ACL (Anterior Cruciate Ligament)
A Personal Approach
What is it?
The Anterior Cruciate Ligament ( ACL) is one of the big ligaments deep within your knee joint. It is one of the primary stabilisers of your knee joint and connects the femur to the tibia. Its role is to provide joint stability during movements such as controlling rotation and the femur slipping forward over the tibia. An ACL rupture will cause the knee to give way, collapse or be unstable in turning, twisting movements. An injury to the ACL is one of the most common knee injuries within sporting activities. An ACL injury can account for around 40% of all sports injuries. With regards to gender, ACL injury is two to eight times greater in females compared to males participating in the same sports, thus there is an increased risk of this injury in the female population.
ACL Injury, How does it occur?
There are two main mechanisms of ACL Injuries that happen called Non-contact and Contact. A Contact injury is due to a collision, fall, impact that then causes a tear of the ACL such as a tackle in rugby or football or a fall Skiing. A non Contact ACL injury is when the ACL is injured during movements without an external force applied. Common non-contact causes can be landing on the leg from a height, changing direction quickly or suddenly stopping. There are different levels of an ACL tear. These can be minor tears or major. In a major tear when someone injuries their ACL they may feel the knee suddenly give way and may feel a "pop" sensation. There will be high levels of pain and possibly loss of movement and an inability to continue with the activity. There may be swelling that is noticeable quickly and some people can walk still but others struggle to weight bear after.
What to do if you think you have injured your ACL
If you believe you have experienced an ACL injury or tear no matter how small, you should still keep weight off your leg to protect it from further trauma. Ice the knee to help swelling and pain and seek assistance from your physiotherapy or doctor as soon as possible.
Treatment- Conservative Treatment
If you have a torn ACL the treatment options may be based on the severity of your tear and your goals and outcomes for recovery. If there is not a full rupture then you should undergo a rehabilitation process with your Physiotherapist. Stuart is highly skilled in this area and can easily guide you through your recovery process. A full ruptured ACL can be treated conservatively or it can be reconstructed.
A Conservative approach - Non-surgery involves a highly progressive rehabilitation programme including exercises aimed at improving strength, stability and balance. This can be highly successful and many young adults have undergone this. Someone who cycles and runs is very different from someone who plays football, rugby, netball and changes direction under speed. Thus your objective can also help decide the best option for you. In the data and some studies, it does appear that young, active adults being treated for acute ACL injury have no significant difference between surgery and conservative treatment in patient-reported outcomes of knee function at two and five years. However, there is a trend in observational studies toward better functional outcomes after ACL reconstruction. As an average across studies, conservative treatment fails in 17.5% (± 15.5%) of patients.
ACL Surgery and Recovery
ACLR (Anterior Cruciate Ligament Reconstruction) Surgery is performed by removing what remains of the torn ligament and replacing it with a tendon from another area of the leg, such as the hamstring, quadricep, or patellar tendon. This is very successful and will allow you to return to normal sporting activity that requires turning, twisting, and changing direction quickly. As the conservative approach, it will be a highly focused rehab plan returning your strength and stability to the same as the other leg however this can take 6-12 months.
If you are Post-operative, you will be advised to use Ice - such as Cryocuff, Ice packs, or a Game ready, and take your medication for the first few weeks as required. You can normally walk in 2-3 weeks and from 3-6 weeks you can usually drive. These can be impacted by other procedures such as meniscal repair which means you may have to be using a brace and crutches for 6 weeks. In ACL-only surgery, after 3 months, you should be able to undergo most normal activities, and from 9-12 months you should be able to return to most sports. The return to sport depends on the nature of your chosen activity and for this, you have to pass a range of physical tests such as the Limb Symmetry Index and others. Of course, it is longer to return to explosive sports such as football, hockey, and rugby compared to undertaking a jog due to the cutting and pivoting thus it may be closer to 12 months for this.
As Stuart is an Expert Physiotherapist in Knee injuries he can assist you with professional care in his Edinburgh Physio clinic.