What is an ACL (Anterior Cruciate Ligament) Injury?
One of the most common problems involving the knee joint is an anterior cruciate ligament (ACL) tear.
The anterior cruciate ligament is one of four ligaments that are critical to the
stability of the knee joint.
The ACL is made of tough fibrous
material and functions to control excessive motion by limiting joint
mobility. Of the four major ligaments of the knee, the ACL injury is
the most common knee ligament injury.
How does an ACL tear occur?
An ACL tear is usually a sports-related injury.
About 80% of sports-related ACL tears are "non-contact" injuries. This means that the injury occurs without the contact of another player, such as a tackle in football. Most often ACL tears occur when pivoting or landing from a jump. The knee gives-out from under you when the ACL is torn.
Female athletes are known to have a higher risk of injuring their ACL (anterior cruciate ligament), while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. There are some suggestions it is biomechanical, strength and hormonally related.
What are the Signs of an ACL Tear?
The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear commonly sustained an injury to the knee. The injury is often sports-related. They may have felt or heard a "pop" in their knee, and the knee usually gives-out from under them.
ACL tears cause significant knee swelling and pain.
On examination, your physiotherapist or sports doctor will look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament and the extent of that tear.
An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee, such as bone bruising or meniscus damage.
Is ACL Reconstruction Surgery Always Necessary?
ACL tears do not necessarily require surgery. There are several important factors to consider before deciding to undergo ACL surgery.
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Do you regularly perform activities that normally require a functional ACL?
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Do you experience knee instability?
If you don't do multidirectional sports that require an ACL, and you don't have an unstable knee, then you may not need ACL surgery.
However, we strongly suggest that you discuss your knee injury after a thorough examination from a knee injury specialist such as a sports physiotherapist, sports physician or knee surgeon.
What are the ACL Treatment Alternatives to Surgery?
Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist.
To avoid surgery these patients should undertake a comprehensive knee rehabilitation program that involves strengthening, proprioception and high level balance retraining, plus sport-specific agility and functional enhancement.
Sports physiotherapists specialise in these ACL deficient knee rehabilitation exercises.
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Surgery for an ACL Tear
The usual surgery for an ACL tear is called an ACL reconstruction. A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament.
There are several options for how to perform ACL surgery.
The most significant choice is the type of graft used to reconstruct the torn ACL. There are also variations in the procedure, such as the new 'double-bundle' ACL reconstruction.
You may have heard of a Lars Procedure, which is a new ACL reconstruction procedure. In some, but certainly not all, ACL ruptures a stub of the old ligament can be used as a part of the repair procedure, which can hasten your recovery time. Your surgeon will know whether a Lars procedure is an option for you or not.
Risks of ACL surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that better than 90% of patients have no complications with ACL surgery.
Post-Surgical ACL Rehabilitation
Post-operative ACL rehabilitation is one of the most important, yet too often neglected, aspects of ACL reconstruction surgery.
The most successful and quickest outcomes result from the guidance and supervision of an experienced Sports Physiotherapist.
Your rehabilitation following ACL surgery focuses on restoring full knee motion, strength, power and endurance. You'll also require balance, proprioception and agility retraining that is individualise towards your specific sporting or functional needs.
As mentioned earlier your sports physiotherapist is an expert in this field. We suggest you contact them for the best advice in your circumstances.
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Common ACL (Anterior Cruciate Ligament) Treatments
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What Sports have a High Incidence of ACL Tears?
Many sports require a functioning ACL to perform common maneuvers such as cutting, pivoting, and sudden turns.
These high demand sports include football, rugby, netball, touch, basketball, tennis, volleyball, hockey, dance, gymnastics and many more.
You may be able to function in your normal daily activities without a normal ACL, but these high-demand sports may prove difficult.
Therefore, athletes are often faced with the decision to undergo surgery in order to return to their previous level of competition. ACL injuries have be known to curtail many promising sporting careers.
How to Prevent ACL Tears?
Preventing ACL tears has been the focus of recent research, especially the prevention of ACL tears in female athletes. Numerous theories have been proposed to explain why people may tear their ACL, and how they can be prevented.
Current investigations have focused on neuromuscular training to prevent ACL tears. Just as we know that ACL reconstruction patients who have extensive post-operative physiotherapy to rebuild their strength, proprioception and agility we do know that these same exercises can help prevent an ACL injury in the first place. For more advice, please consult with your sports physiotherapist.
ACL Tears in Children
ACL reconstruction surgery is the standard treatment for young, active people who sustain an ACL tear. But what happens when you’re young? Should ACL surgery be delayed until the child is older, or should ACL reconstruction be performed before skeletal maturity?
The concern of performing ACL surgery in children is that there is a risk of causing a growth disturbance in growing children. Growth plate problems as a result of ACL surgery could potentially lead to early growth plate closure or alignment deformities.
However, recent research is showing that the risk of growth plate problems is much less then the risk of permanent knee damage if the ACL is not fixed.
Your knee surgeon is the best person to discuss whether ACL reconstruction is advisable or not.
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FAQs about ACL (Anterior Cruciate Ligament) Injuries
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