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Anterior Cruciate Ligament Injury And Physiotherapy

What is an anterior cruciate ligament Injury?

Your anterior cruciate ligament (often abbreviated to ACL) refers to one of four (4) knee ligaments that are vital and critical to the stability of your knee joint. 

Your anterior cruciate ligament is made of very tough fibrous material and its main functions is to control/decrease excessive knee motion by limiting joint mobility.

Unfortunately, one of the most common problems involving the knee joint is an anterior cruciate ligament injury or ACL tear. Of the four major knee ligaments of the knee, an ACL injury or rupture is the most debilitating knee ligament injury.

What Causes an anterior cruciate ligament Injury?

An ACL injury is usually a sports-related knee injury or related to trauma.

80% of sports-related ACL tears are "non-contact" injuries, which basically means that the injury occurs without the contact of another player, such as a tackle in football/soccer.

Most often ACL tears occur when pivoting or landing from a jump, and what happens is that your knee gives out from under you once you tear your ACL.

Female athletes/sportspersons are known to have a higher risk of an ACL tear while participating in competitive sports.

Unfortunately, it is still not clear why why women are more prone to ACL injury. There are some suggestions that is's physical (biomechanical, strength) and hormonally related. Or maybe a combination of all three factors.

What Sports have a High Incidence of anterior cruciate ligament Injuries?

Most sports require a stable and functioning ACL to perform common manoeuvres such as cutting, pivoting, and sudden turns and sprints/burst of run.

These high demand sports include football, rugby, netball, touch, basketball, tennis, volleyball, hockey, dance, gymnastics and much more. Yes, you may be able to function in your normal daily activities, work and relationships with a damaged ACL/without an ACL, but high-demand sports may be challenging.

That's why athletes are often faced with the decision to undergo knee surgery so that they can return to their previous level of competition. (ACL injuries have been known to curtail many promising sporting careers.)

What are the Symptoms of an anterior cruciate ligament Injury?

The diagnosis of an ACL tear is confirmed by several methods and techniques.

Patients who have an ACL tear commonly sustain a sports-related knee injury, they may have felt or heard a "pop" in their knee, and the knee usually gives out from under them and ACL tears cause significant knee swelling and pain.

Patients will also feel that their injured knee becomes very "loose" and unstable, and may "crumble/give out" easily.

How is an anterior cruciate ligament Injury Diagnosed?

On clinical knee examination, your physiotherapist or sports doctor will look for signs of ACL ligament instability.

These special ACL tests place stress on the anterior cruciate ligament and can detect an ACL tear or rupture.

An MRI may also be used to determine if you have an ACL tear.

It will also look for signs of any associated injuries in the knee, such as bone bruising or meniscus damage, that regularly occur in combination with an ACL tear.

X-rays are of little clinical value in diagnosing an ACL tear, because X-rays are set out to detect bony (hard tissue) abnormalities and fractures, whereas ligaments are soft tissue and doesn't come up in X-rays.

How is an anterior cruciate ligament Injury Treated?

Most patients with an ACL tears will start to feel better within a few days or weeks of an ACL injury.

They may feel as though their knee is normal again because the swelling in their injured knee has started to settle. But this is the scary part because THIS IS WHEN your problems with knee instability and giving way may start or worsen.

ACL tears doesn't always require ACL reconstruction surgery.

There are several important factors to consider before deciding to undergo ACL reconstruction surgery.

• Firstly, it depends on how severe the tear is.
  
• Secondly, what is your age?
  
• Thirdly, would you regularly perform sports or activities that normally require a functional ACL?
• Fourthly, do you experience knee instability?
• Fifthly, what are your plans for the future?

If you don't participate in a multi-directional sport that requires a patent ACL, and you don't have an unstable knee, then you may not need ACL surgery.

We recommend ACL injury if you are young, wants to be active, and have a moderate to full tear (rupture) of the ACL, but it depends on the orthopedic surgeon and patients too.

Physiotherapy & anterior cruciate ligament Exercises

Your best way to avoid anterior cruciate ligament reconstructive surgery is to undertake a comprehensive ACL-Deficient Knee Rehabilitation Program that includes and involves:

• leg strengthening
• proprioception and high-level balance retraining
• sport-specific agility and functional enhancement.
  

We have senior sports physiotherapists who sub-specialize in knee and ACL management.

Physiotherapy treatments will aim to:

• Reduce pain and inflammation
• Normalize your joint range of motion
• Strengthen your knee: esp Quadriceps (esp VMO) and Hamstrings
• Strengthen your lower limb: Calves, Hip and Pelvis muscles
• Improve patellofemoral (kneecap) alignment
• Normalize your muscle lengths
• Improve your proprioception, agility and balance
• Improve your technique and function eg walking, running, squatting, hopping and landing.
• Minimize your chance of re-injury.

We strongly suggest that you discuss your knee injury after a thorough examination from a knee injury specialist such as a sports physiotherapist, sports physician or knee surgeon.