runs along the inner side of the knee.

    • Lateral Collateral Ligament: It runs along the outer side of the knee.

  • Muscles: It contains two muscles namely hamstrings and quadriceps.

What Causes Anterior Cruciate Ligament Injury?

ACL injuries happen when there is a sudden restriction, direct blows to the knees, or a change in the direction of the knee. Some of the factors that torn ACL include

  • Sports Activities: Torn ACLs are common in sports that need sudden stops, pivoting, and jumps. Some sports activities that have increased risk for anterior cruciate ligament injuries include basketball, football, skiing, tennis, and soccer.

  • Collision: Activities like a direct blow to the knee may cause a torn ACL. This collision that causes ACL injury happens during sports or accidents.

  • Incorrect Landing While Jumping: Poor or incorrect landing while jumping, particularly when the knee is extended, and the body weight is not distributed equally, may cause a torn ACL.

  • Imbalance of Muscles: Weakness in the muscles around the knees, like hamstrings and quadriceps, may affect joint stability, and that, in turn, may cause injury to an anterior cruciate ligament.

In addition to this, many factors that cause anterior cruciate ligament injury include uneven playing surface, gender, age, and previous injuries. Usually, torn ACL often happens with other injuries in the adjacent ligaments, like tears in the medial cruciate ligament and the meniscus cartilage. Most torn ACLs occur in the middle of the ligament. These torn ACLs do not heal on their own.

What Is the First Aid for a Torn ACL?

The person should raise their leg above the heart level. Then, the person should apply ice on the knee and can take painkillers like Ibuprofen or some other non-steroidal anti-inflammatory drugs.

What Are the Symptoms of ACL Injury?

The symptoms of anterior cruciate ligament injury often vary in their intensity and depend on the extent of the injury. Some of the common symptoms include

  • People often experience immediate pain after an injury that may vary from mild to severe.

  • Knee swelling is a common symptom of anterior cruciate ligament injury that occurs within a few hours after injury.

  • The person may feel instability of the knee. The knee may feel like it cannot support the weight of the body.

  • The person may hear a pop sound at the time of injury. This may not be present in all cases.

  • The person may experience difficulty in bending or straightening the knee. There will be a limited range of motion of the knee due to swelling and pain.

  • The person may experience tenderness on touch over the ligament area.

  • The person may experience discomfort and pain while performing weight-bearing activities like running, walking, and climbing stairs.

  • The person may experience difficulty engaging in physical activities.

How Is Anterior Cruciate Ligament Injury Diagnosed?

The first step to diagnosing torn ACL is taking a proper clinical and personal history. Then, the specialist conducts a local physical examination of the affected areas, followed by medical imaging such as X-rays, magnetic resonance imaging (MRI) scans, and computed tomography (CT) scans to identify the location of the underlying pathology. The treatment plan is then devised accordingly. Arthroscopy is inserted into the knee joint through a small incision to visualize the ligaments and their structures. In addition to this, diagnosis involves the assessment of functional movements.

How Is Anterior Cruciate Ligament Injury Treated?

Treatment plans for torn ACL depend upon the extent of the damage to the joint and may warrant one of the following procedures:

  • Torn ACL may be treated first with conservative treatments like rest and rehabilitation procedures.

  • It can also be treated non-surgically using braces. Braces are used for stability and support of the knee joint during the healing process.

  • Pain and inflammation in the joint can be managed by prescribing non-steroidal anti-inflammatory drugs.

  • The surgical treatments for anterior cruciate ligament injury involve ACL reconstruction. Anterior cruciate ligament reconstruction is done by using arthroscopy. In the ACL reconstruction procedure, a torn ACL is replaced with a graft that is often taken from the patellar or hamstring tendon.

  • After surgery, the person should be instructed to go for physical therapy. Bracing and other supportive measures should be taken postoperatively to achieve better recovery.

Conclusion

ACL reconstruction is considered a somewhat risk-free surgical procedure intended to eliminate knee pain, damaged tissue, and reconstruction of injured ligaments from repetitive strain and overuse. Recovery usually takes a few weeks with certain precautions, occupational therapy, and pain management. Care must be taken to prevent addiction to opioids prescribed for pain management. Reaching out to a specialized healthcare provider may be beneficial.

Frequently Asked Questions

1.

How to Differentiate an ACL Tear and a Sprain?

The anterior cruciate ligament (ACL) is a ligament that interconnects one of the two bones of the leg below the knee and the thigh bone.  An ACL tear is when the anterior cruciate ligament is either partially or fully torn and one can hear a popping sound in the knee during the injury. Whereas in the ACL sprain the ligament is stretched excessively leading to a sprain of the ACL.

2.

Name the Most Common Type of ACL Injury

The ACL injury is generally divided into three grades based on the extent of the injury. Among the three grades, the most common type of ACL injury is grade 3 of ACL injury. In this type of ACL injury, there is a complete tear of the ACL and there is complete disruption of the ligament resulting in an unstable knee joint.

3.

