With an increasing focus on sports right from the school going age, there has been a rise in the injuries to knee ligaments. Knee ligaments are mainly injured from indirect twisting or bending forces on the knees. Ligaments are simply a band of connective tissue that connect a bone to another bone; of all the four ligaments of the knee, the Anterior Cruciate Ligament (ACL) is most commonly injured. This happens in association with tears of medial or lateral collateral ligaments. ACL injury is a common sports injury affecting athletes, and women are more susceptible to this injury than men.
ACL is a vital internal stabilizer of the knee joint that connects the lower part of the thigh bone to the upper part of the shin bone. The prognosis of this injury mainly depends upon the severity of the tear and the extent up to which the stability of the knee joint is affected. The degree of tear varies from a rupture of just a few fibers to a complete tear.
Causes Of ACL Injury
This injury occurs because of excessive stress on the knee, as in the following cases:
- A very hard hit on the side of your knee during a game of football
- When you hyperextend your knee joint
- Suddenly and quickly stop moving and change direction while running or turning
- Landing from a jump incorrectly
- Pivoting with your foot firmly planted
ACL tears are common in sports such as basketball, football, and skiing. ACL injuries also occur with other injuries such as tears to the medical cruciate ligaments and the shock absorbing cartilage of the knee. Common site for ACL tears is the middle of the ligament, or the ligament is pulled off the thigh bone. These injuries form a gap between the torn edges and do not heal on their own.
Signs And Symptoms Of ACL Injuries
- The most common complaint which calls for a doctor’s visit is pain, swelling, and stiffness of the knee.
- Patient will hear a pop sound of a tear in the knee joint, which is usually preceded by a deforming force at the knee.
- Severe pain with inability to continue activity
- Swelling that begins within a few hours
- Loss of range of movement
- Sensation of instability or giving away with weight bearing
A complete clinical examination is required for its diagnosis. Plain X-ray and MRI scan maybe advised to confirm diagnosis and determine the extent of tear and involvement of other structures.
Treatment
Traditional treatment methods include non-operative methods; however, newer methods that involve surgery have been developed. Due to the widespread availability of newer techniques and its increasing demands, especially in young athletes, better results have been obtained by operative reconstruction of ligaments. These reconstructive surgeries are mainly done for complete ACL tear. In this surgery, repair and reconstruction of the ACL along with surrounding structures is performed. Hamstring tendons are a major focus of this surgery. Following this surgery, a rehabilitation of 6-12 months is needed for getting back to daily activities.
Conservative methods such as immobilization in a cast or brace for 3-6 weeks are equally effective. Swelling subsides and adequate strength can be regained through physiotherapy. Complete rest to the knee is advised for a few weeks.
Rehabilitation
Rehabilitation and follow up is an important factor in the prognosis of ACL injury irrespective of surgery. Rehabilitation significantly helps to improve the outcome of surgery as well as to maintain strength and function of the joint. Recurrent instability of the knee joint or the knee giving away is common in many cases and is treated conservatively. Physiotherapy should be performed regularly as per medical supervision for complete functional recovery.
