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Anterior Cruciate Ligament (ACL) Tear Physiotherapy

An anterior cruciate ligament (ACL) tear is an injury to the knee commonly affecting athletes, such as

• soccer/football players
• basketball players
•  skiers
• gymnasts

Of course, nonathletes can also experience an ACL tear due to injury or accident.

In just the United States alone, there is about 200,000 anterior cruciate ligament injruies diagnosed every year. 50% of them are estimated ruptures (100% tear) and 100,000 anterior cruciate ligament reconstruction operations done.

For ACL tears in sports,

• 70% are non-contact injuries
• 30% are contact injuries (player-to-player, player-to-object)

Women are more likely than men to experience an anterior cruciate ligament tear.

What our senior knee physiotherapists do is to help individuals with ACL tears

• reduce knee pain and swelling
• regain knee strength and movement
• return to desired activities and lifestyle
  

What is an ACL Tear?

Our anterior cruciate ligament is one of the major bands of tissue (ligaments) that connects our thigh bone (femur) to our shin bone (tibia) at the knee joint. Our ACL can easily tear if you:

• Twist your knee while keeping your foot planted on the ground
• Stop suddenly while running
• Suddenly shift your weight from one leg to the other
• Jump and land on an extended (straightened) knee
• Stretch the knee farther than its usual range of movement
• Experience a direct hit to the knee

How Does an acl tear Feel like?

If you ever tear your anterior cruciate ligament of your knees (and we hope you never ever have to experience this), you may:

• feel a sharp, intense pain or hear a loud "pop" or snap
• not be able to walk on the injured leg because you can’t support your weight through your knee joint
• experience immediate swelling in your knee (within minutes to a few hours)
• feel that your knee "unlocks, unhinges or just gives way" when you walk or put weight on it

How Is It Diagnosed?

Immediately following an ACL injury, you may be examined by

• our senior physiotherapist
• an athletic trainer
• orthopedic surgeon

If you see our senior physiotherapist first, we will conduct a thorough evaluation that includes reviewing your health history. Your physical therapist will ask:

• What you were doing when the injury occurred.
• If you felt pain or heard a "pop" when the injury occurred.
• If you experienced swelling around the knee in the first 2 to 3 hours following the injury.
• If you felt your knee buckle or give out when you tried to get up from a chair, walk up or down stairs, or change direction while walking.

They may perform gentle "hands-on" tests to determine the likelihood that you have an ACL tear, and may use additional other tests to assess possible damage to other parts of your knee.

An orthopedic surgeon may order further tests, including magnetic resonance imaging (MRI), to confirm the diagnosis and rule out other possible damage to the knee.

Surgery

Most people who sustain an ACL tear will require to undergo surgery to repair the ACL tear; that being said, some patients may prefer not to have knee surgery and prefer to live with their ACL their by modifying their physical activity to relieve stress on the knee. In fact, a select group can actually return to vigorous physical activity following rehabilitation without having knee surgery following an anterior cruciate ligament tear..

Our senior physiotherapist, together with your surgeon, can help you determine if nonoperative treatment (rehabilitation without surgery) is a reasonable option for you. Of course if you do decide to have corrective ACL reconstruction surgery, our senior physiotherapist will help you prepare both for surgery and to recover your strength and movement following surgery.

How Can our senior physioTherapist Help?

Once an ACL tear has been diagnosed, you will work with your surgeon and our senior physiotherapist to decide if you should have surgery, or if you can recover without surgery.

If you don’t need or want surgery, our senior physiotherapist will work with you to restore your muscle strength, agility, and balance, so you can return to your regular activities. We may teach you ways to modify your physical activity in order to put less stress on your knee. If you decide to have surgery our senior physiotherapist can help you before and after the procedure.

Treatment Without Surgery

Current research has identified a specific group of patients (called "copers") who have the potential for healing without surgery following an ACL tear. These patients have injured only the ACL, and have experienced no episodes of the knee "unlocking, unhinging or knee giving out" following the initial knee ACL injury.

If you fall into this category, based on the specific tests your physical therapist will conduct, our senior physiotherapist will design an individualized physical therapy treatment program for you. It may include treatments such as

• gentle electrical stimulation applied to the quadriceps muscle
• muscle strengthening
• balance training

Treatment Before Surgery

If your orthopedic surgeon determines that surgery is necessary, our senior physiotherapist can work with you before and after your surgery. Some surgeons refer their patients to us for a short course of rehabilitation before surgery (increasing fitness and strength pre-surgery can improve the wound, muscle and discharge timing). We will help you

• decrease your swelling
• increase the range of movement of your knee
• strengthen your thigh muscles (quadriceps)

Treatment After Surgery

Your orthopedic surgeon will provide post-surgery instructions to us, and then we will design an individualized ACL physiotherapy treatment program based on your specific needs and goals. Your treatment program may include:

Bearing weight. Following surgery, you will use crutches to walk. The amount of weight you are allowed to put on your leg and how long you use the crutches will depend on the type of reconstructive surgery you have received. We will design a treatment program to meet your needs and gently guide you toward full weight bearing.

Icing and compression. Immediately following surgery, we will control your swelling with a cold therapy, such as an ice sleeve, that fits around your knee and compresses it.

Bracing. Some surgeons will give you a brace to limit your knee movement (range of motion) following surgery. We will fit you with the brace and teach you how to use it safely. Some athletes will be fitted for braces as they recover and begin to return to their sports activities.

Movement exercises. During your first week following surgery, we will help you begin to regain motion in the knee area, and teach you gentle exercises you can do at home. The focus will be on regaining full movement of your knee. The early exercises help with increasing blood flow, which also helps reduce swelling.

Electrical stimulation. We may use electrical stimulation to help restore your thigh muscle strength, and help you achieve those last few degrees of knee motion.

Strengthening exercises. In the first 4 weeks after surgery, we will help you increase your ability to put weight on your knee, using a combination of weight-bearing and non-weight-bearing exercises. The exercises will focus on your thigh muscles (quadriceps and hamstrings) and might be limited to a specific range of motion to protect the new ACL. During subsequent weeks, your physical therapist may increase the intensity of your exercises and add balance exercises to your program.

Balance exercises. We will guide you through exercises on varied surfaces to help restore your balance. Initially, the exercises will help you gently shift your weight on to the surgery leg. These activities will progress to standing on the surgery leg, while on firm and unsteady surfaces to challenge your balance.

Return to sport or activities. As athletes regain strength and balance, they may begin

• running
• jumping
• hopping
• and other exercises specific to their individual sport

Of course, this phase varies greatly from person-to-person. Our senior physiotherapists design return-to-sport treatment programs to fit individual needs and goals.