Anterior Cruciate Ligament (ACL) Injuries - Topic

Overview
What is an anterior cruciate ligament (ACL) injury?
An anterior cruciate ligament, or ACL, injury is a tear in one of the kneeligaments
thatjoins the upper leg bone with the lower leg bone. The ACL keeps the knee
stable.
Injuries range from mild, such as a small tear, to severe, such as when the ligament
tearscompletely or when the ligament and part of the bone separate from the rest of
the bone.
Without treatment, the injured ACL is less able to control knee movement, and the
bonesare more likely to rub against each other. This is called chronic ACL
deficiency. Theabnormal bone movement can also damage the tissue (cartilage) that
covers the ends of thebones and can trap and tear the pads (menisci) that cushion
the knee joints. This damagecan lead to osteoarthritis.
Sometimes other knee ligaments or parts of the knee are also injured. This
includescartilage such as the menisci, or bones in the knee joint, which can be
broken.

What causes an ACL injury?

Your ACL can be injured if your knee joint is bent backward, twisted, or bent side
toside. The chance of injury is higher if more than one of these movements occurs at
thesame time. Contact (being hit by another person or object) also can cause an
ACL injury.
An ACL injury often occurs during sports. The injury can happen when your foot is
firmlyplanted on the ground and a sudden force hits your knee while your leg is
straight orslightly bent. This can happen when you are changing direction rapidly,
slowing down whenrunning, or landing from a jump. This type of injury is common in
soccer, skiing,football, and other sports with lots of stop-and-go movements,
jumping, or weaving.Falling off a ladder or missing a step on a staircase are other
likely causes. Like anyother body part, the ACL becomes weaker with age. So a tear
happens more easily in peopleolder than age 40.

What are the symptoms?

Symptoms of an acute ACL injury include:
Feeling or hearing a pop in the knee at the time of injury.
Pain on the outside and back of the knee.
The knee swelling within the first few hours of the injury. This may be a sign of
bleedinginside the knee joint. Swelling that occurs suddenly is usually a sign
of a serious kneeinjury.
 Limited knee movement because of pain or swelling or both.
The knee feeling unstable, buckling, or giving out.
After an acute injury, you will probably have to stop whatever you are doing because
ofthe pain, but you may be able to walk.
The main symptom of chronic ACL deficiency is the knee buckling or giving out,
sometimeswith pain and swelling. This can happen when an ACL injury is not
treated.

How is an ACL injury diagnosed?

Your doctor can tell whether you have an ACL injury by asking questions about your
pasthealth and examining your knee. The doctor may ask: How did you injure your
knee? Have youhad any other knee injuries? Your doctor will check for stability,
movement, andtenderness in both the injured and uninjured knee.
You may need X-rays, which can show damage to the knee bones. Or you may need
otherimaging tests, such as an MRI. An MRI can show damage to ligaments,
tendons, muscles, andknee cartilage. Arthroscopy may also be done. During
arthroscopy, your doctor insertssurgical tools through one or more small cuts
(incisions) in the knee to look at theinside of the knee.

How is it treated?
Start first aid right away. These first-aid tips will reduce swelling and pain. Use
theRICE method. The letters stand for Rest the knee, put Ice on it, use an elastic
bandage togive gentle Compression to the knee, and Elevate the leg by propping it
up above the levelof your heart. And at first it's also important to move your leg as
little as possible.
Take over-the-counter pain medicine. Be safe with medicines. Read and follow
allinstructions on the label.
You may need to walk with crutches and use a knee immobilizer to keep your knee
still forthe first few days after the injury.
Your knee will need to be checked by your doctor. It's important to get treatment. If
youdon't, the injury may become a long-lasting problem. There are two ways to treat
theinjury:
Exercises and training, also called rehab. It takes several months of rehab for
your kneeto get better.
Surgery. You and your doctor can decide if rehab is enough or if surgery is
right for you.
If you have surgery, you will also have several months of rehab afterward.
Your treatment will depend on how much of the ACL is torn, whether other parts of
the kneeare injured, how active you are, your age, your overall health, and how long
ago theinjury occurred.
There are three main treatment goals:
Make the knee stable if it is unsteady, or at least make it stable enough to do
your dailyactivities.
Make your knee strong enough to do all the activities you used to do.
Reduce the chance that your knee will be damaged more.

How can you prevent ACL injuries?

The best way to prevent ACL injuries is to stretch and strengthen the leg
muscles,especially the front and back muscles of the thigh (quadriceps and
hamstrings).
Here are other things you can do that may help prevent ACL injuries:
Avoid wearing shoes with cleats in contact sports.
Avoid wearing high-heeled shoes.
Avoid sports that involve lots of twisting and contact.

