Anterior Cruciate Ligament (ACL) injuries are some of the most dreaded injuries among sports professionals and even amateurs. They are usually season-ending and often entail surgery and a prolonged period of rehabilitation. So what exactly are ACL injuries, the causes and treatment options?

What is an ACL?

An ACL connects the thigh bone (femur) with the shin bone (tibia). An ACL stabilises the knee for cutting, twisting, jumping and pivoting activities. This ligament is located in the centre of the knee joint and prevents abnormal rotation of the femur on the tibia.

ACL injuries are common in a wide variety of sports especially where twisting and pivoting are involved such as basketball, netball and football. It affects both men and women and is in fact eight times more common in women than men.

Without an ACL most people have trouble with twisting and pivoting during sports. In severe cases, the patient has trouble even with activities of daily living.

How does the ACL get injured?

Most ACL injuries tend to be a result of a deceleration injury. The foot gets trapped in a tackle or uneven ground and the weight of the body rotates around the knee thereby causing the ligaments to rupture.

When you tear an ACL, you will often feel or hear a pop. You will also feel the knee shift out of place and develop significant swelling in just a few hours. Most people are unable to continue play and some will have severe pain and be unable to bear weight at all.

What should we do immediately after an injury?

Play should be discontinued. The knee should be iced and the leg elevated. A commonly used regime is to ice the knee for 20 to 30 minutes every two to three hours.

Pain killers and anti-inflammatory medication are useful for patient comfort and a sports physician, an orthopaedic surgeon or a phsiotherapist should evaluate the injury. A Magnetic Resonance Imaging (MRI) scan is usually ordered to confirm the diagnosis and to exclude injury to the other ligaments in the knee as well as the articular cartilage and the meniscus.

Who should go for surgery?

If the ACL has been torn, surgical reconstruction of the ligament may be indicated, as the ligament rarely heals by itself. However not everyone who tears an ACL will need surgery.

Individuals who should consider surgery are those who are keen to continue playing sports as well as those who have instability (giving way) during daily or sporting activities. Patients with associated injuries to the other structures in the knee and those who are young should consider surgery.

Current thinking is that recurrent instability in the knee will cause damage to the cartilage and menisci (crescent-shaped cartilage pad between the two joints formed by the thigh bone and the shin bone) and lead to accelerated degenerative arthritis.

The rationale behind surgery is to stabilise the knee for twisting and pivoting activities and to slow down the development of arthritis.

What happens during a surgery?

In surgery, the ACL is recreated by using a “graft” which can be taken from the patient’s own tissue.

The surgery is performed via an arthroscopic or ‘key-hole’ technique. This allows for a rapid recovery and less pain compared to non-arthroscopic techniques. Most times the surgery can be done as a day surgery procedure.

Post Surgical Rehabilitation

The patients’ commitment to a rehabilitation programme is of the utmost importance in determining the success or failure of the surgery. Non-compliance or poor compliance with the rehabilitation programme is a common cause of inability to return to sports.

The rehabilitation programme consists of range of motion, strengthening and finally sports-specific agility training.

Returning to sports will vary from individual to individual but generally nine to twelve months is the norm.

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