Definition
An Anterior Cruciate Ligament (ACL) rupture or tear refers to an injury involving the tearing of the anterior cruciate ligament, which is one of the major ligaments in the knee. The ACL is located in the centre of the knee joint and plays a crucial role in providing stability by connecting the femur (thighbone) to the tibia (shinbone). Its primary function is to control and limit the movement of the tibia relative to the femur.
ACL injuries often occur during activities that involve sudden stops, changes in direction, or direct impact to the knee. Sports such as soccer, basketball, netball and football are commonly associated with ACL tears. When the ACL is torn, it can result in pain, swelling, instability, and a loss of range of motion in the affected knee. In some cases, surgery may be recommended to reconstruct the torn ligament, followed by rehabilitation to restore strength and function to the knee joint. ACL injuries are relatively common, especially among athletes, and they require proper medical evaluation and treatment for optimal recovery.
Clinical Presentation
The clinical presentation of an ACL tear typically includes a combination of signs and symptoms. These may vary in intensity and can be influenced by factors such as the severity of the injury and the presence of associated damage to other structures in the knee. Common clinical presentations of an ACL tear include:
- Sudden Pain: Patients often report a sudden and sharp pain at the time of injury. This may be accompanied by a popping or snapping sound.
- Swelling: Swelling in the knee joint is a common early sign. The swelling may develop rapidly within a few hours of the injury and is often due to bleeding into the joint space.
- Limited Range of Motion: Individuals with an ACL tear may experience difficulty in fully straightening or bending their knee.
- Difficulty Walking or Weight-bearing: Some individuals may have difficulty walking, and weight-bearing may be painful or challenging.
- Instability: A feeling of instability or giving way in the knee is a common symptom. Patients may feel like their knee is not able to support their weight properly, especially during activities that involve cutting, pivoting, or changing direction.
It’s important to note that not all individuals with an ACL tear will experience all of these symptoms, and the severity of symptoms can vary. Additionally, other knee injuries, such as meniscus tears or collateral ligament injuries, may accompany an ACL tear, further influencing the clinical presentation. Proper diagnosis typically involves a thorough physical examination, imaging studies (such as MRI), and sometimes arthroscopy for a direct visualisation of the internal structures of the knee joint. If an ACL tear is confirmed, appropriate management, which may include both conservative measures and surgical intervention, will be determined based on the individual’s circumstances and goals.
Treatment Options
The treatment options for an ACL tear depend on various factors, including the severity of the injury, any associated injuries, the individual’s activity level, age, and overall health. Treatment options can be broadly categorised into conservative (non-surgical) and surgical approaches:
Conservative (Non-Surgical) Treatment:
- Physical Therapy: Rehabilitation is a key component of non-surgical management. Physical therapy focuses on strengthening the muscles around the knee, improving range of motion, and enhancing overall knee stability.
- Bracing: The use of a knee brace may be recommended to provide stability and support to the injured knee. Bracing can be considered in cases where surgery is not immediately pursued.
- Activity Modification: Individuals may be advised to modify their activities and avoid high-impact or pivoting activities that could further stress the injured knee.
- Anti-Inflammatory Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to help manage pain and reduce inflammation.
Surgical Treatment:
- ACL Reconstruction: This is the most common surgical intervention for a complete ACL tear, especially in individuals with a high activity level or those experiencing persistent instability. During ACL reconstruction, the torn ligament is replaced with a graft, often from the patient’s own hamstring or patellar tendon or from a donor source.
- Arthroscopy: ACL reconstruction is typically performed arthroscopically, using small incisions and a camera to guide the surgeon. This minimally invasive technique allows for quicker recovery and less postoperative pain.
- Rehabilitation: Post-surgery, a structured rehabilitation program is essential for optimal recovery. Physical therapy is crucial to regain strength, stability, and range of motion in the knee.
- Return to Activity: Full return to sports or high-impact activities usually occurs after a period of rehabilitation and when the knee is deemed stable by the surgeon and physical therapist.
The choice between conservative and surgical management is often individualised based on factors such as the patient’s age, activity level, the extent of injury, and the presence of associated injuries.
To schedule an appointment with Dr Matthew Evans to discuss your Knee Injury, please contact us by phone – (03) 9529 3820, or email evansadmin@mog.com.au
