Anterior Cruciate Ligament (ACL) tears

The ACL is shown in red in this picture

The ACL is located deep within the knee joint. It is one of the four principle ligaments of the knee and prevents the forward and rotational movement of the tibia (shin bone) relative to the femur (thigh bone).

ACL tears are very common sporting injuries, particularly in sports involving agility and pivoting (e.g. football, basketball, hockey, etc), Both men and women may be affected but a higher incidence is reported amongst female athletes. ACL tears may occur in isolation or in combination with other soft tissue injuries of the knee, such as meniscal injuries and MCL tears.

Common ways of injuring the ACL include landing awkwardly from a jump, pivoting or twisting the knee. It is likely that you will hear a ‘pop’ and this is followed by extreme pain. At the time of the ACL tear you are usually unable to continue with your activity ad may not be able to walk to begin with. Over the next few hours a large tense swelling of the knee usually develops (haemoarthrosis), although the degree of swelling may vary.

Diagnosis of an ACL rupture can often be suspected on the basis of how the injury happened and what is found on clinical examination. However, in the early stages of injury where there is still a lot of swelling an pain, clinical examination is often painful and difficult to interpret. Ultimately an MRI scan should be performed to confirm the diagnosis.

Images from arthroscopy showing intact ACL

The best choice of treatment for ACL rupture is controversial and is not the same for all individuals. The options are early surgery, or a trial of non-operative management. While some will find that after a course of physiotherapy they are able to return to all of their usual activities, others will have ongoing symptoms. These symptoms include a feeling of instability in the knee or giving way, and are particularly common when doing sports that involve twisting, turning and changing direction.

The decision on whether to opt for conservative or surgical management is dependent on a number of factors. Professional athletes and those who are regularly involved in sports involving twisting and turning movements are more likely to experience instability symptoms after non-operative management and so may elect to have early surgery. Other factors include including age, knee instability, associated injuries, expectations, and the whether or not the you can commit to the lengthy post-operative rehabilitation. Ultimately the decision for surgery should be made by the individual, guided by the clinician.

Images from arthroscopy showing torn ACL stump

If a trial of non-operative management is chosen, then after the initial pain and swelling starts to settle down, individuals can begin to get the knee moving again and build up their activities. Initial physiotherapy goals focus on reduction of pain and swelling, and restoration of full range of movement. A knee brace is often used to provide additional stability. Later phases focus on proprioception and muscle strengthening. All muscle groups are important but special attention is paid to strengthening the hamstrings (muscles at the back of the thigh), which can help compensate for the loss of function caused by the rupture of the ACL. Finally agility work and sport specific exercises are introduced prior to returning to sport.

If following nonoperative treatment the knee still feels like it will give way, this period of time will not have been wasted. It will have acted as a course of ‘pre-habilitation’ (a time where you improve your knee function in readiness for surgery). This can make the post-operative rehabilitation easier.

Surgery is not without risks and complications, but offers the potential for excellent outcomes, including in those who have ongoing symptoms despite conservative management.

ACL Reconstruction Patellar Tendon

The video below shows a detailed explanation of the causes and presentation of ACL Reconstruction Patellar Tendon. They show a basic outline of the procedures used by Amir Qureshi and after care required in order that you, the patient, may recover to your full fitness once again.