AnteriorCruciateLigament
(ACL)
Injuries
One of the most common knee injuries is an anterior cruciate ligament sprain or tear.
Athletes who participate in high demand sports like soccer, football, and basketball
aremore likely to injure their anterior cruciate ligaments.
If you have injured your anterior cruciate ligament, you may require surgery to
regainfull function of your knee. This will depend on several factors, such as the
severity ofyour injury and your activity level.
Anatomy
 Normal knee anatomy, front view
Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia),
andkneecap (patella). Your kneecap sits in front of the joint to provide some
protection.
Bones are connected to other bones by ligaments. There are four primary ligaments
in yourknee. They act like strong ropes to hold the bones together and keep your
knee stable.
Collateral Ligaments
These are found on the sides of your knee. The medial collateral ligament is on the
insideand the lateral collateral ligament is on the outside. They control the sideways
motion ofyour knee and brace it against unusual movement.
Cruciate Ligaments
These are found inside your knee joint. They cross each other to form an "X" with
theanterior cruciate ligament in front and the posterior cruciate ligament in back.
Thecruciate ligaments control the back and forth motion of your knee.
The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents
thetibia from sliding out in front of the femur, as well as provides rotational stability
tothe knee.
Description
About half of all injuries to the anterior cruciate ligament occur along with damage
toother structures in the knee, such as articular cartilage, meniscus, or other
ligaments.
Injured ligaments are considered "sprains" and are graded on a severity scale.
Grade 1 Sprains .The ligament is mildly damaged in a Grade 1 Sprain. It has been
slightlystretched, but is still able to help keep the knee joint stable.
Grade 2 Sprains .A Grade 2 Sprain stretches the ligament to the point where it
becomesloose. This is often referred to as a partial tear of the ligament.
Grade 3 Sprains .This type of sprain is most commonly referred to as a complete
tear ofthe ligament. The ligament has been split into two pieces, and the knee joint is
unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

Cause
The anterior cruciate ligament can be injured in several ways:
Changing direction rapidly
Stopping suddenly
Slowing down while running
Landing from a jump incorrectly
Direct contact or collision, such as a football tackle
Several studies have shown that female athletes have a higher incidence of ACL
injury thanmale athletes in certain sports. It has been proposed that this is due to
differences inphysical conditioning, muscular strength, and neuromuscular control.
Other suggestedcauses include differences in pelvis and lower extremity (leg)
alignment, increasedlooseness in ligaments, and the effects of estrogen on ligament
properties.
Symptoms
When you injure your anterior cruciate ligament, you might hear a "popping" noise
and youmay feel your knee give out from under you. Other typical symptoms include:
Pain with swelling. Within 24 hours, your knee will swell. If ignored, the
swelling andpain may resolve on its own. However, if you attempt to return to
sports, your knee willprobably be unstable and you risk causing further
damage to the cushioning cartilage(meniscus) of your knee.
Loss of full range of motion
Tenderness along the joint line
Discomfort while walking
Doctor Examination
Physical Examination and Patient History
During your first visit, your doctor will talk to you about your symptoms and
medicalhistory.
During the physical examination, your doctor will check all the structures of your
injuredknee, and compare them to your non-injured knee. Most ligament injuries can
be diagnosedwith a thorough physical examination of the knee.
Imaging Tests
Other tests which may help your doctor confirm your diagnosis include:
X-rays.Although they will not show any injury to your anterior cruciate ligament,
x-rayscan show whether the injury is associated with a broken bone.
Magnetic resonance imaging (MRI) scan.This study creates better images of soft
tissueslike the anterior cruciate ligament. However, an MRI is usually not required to
make thediagnosis of a torn ACL.
Treatment
Treatment for an ACL tear will vary depending upon the patient's individual needs.
Forexample, the young athlete involved in agility sports will most likely require
surgery tosafely return to sports. The less active, usually older, individual may be
able to returnto a quieter lifestyle without surgery.
Nonsurgical Treatment
A torn ACL will not heal without surgery. But nonsurgical treatment may be effective
forpatients who are elderly or have a very low activity level. If the overall stability
ofthe knee is intact, your doctor may recommend simple, nonsurgical options.
Bracing. Your doctor may recommend a brace to protect your knee from instability.
Tofurther protect your knee, you may be given crutches to keep you from putting
weight onyour leg.
Physical therapy . As the swelling goes down, a careful rehabilitation program is
started.Specific exercises will restore function to your knee and strengthen the leg
muscles thatsupport it.
Surgical Treatment
Rebuilding the ligament . Most ACL tears can not be sutured (stitched) back
together. Tosurgically repair the ACL and restore knee stability, the ligament must be
reconstructed.Your doctor will replace your torn ligament with a tissue graft. This
graft acts as ascaffolding for a new ligament to grow on.
Grafts can be obtained from several sources. Often they are taken from the
patellartendon, which runs between the kneecap and the shinbone. Hamstring
tendons at the back ofthe thigh are a common source of grafts. Sometimes a
quadriceps tendon, which runs fromthe kneecap into the thigh, is used. Finally,
cadaver graft (allograft) can be used.
There are advantages and disadvantages to all graft sources. You should discuss
graftchoices with your own orthopaedic surgeon to help determine which is best for
you.
Because the regrowth takes time, it may be six months or more before an athlete
can returnto sports after surgery.
Procedure . Surgery to rebuild an anterior cruciate ligament is done with an
arthroscopeusing small incisions. Arthroscopic surgery is less invasive. The benefits
of lessinvasive techniques include less pain from surgery, less time spent in the
hospital, andquicker recovery times.
Unless ACL reconstruction is treatment for a combined ligament injury, it is usually
notdone right away. This delay gives the inflammation a chance to resolve, and
allows areturn of motion before surgery. Performing an ACL reconstruction too early
greatlyincreases the risk of arthrofibrosis, or scar forming in the joint, which would
risk aloss of knee motion.
Rehabilitation
Whether your treatment involves surgery or not, rehabilitation plays a vital role
ingetting you back to your daily activities. A physical therapy program will help you
regainknee strength and motion.
If you have surgery, physical therapy first focuses on returning motion to the joint
andsurrounding muscles. This is followed by a strengthening program designed to
protect thenew ligament. This strengthening gradually increases the stress across
the ligament. Thefinal phase of rehabilitation is aimed at a functional return tailored
for the athlete'ssport.
Visit our website
https://nydnrehab.com/what-we-treat/knee-pain/acl-treatment-in-new-york/to make
an appointment today.