Empire Physiotherapy

Anterior Cruciate Ligament injury

Summary of Anterior Cruciate Ligament injury

The anterior cruciate ligament (hereby known as ACL) binds the base of the thigh bone with the top of the shin bone, and is located deep within the knee joint. It is vital to providing the stability your knees need to withstand day to day movement and activity. Tearing your ACL is the most common injury that can be caused by sporting activity, and the extent of the damage is imperative in deciding if the remedy can be led by home exercises or surgical treatment.

Anterior Cruciate Ligament injury FAQ's

The ACL is one of four key ligaments that aid the function of the knee. The ACL is positioned in the centre of the knee joint, connecting the base of the thigh with the top of the shin, and thus is vital in resisting forward movement of the shin relative to the thigh bone. If the ligament becomes overstretched, this can cause inflammation, injury and ultimately pain inside the knee, leading to instability. There are three grades by which clinicians define the extent of the injury:Grade 1 – A mild injury caused by microscopic tears to the ACL, which do not affect movement of the knee.Grade 2 – A moderate injury that can leave the individual feeling unstable especially when walking.Grade 3 – A severe injury in which the ACL is completely torn and the individual is extremely unsteady.The majority of ACL injuries are diagnosed as Grade 3 and require surgery to repair the tear.
At the point of injury, a loud pop or crack is often heard coming from the knee, followed by swelling around the knee. This can be very painful and even when the swelling has subsided the individual will often feel unsteady when walking. The severity of the instability relates directly to how serious the injury is and how damaged the fibres within the ACL are. In the most severe cases we may see that other ligaments are affected, ultimately causing further pain and instability around the knee area through clicking, or restricted movement.
This depends on the severity of the injury and whether or not you opt for surgery. A full recovery without surgery is possible within 2-3 months, relying on strengthening exercises to provide stability to the knee and the knee joint. If the injury is classed as a Grade 2, without surgery it may never be the same again but you can achieve a relatively normal range of motion with regular strengthening exercises and the support of a knee brace.A Grade III tear is most likely to require surgery. Success rates are high but the recovery process is long and can last between 4 and 12 months depending on your body and the injury. The clinician will require a say in when you return to sporting activity, looking at a progressive approach to regaining motion and fitness.
Most ACL injuries are non-contact, that is they occur when the individual falls onto the knee or locks their foot and causes the knee to twist. This could be related to changing direction suddenly, or coming to a sudden stop.In other cases, the injury could be caused by a blow to the back of the knee, for example from a ball during sport or during a tackle in contact sports. In all cases, with a great enough force the ACL will completely tear, which is why most injuries are reported as Grade 3.
The first steps are to reduce the pain and bring the swelling down, regaining motion in the knee. In most cases this can be achieved with rest and elevation of the knee joint, allowing the clinician to then assess the extent of the injury and decide if surgical intervention is necessary. This is a decision made with the support of the patient, taking into account the patient’s age and lifestyle. It is possible for a person to carry on a normal daily life with a partial tear of their cruciate ligament, for example an older individual who could strengthen the knee joint and its surrounding muscles, but who does not require surgery as their lifestyle simply doesn’t call for it. A younger individual or someone heavily into sport is more likely to opt for the surgical fix. This involves a complex and lengthy rehabilitation process, beginning with gradual movements of the knee joint, a strengthening programme and balance work.
The exercises programme will be tailored to your needs and must be performed correctly according to each stage of healing. Strengthening exercises involving the whole leg will provide the best support to the knee joint and are vital to making a full recovery. Failure to do this will leave the knee joint vulnerable to future injury.