Do I have an ACL tear?
The Anterior Cruciate Ligament or ACL rupture is one of the injuries most dreaded by sports people. Commonly injured in skiing accidents, rugby, football and netball, it can signal the end of a promising sporting career. ACL knee injuries usually occur due to trauma or impact. It can occur during a severe impacts in rugby and football tackles, it can occur during a bad land in skiing or windsurfing or it can occur in sudden stopping and twisting actions in games like hockey and netball. In serious incidents the Posterior Cruciate Ligament can also get ruptured. It is not uncommon to rupture the ACL, the cartilage and the medial collateral ligament all in the same injury.
Symptoms of an ACL injury
The patient describes an audible popping sound. This will be followed by intense knee pain and immediate, severe swelling. The patient will also describe a feeling of their knee giving way. These symptoms will be worse if the medial ligament and medial cartilage have been torn as well.
Diagnosis of Anterior Cruciate Ligament Rupture
There are special stability tests that will be performed by your doctor or physiotherapist which are fairly accurate. If there is significant swelling the tests may not be accurate until this has gone down- do you may have to wait a week or so for confirmation. They might also confirm your diagnosis and look for associated damage with MRI scan.
What is the Best Treatment for ACL tear?
Because ACL rupture can be so devastating, there has been a lot of research into best treatment practices and as a result, recovery and outcomes are much more positive and sports people can often go back to sport at elite level if managed well. In the first few days the goal is the minimise swelling. Ice packs should be immediately placed on the knee after the injury. Use every 2 hours.
The ACL is situated deep inside the knee joint. It acts as the connective ligament between the thigh and shin bones. The ACL’s primary function is to stop the shin moving too far forwards and to prevent the knee excessively rotating. The ACL stabilizes the knee joint.
The ligament cannot be repaired so it needs to be reconstructed usisng another tendon or ligament-typically this will be the patella tendon or the hamstring tendon. Some people opt not to have surgery. If the patient does not wish to return to sport, they can carry out day to day activities without an ACL. Several months of rehab will be required to build up the muscles around the knee sufficient to stabilise the knee. Most cases of ACL rupture however will require full reconstruction.
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This video is not for the squeamish (!) but you can see that on top of the trauma of the initial accident, there is a fair bit of pain and swelling as a result of the surgical procedure.
Rehab for ACL
Every case of ACL rupture requires a comprehensive and specialised rehabilitation program for full recovery to happen.
Rehabilitation will first concentrate on regaining full range of movement into the joint. The next steps focus on gradual strengthening of the knee and surrounding muscles. Gait retraining, balance and proprioception are critical elements to rehab following by sports specific training. Rehab is a delicate balance of getting movement, strength and finction back asap but not overstressing the new reconstruction. Too much and progress can be delayed, too little and progress will be delayed. make sure you take advice and work with an experienced therapist.
Do not try to do this on your own. It’s just not worth it.
Typical rehab times range from 7 months to 1 year before the patient is back playing sport, confident in their knee. It can be vary depending on how diligent the patient is with their programme. Overall ACL outcomes are very good- but it does require significant work from both the therapist and the patient.
In summary this is a major injury and a major operation requiring some major rehab. With some hard work and good rehab a sucessful outcome usually occurs but it does involve more than a few simple leg lifts and basic stretches(!)
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Tags: ACL rehab, ACL repair, anterior cruciate ligament rehab, sports physio
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