Explain Some of the Common Causes of ACL Injury

A person develops an ACL tear when there is a sudden twisting movement and a rapid change in direction of the movement especially when landing after a jump or pivoting the foot that is firmly placed in the ground. A person may also undergo an ACL tear when there is a sudden, high-impact injury while playing sports involving sudden changes in direction or jumping. The affected individual may hear a popping sound during the incident.

4.

What Is the Recovery Time for an ACL Injury?

 
The recovery time for an ACL injury varies for each individual based on surgical management and rehabilitation therapy. A longer and more successful rehabilitative therapy can reduce the risk of recurrent injury and injury to the opposite knee. In general, it is safe to take around a year for the affected individual to resume their physical activity. 

5.

Is It Possible for an ACL to Self-Heal?

It is not possible for an ACL to self-heal since there is no blood supply to the ligament, especially in cases of complete rupture. An ACL tear is often treated with surgical management. However, in cases of minor injury, physical therapy along with some lifestyle modifications are believed to be effective in individuals who follow a sedentary and inactive lifestyle.

6.

Is It Alright to Walk With a Torn ACL?

An ACL tear often results in instability in the knee joint. It might be alright to walk in straight lines once the pain and swelling in the affected area subside. An affected individual is allowed to walk with a torn ACL after management and intensive physical therapy for rehabilitation. However, it is not recommended to walk soon after the injury which could increase the risk of swelling and pain.

7.

Is It Alright to Bend the Knee After a Torn ACL?

A tear in the ACL can often result in a reduced range of motion in the knee, pain, and swelling. The affected individual might find it difficult to bend and flex the knee after an ACL tear. Usually trying all these movements may increase the intensity of the pain in these individuals. One might be able to bend their knee joint after the surgical management of an ACL tear typically recommended after four to six weeks of rehabilitation.

8.

How Do Doctors Diagnose an ACL Tear?

 
The doctor generally enquires about the history of the injury and performs a thorough physical examination of the affected knee. The doctor may also perform various other provocative tests to rule out other diagnoses. They will perform radiographic investigations such as X-ray, MRI (Magnetic Resonance Imaging), and CT (Computed Tomography) to evaluate the soft tissue and bone structure of the knee joint. 

9.

Are ACL Tears Considered to Be Major Injuries?

ACL tear affects the ligament that provides major stability to the knee joint. Minor injuries can be treated with proper physical therapy and lifestyle modifications. However major cases always require surgical management. Instability in the knee joint after an ACL tear may lead to other major complications like knee arthritis (a painful disease that causes degenerative changes in the knee joint).

10.

Does an ACL tear Always Require Surgical Management?

An ACL tear often causes instability in the knee joint after the injury. Some patients may prefer non-surgical treatment like physical therapy in minor cases with no instability. However, it is recommended to have surgical management in cases with the instability of the knee joint to prevent injuries to other parts of the knee. Non-surgical treatment options might be successful in patients with inactive lifestyles and minor injuries with no symptoms and instability.

11.

Are ACL Reconstructions High-Risk Procedures?

An ACL tear is treated by performing a surgical procedure called ACL reconstruction that involves the repair and reconstruction of the affected ligament. Even though the duration of the procedure is usually shorter, it is still considered to be a high-risk procedure. Like any other surgical procedure, an ACL reconstruction procedure has its own risks. There may be bleeding from the site of surgery, unsettled pain, and long-term stiffness in the knee joint.

12.

How to Strengthen the ACL Ligament?

Performing ACL strengthening exercises regularly can prevent an ACL injury in the long run. Strengthening exercises are performed to strengthen the muscles around the knee joints. Some examples of ACL-strengthening exercises are walking lunges, hamstring lunges, split jumps, and squats. It is also important to strengthen the core muscles to prevent an injury to the ligaments of the knee.

13.

How Can One Support the Healing of Ligaments?

When suspected of a ligament injury in the knee, it is recommended to immediately get help from a healthcare professional. One can support the healing of ligaments by following the R.I.C.E method. R.I.C.E method refers to rest, ice application, compression, and elevation of the affected joint. It is recommended to apply ice immediately after the injury to prevent pain and swelling.

14.

Are ACL Reconstructions Painful Procedures?

ACL reconstruction procedure helps to improve the stability of the knee joint. However, there might be slight pain, swelling, or discomfort post-surgically in the first week. The pain is temporary and gradually reduces over time. The affected individuals are often able to resume their daily normal activities within two to three weeks after the surgery. Patients are advised with pain-reliever medications to alleviate the pain.

15.

How to Self-Test a Possible ACL Tear?

When suspected of an ACL tear, it is always recommended to visit a healthcare provider to get the diagnosis. However, there are a few signs that indicate a possible ACL tear. One can perform a Lachman test with help of a caregiver at home to self-test an ACL tear. The affected individual is in a supine position with the knees bent at 20 degrees. The caregiver is asked to stabilize the person's thighbone with one hand and to slowly pull the shin bone forward. In an intact ligament, the caregiver will be able to feel a catch at the end-limiting the forward motion.
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Dr. Ranvir Sachin Tukaram
Dr. Ranvir Sachin Tukaram

Orthopedician and Traumatology

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knee replacement surgeryacl injury
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