Anterior Cruciate Ligament (ACL) Injury

The anterior cruciate ligament is one of the important ligaments which helps to maintain knee stability. Injuries of the anterior cruciate ligament are relatively more common knee injuries among athletes. They occur most frequently in those who play sports involving pivoting such as football, basketball, netball, soccer, gymnastics, and downhill skiing. The injury can be mild such as small tears, or sprain or can be severe when the ligament is completely torn.

Both contact and non-contact injuries can occur, but non-contact tears and ruptures are most common when the limb is in non-contact and combined with valgus and internal rotation trauma. It is seen that females are more prone to have a higher incidence rate of ACL injury compared to males, because of differences in Physical conditioning, Muscular strength, Neuromuscular control of pelvis and lower leg alignment, and the effects of estrogen on ligament properties.

ACL injuries most likely require surgery to regain full function. Most ACL injuries are complete or near complete tears, partial tears are usually rare.

ACL Injury: Causes

The anterior cruciate ligament can be injured in many ways. Some of the causes resulting in anterior cruciate ligament are

• Direct contact while playing games such as football

• Jumping from the height and landing incorrectly

• Sudden slowing down while running

• Stopping suddenly

• Changing of direction rapidly

• Secondary damage may occur in patients who have repeated episodes of instability due to ACL injury.

• ACL injuries can also occur in combination with damage to the meniscus, articular cartilage, or other ligaments

ACL Injury: Symptoms

• Patient may hear a "popping" noise once the ACL has been damaged

• Pain with swelling is present

• Restriction of movements

• Pain along the joint line causing discomfort while walking

An ACL injury is considered a sprain and is divided into 3 grades based on the amount of ligament damaged −

• Grade 1 Sprains − In this, the ligament is mildly damaged; It is slightly stretched but is still can keep the knee joint stable.

• Grade 2 Sprains − In this, the ligament can be stretched to the point where it becomes loose and is often referred to as a partial tear of the ligament

• Grade 3 Sprains. − In this type of sprain, the ligament is completely torn, the ligament is split into two pieces, and the knee joint is unstable.

ACL Injury: Risk Factors

Some of the factors which increase the risk of an ACL injury include.

• Age − adult age group people are more susceptible because of the increase in the number of adults participating in various sports but any age group can be affected.

• Sex − females are more prone because of differences in Physical conditioning, Muscular strength, Neuromuscular control of the pelvis and lower leg alignment, and the effects of estrogen on ligament properties.

• Athletes are more prone to ACL injury either by direct or indirect contact while playing sports such as football, basketball, etc.

• Style of playing, kind of game, weather, and shoe surface

• Intrinsic factors such as body size, hamstring strength, quadriceps strength, leg dominance, ligament dominance, and foot morphology also influence ACL injury

ACL Injury: Diagnosis

Diagnosis of the ACL injury can be made based on the −

• The medical history of the patient

• Physical investigation: it is done by various methods of testing such as the Lachman’s test, pivot shift test, and anterior drawer test

• Investigations such as MRI and Arthroscopy

ACL Injury: Treatment

ACL injuries can be treated conservatively or surgically depending on the amount of ligament injured.

Conservative Treatment − Nonsurgical treatment can be effective in patients who are elderly or have a very low activity some of the conservative methods include −

• Level Bracing − A brace is given to protect the knee from instability.

• Crutches − To avoid putting weight on your leg and to further protect the knee crutches are advised

• Physical therapy − once the swelling goes down, a careful rehabilitation program can be started. Specific exercises can restore the function of the knee and strengthen the leg muscles that support it.

• Analgesics − to relieve the pain

• Ample rest − Cold compression with ice

Surgical Treatment − Most ACL injuries cannot be stitched back together. The ligament should be reconstructed with a tissue graft. Grafts can be taken from the patellar tendon. It may take several months for an athlete to return to the sport. Surgery is done to rebuild the ACL is done with an arthroscope using small incisions. Arthroscopic surgery is less invasive, leading to less time spent at the hospital and quick recovery time. ACL reconstruction is usually not done immediately, time is given to reduce the inflammation.

Rehabilitation − A physical therapy program is essential for a successful ACL recovery. Physical therapy aims at returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the strength across the ligament

ACL Injury: Prevention

Prevention of ACL injury can be done by making the muscles strong and flexible around the knee. Some of the methods to prevent ACL injury include:

• Exercising regularly − flexibility exercises, jogging, strengthening exercises,

• plank and polymetric, all these kinds of exercises strengthen the knee muscles

• Exercise should be avoided when the person is fatigued

• Avoid moving the legs rapidly and stiff joints while jumping

• Strengthening of hamstrings and quadriceps also should be taken care of

• Learning proper landing techniques after jumps

Conclusion

ACL injuries are the more common injuries seen in athletes, especially women athletes. The anterior cruciate ligament is necessary for maintaining the strength of the knee and helps in its flexibility all around

ACL injuries are usually diagnosed based on history and physical examination. The pop sound is heard when the ligament is injured and restriction of the movement is seen. ACL injuries can be prevented by making the muscles around the knee strong and strengthening the hamstring muscles as well as the quadriceps muscle

Most ACL injuries are complete or near complete tears, partial tears are usually rare. ACL injuries most likely require surgery to regain full function.