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Anatomy of Anterior Cruciate Ligament injury

Anterior Cruciate Ligament Injury (ACL tear)

The anterior cruciate ligament is located deep in your knee joint and prevents the shin bone (the tibia) from slipping forward from the thigh bone (the femur).

Symptoms:

Following a collision or fall to the ground you will experience an Instant pain in the knee, which increases with weight bearing . You will be unable to play on after this type of knee injury. You may hear a popping sound at the time of the injury and the knee will feel unstable. Swelling will usually occur within 2 hours. You are likely to have reduced range of motion in the knee in the following 48 hours and pain on weight-bearing.

ACL injuries often occur in combination with other injuries, such as meniscal tears, medial collateral ligament (MCL) tears and occasionally fractures and vascular injuries that need immediate medical attention.

Onset:

Is sudden and can be traumatic e.g. a tackle or collision but the majority of cases are actually non -traumatic and occur when quickly changing direction, slowing down or landing .

Aggravating Factors:

Weight-bearing / walking /instability when changing direction or twisting/ pivoting on the knee.

Easing Factors:

Avoiding aggravating factors/ Using Ice and devices to enable you to strengthen whilst reducing the load placed on your e.g a knee support or hydrotherapy belt.

Management:

Some people will have surgery to reconstruct the ACL ligament using either the hamstrings or patellar tendon graft. Others will not undergo surgery but both groups will undergo an intensive course of rehabilitation for around 12 months. Whether your management is surgical or non-surgical your rehab will involve the principles of POLICE. (protection , optimal loading , ice, compression and elevation).

In the acute phase, pain and swelling management is key and can be achieved with the use of ice (cryotherapy products) alongside medication. The use of products such as hydrotherapy belts and braces to offload the knee joint, whilst still allowing for joint movement and muscle strengthening, is advised.

Achieving a normal walking pattern, full knee range of motion and lower limb Strength, kinetic (neuromuscular) control and endurance are all key. Specific drills and tests for a variety of sports under the supervision of a physiotherapist are essential before returning to play.

References:

Alshewaier S, Yeowell G, Fatoye F. The effectiveness of pre-operative exercise physiotherapy rehabilitation on the outcomes of treatment following anterior cruciate ligament injury: a systematic review. Clin Rehabil. 2017;31(1):34-44.

Grindem H, Granan LP, Risberg MA, Engebretsen L, Snyder-Mackler L, Eitzen I. How does a combined preoperative and postoperative rehabilitation programme influence the outcome of ACL reconstruction 2 years after surgery? A comparison between patients in the Delaware-Oslo ACL Cohort and the Norwegian National Knee Ligament Registry. Br J Sports Med. 2015;49(6):385-9

Monk AP, Davies LJ, Hopewell S, Harris K, Beard DJ, Price AJ. Surgical versus conservative interventions for treating anterior cruciate ligament injuries. Cochrane Database Syst Rev. 2016;4:CD011166.

van Melick N, van Cingel RE, Brooijmans F, Neeter C, van Tienen T, Hullegie W, et al. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016;50(24):1506-15.





Knee Injuries