ACL injuries or ouch my knee!

It seems like everyone knows someone who has torn their ACL or anterior cruciate ligament in their knee. This small but serious ligament in our knees connects the between the tibia and femur, holding these bones together and providing stability to the knee. While there are 3 grades of strains that can occur to the ACL, unfortunately, the most common is a complete tear.

Spraining of the ACL occurs typically due to a sudden change in direction or stop, landing incorrectly or from direct impact to the knee such as through contact sports. Injuries to the ACL may produce a popping noise or feeling at the time of injury and pain as well as loss of motion and swelling is guaranteed.

It is recommended to seek immediate medical care for an injury to the ACL ligament, which may be diagnosed with the use of XRAY or MRI. It is best to try and have the joint reviewed before the onset of swelling, as it can be more difficult once swelling as set in. The clinician may use the Lachman’s test, which is a maneuver used to test the joint. A full tear will require a surgical reconstruction of the knee, although for children, this may be delayed dependent on their stage of growth – in which case a full brace will be used to support the knee joint. A brace will also be recommended after surgery for rehabilitation and support.

Extensive rehabilitation, particularly exercise rehabilitation, is required before and after surgical repair to ensure recovery of range of motion and function to joint. Typical rehabilitation will start with the use of an exercise bike and weight bearing exercises to increase range of motion and to regain functional stability. Balance and proprioceptive (sense of the body’s position) exercises are also encouraged.

Physiotherapy technique such as manual therapy, gait re-education, exercise programs will be introduced, typically with progressive exercise modifications to regain normal functionality. As rehabilitation progresses, returned range of motion and good balance control will see more exercises added to increase strength and stability back to the knee joint and muscles. Typically, after adherence to rehabilitation, it is expected that return to sport can be possible within 6-12 months after surgery.

Some additional problems that may stem from an ACL injury can include lower back pain, due to altered gait and or from the use of crutches, therefore it is important to have your rehabilitation guided by a physiotherapist, so that any additional issues can be also treatment or modifications can be provided to ensure these problems are minimized.

3 Important things to be aware of:

1. Re-injury of the ACL can also occur after a reconstruction, most likely seen within the first 12 months after injury if the joint is not properly rehabilitated or if returning to sport too early.

2. Those who have injured their ACL are at a greater risk of developing osteoarthritis in that joint, therefore it is extremely important to not only ensure proper rehabilitation in the immediate period after the ACL injury, but also to ensure upkeep of rehabilitation and joint health.

3. Women can have a higher chance of having an ACL injury, as oestrogren makes ligaments increase in laxity and during growth and development, women develop less muscle strength in the legs. There is an increased incidence due to the mild differences to anatomy with a smaller ALC and wider pelvis influencing biomechanics. Women also tend to be stronger through their quadriceps than their hamstrings, which can increase stress to the knee joint. Therefore, it is important to ensure that correct positioning and care is taken if partaking in activities that may rely heavily on knee use. It is also recommended that that if partaking in sporting activities, focus on increasing leg strength is recommended.

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