ACL Tear Treatment
The anterior cruciate ligament (ACL) is a crucial component of the knee, connecting the femur (thigh bone) to the tibia (shin bone). It helps keep your knee stable by preventing the tibia from moving too far forward compared to the femur. This stability is vital for controlling and limiting knee movement during various activities.
ACL tears are prevalent in athletes who engage in sports that involve quick pivots, sudden stops, or high-impact movements. For example, playing football, making sharp turns in basketball, or landing from a volleyball jump can significantly strain the ACL. When the ACL is torn, it can make the knee feel unstable, making it difficult to perform everyday activities or return to sports without proper treatment and rehabilitation.
ACL tears are classified into three grades, each reflecting the severity of the injury. Here’s a closer look at each type:
Grade 1 ACL tears are the least severe. The ligament is stretched but not fully torn. You might experience some discomfort and swelling, but the ACL can still keep the knee joint relatively stable. This type of tear usually doesn’t cause significant functional issues.
With a Grade 2 ACL tear, the ligament is partially torn. It becomes loose and can’t provide complete stability to the knee. This often leads to knee instability and difficulty with activities involving quick movements or direction changes.
A Grade 3 ACL tear is the most severe. The ligament is completely torn or ruptured into two pieces, causing significant instability in the knee. This type of injury is the most common and often requires surgery and extensive rehabilitation to regain full knee function and stability.
The common symptoms of ACL tears are:
ACL tears are often associated with specific movements and situations, particularly during sports and physical activities.
Abruptly slowing down and changing direction, especially in sports like basketball or soccer, puts significant stress on the ACL. This sudden pivoting can cause the ligament to stretch or tear.
Pivoting while your foot is planted firmly on the ground can strain the ACL excessively. This movement is expected in activities such as football and tennis, where quick direction changes are frequent.
Landing awkwardly from a jump, such as in volleyball or basketball, can place undue stress on the knee. If the landing is poorly executed, it can lead to a tear in the ACL.
Quickly stopping during high-intensity activities, like sprinting or playing sports, can strain the ACL. The abrupt deceleration forces the ligament to absorb significant stress, which may result in an injury.
Receiving a direct blow to the knee or being involved in a collision, such as a football tackle, can cause an ACL tear. The impact can force the knee into an unnatural position, damaging the ligament.
In cases of mild injury, the ACL might be overstretched rather than torn. This overstretching can lead to instability and discomfort but does not always result in a complete tear.
ACL tears can happen for various reasons, and certain factors make some people more likely to experience this kind of injury. Here’s a look at the main risk factors:
If you play sports that involve a lot of rapid cutting, pivoting, or sudden changes in direction, like basketball, soccer, or rugby, you’re at a higher risk for an ACL tear. These movements put extra stress on your knee, leading to injury.
Women are generally more at risk for ACL tears than men. This is partly because women often have muscle imbalances, with weaker hamstrings compared to their quadriceps. Additionally, women’s knees typically have a greater Q-angle (the angle between the thigh and shin bones), making the knee more vulnerable.
Lack of proper strength and conditioning can make you more likely to injure your ACL. Being unfit or lacking in strength and conditioning can make your muscles and ligaments less able to handle the stresses placed on them.
The surface you’re exercising on can also contribute to ACL injuries. Uneven ground or slippery surfaces, especially during bad weather, can make your movements less stable and increase your risk of an ACL tear.
Diagnosing an ACL tear involves assessing symptoms through a physical exam and using imaging tests to understand the extent of the injury and exclude other conditions. The process typically includes the following steps:
During the physical exam, the doctor will compare your knee to your uninjured knee to examine for swelling and tenderness. They will also move your knee through various positions to check its range of motion and overall function. This helps determine if there is an ACL tear and assesses the joint’s stability.
X-rays are used to rule out bone fractures or other issues with the bone structure. While they can identify breaks or significant damage to the bones around the knee, X-rays do not show soft tissues such as ligaments.
An MRI provides detailed images of the knee’s hard and soft tissues. It uses radio waves and a strong magnetic field to produce clear pictures that reveal the extent of an ACL injury and any damage to surrounding structures, including cartilage. This is important for evaluating the full scope of the tear.
Ultrasound uses sound waves to create images of the internal structures of the knee. This test helps visualise injuries in the ligaments, tendons, and muscles, offering additional insights into the condition of the ACL and other related tissues.
The treatment approach for ACL tears often starts with conservative methods to address pain, swelling, and muscle weakness, as well as to restore knee function. Depending on the severity of the injury, more surgical interventions may be necessary.
Initially, the focus is on managing symptoms and improving knee function. This involves:
Physiotherapy is a part of conservative management and includes:
In some cases, if conservative management and physiotherapy don’t resolve the issue or if knee instability continues, ACL reconstructive surgery may be necessary.
ACL reconstructive surgery involves:
ACL tears are significant injuries that can lead to various complications, even with appropriate treatment. Here are some common issues that may arise after an ACL tear, especially in more severe cases.
Chronic Instability: One of the primary complications following an ACL tear is ongoing instability in the knee. Even with treatment, some individuals may experience the knee “giving way” during physical activities, leading to further discomfort and potential injury.
Development of Osteoarthritis: Over time, damage from an ACL tear may contribute to the development of osteoarthritis in the knee joint. This happens when the cartilage wears down, causing pain and stiffness, which can persist long after the initial injury has healed.
Re-tear or Graft Failure: In cases where surgical reconstruction of the ACL is necessary, there is a possibility of re-tear or graft failure. This could lead to additional surgeries and prolonged rehabilitation periods.
Muscle Weakness and Limited Mobility: After an ACL tear, some individuals may experience long-term weakness in the surrounding muscles, especially if rehabilitation isn’t performed correctly. This can lead to limited mobility, affecting daily activities and athletic performance.
These potential issues make early diagnosis and proper management of ACL tear symptoms and treatment crucial for successful recovery.
Focus on strengthening exercises, proper techniques and using the right gear to lower your risk of ACL injuries. Consider the following strategies:
Building strength in important muscle groups supports knee stability. Focus on:
Learning and practising proper techniques can make a difference:
Select sport-specific shoes that provide adequate support and traction to help prevent slips and falls and offer extra protection to your knees.
While knee braces are sometimes used, they may not effectively prevent ACL injuries or reduce the risk of re-injury after surgery. They should be complemented by strength training and proper technique.
The ACL (anterior cruciate ligament) is a short, thick ligament that resists twisting movements at the knee. The most common way that it is torn is when the foot is planted firmly on the ground whilst the body and thigh rotates outwards. Twisting forces are concentrated in the knee and sometimes exceed the strength of the ligament causing it to rupture.
ACL tear symptoms include a loud popping sound at the time of injury, severe pain, rapid swelling, and instability in the knee. Treatment options vary from rest and physiotherapy to surgery, depending on the severity of the tear and individual needs.
If you do not seek treatment for an ACL injury, you may experience chronic knee instability, increased pain, and a higher risk of further damage to the knee joint.
Living with an ACL tear without proper treatment can lead to ongoing pain and instability. However, with appropriate treatment management, many people can return to normal activities.
After ACL surgery, you will undergo a rehabilitation programme that includes physical therapy to restore knee strength and function. Proper post-surgery care is crucial for recovery.
The decision to return to sports is based on several factors, including the healing of the ACL tear, symptoms, and treatment progress. A healthcare professional will assess your knee stability, strength, and overall function before giving the green light to resume sports activities.
Dr Bryan Tan