Anterior Cruciate Ligament (ACL) Rupture
What is an ACL rupture?
Your anterior cruciate ligament is an exceptionally important structure within the knee. Before the advent of modern surgical techniques an ACL rupture would end a sporting career. Nowadays elite level sports people are able to return to representative level sport with the right surgery and rehabilitation.
The word anterior in medical parlance means ‘near the front’. The term cruciate can be said to mean ‘cross shaped’ Your ACL along with your posterior cruciate ligament form a cross within the knee. Your ACL is the foremost and is clearly seen on the picture here.
The job of your ACL is to provide the knee with stability particularly on rotation and in full extension (when straight).
ACL ruptures tend to occur during sporting activity (Football, Rugby) or during forced rotation (a fall while skiing when your bindings do not release).
The mechanism of injury is often associated with deceleration coupled with direction changing, pivoting or sidestepping maneuvers, awkward landings or "out of control" play. Interestingly it is seen that 70% of ACL ruptures occurring on the field of play do so without contact by another player. The exact reason why this may happen is still a subject for academic study but it is thought to be a combination of environmental, anatomic, hormonal, and biomechanical factors.
ACL rupture may be complete or partial. The course of treatment that you may require depends very much on the extent of your tear, your response to treatment and your aspirations regarding return to sport.
Because of the nature of this type of injury, whereby your knee is essentially momentarily dislocated, it is common that an ACL injury can be sustained along with other types of injury such as MCL strain [hyperlink], meniscal tear [hyperlink] and fracture.
What are the symptoms of ACL rupture?
At the time of ACL rupture people often report that they feel a pop or hear a crack from within the knee joint. It is often very difficult to continue playing your sport or even walk on the knee after such an injury due to pain.
The ACL has a healthy blood supply, so if it is torn it can bleed into the middle of the knee joint. This causes swelling to accumulate quickly within the knee: Often immediately or within the first few hours.
Sometimes if the ACL is torn the remnant of the ligament can disrupt the movement of the knee meaning that it cannot be fully straightened.
If the knee is left to settle and the pain subsides the knee may well be left feeling really quite unstable. This may manifest as an inability to get back to previous activities due to a feeling that the knee cannot be trusted or frankly gives way. In some instances when people do not get the specialist assessment that they require and an ACL rupture is not diagnosed or treated people may experience recurrent episodes of giving way.
What can I do for myself?
Due to the forces placed through the knee during this type of injury it is a good idea to start with a specialist assessment. If you are unable to put weight through the knee and your knee has swollen up quickly it is probably best that you present at an A&E. If you are unsure then a specialist assessment is recommended. This is a service that we are able to offer.
It is a good idea to start your self-guided treatment by following the advice regarding acute soft tissue injuries here. It would be fair to suggest that early good quality injury management means that you should improve as quickly as possible. This is a service we are able to offer.
Treatment from this point depends upon:
- The extent of your ACL injury (this can be assessed clinically and by MRI)
- The level of instability your knee presents with.
- Your normal activity levels
- Your aspirations for return to activity.
These are complex decisions requiring a full appreciation of the risks and benefits of different treatments and the effects that adherence to these treatments will have on your life. This type of decision is best made supported by a specialist professional. Again this is a service we are very able and willing to provide.
What treatments are available?
Some people will be able to reach the level of activity they need with good quality guided rehabilitation. Available at Cycloform Physiotherapy. Others will need ACL reconstruction to enable a return to normality.
ACL reconstruction is a surgical technique which more often than not takes another piece of your knee anatomy and replaces your absent ACL with a new ‘graft’. In time and with guided rehabilitation the new graft supports the knee and ensures that activities can be undertaken while the knee remains stable. If you have had an ACL reconstruction and need rehabilitation we are very able to offer the rehabilitation you require.