Anterior Cruciate Ligament (ACL) Tears: Anterior Cruciate Ligament or ACL tears are one of the most common injuries of the knee, particularly amongst young and active individuals. ACL tears usually occur in sports that involve sudden stops or changes in direction including, soccer, skiing, football, and basketball. Many times, a “pop” in the knee is heard with subsequent pain, swelling and decreased range of motion. ACL tears may be accompanied by other injuries including Collateral Ligament tears (MCL or LCL) and meniscus tears.
There are 4 ligament stabilizers of the knee:
- Anterior Cruciate Ligament (ACL): Located inside the knee joint attaching from the thigh bone (femur) to the shin bone (tibia). Helps control back and forth motion of the knee and also provides rotational stability.
- Posterior Cruciate Ligament (PCL): Also located inside the knee joint attaching from the thigh bone (femur) to the shin bone (tibia). Forms an X with the ACL. Also helps control back and forth motion of the knee and provides rotational stability.
- Medial Collateral Ligament (MCL): Located outside of the knee joint. Extends from the medial thigh bone (medial femoral condyle) to the shin bone (tibia). The MCL helps stabilize the knee and prevents it from bending inward.
- Lateral Collateral Ligament (LCL): Located outside of the knee joint. Extends from the lateral thigh bone (lateral femoral condyle) to the head of the fibula. The LCL helps stabilize the knee and prevents it from bending outward.
Injury to the ligaments are divided into 3 Grades and are classified as sprains:
- Grade 1 Sprain: The ligament is slightly stretched but not torn. In this case your knee joint is still stable if there are no other injuries.
- Grade 2 Sprain: The ligament is partially torn. The knee joint may be stable or unstable.
- Grade 3 Sprain: The ligament is completely torn. In this case you will have an unstable knee joint.
Symptoms of ACL tears include pain, knee swelling and effusion, decreased range of motion, and difficulty or inability to bear weight on the knee. Patients may also feel instability of the knee or feeling of the knee “giving out.” The long-term complication for ACL tears is that it increases the chance of developing early onset osteoarthritis of the knee, especially if it is associated with other injuries of the knee, including meniscus tears.
Diagnosis of ACL Tears
ACL tears can be inferred with physical examination including the Lachman Test and the Anterior Drawer Test. X-rays can be obtained to rule out a fracture but they are not able to visualize the ligaments or menisci. MRI is the gold standard as it can accurately identify the degree of ACL injury as well as injury to other ligaments, meniscus tears, and cartilage injury.
Treatment of ACL Tears
Immediate treatment after an ACL injury is focused on reducing pain and swelling with the RICE Protocol (Rest, Ice, Compression, Elevation). Further treatment includes physical therapy to restore range of motion and strengthen the regional muscles. Crutches may also be administered for a short period of time if the patient has a lot of discomfort on ambulation.
The degree of the ACL sprain (Grade 1, 2, 3), whether there is injury to other ligament or menisci of the knee, and the patient’s activity level (high level athlete vs. sedentary) will dictate further course of treatment.
At the Advanced Healing Institute, Platelet Rich Plasma therapy is often performed on Grade 1 and 2 ACL tears to stimulate faster healing and get patients back to their active lifestyle. In additional PRP will also help in reducing knee pain and healing other knee structures that may have been involved during the injury.
Grade 3 tears, usually result of higher impact injury, are usually accompanied by other injuries including meniscus tears, collateral ligament injury and cartilage injury. In these cases, knee surgery may be the best option. This is especially important if you are an athlete and want to continue doing high demand sports which involve doing rapid acceleration, deceleration, jumping and pivoting.
Prevention of ACL injuries
Strength training, including strengthening the quadriceps and hamstring muscles and balance exercises can help reduce risk of developing ACL tears. Neuromuscular and proprioceptive treatments also help improve the reflex response during sports activities which can also reduce the chance of developing ACL injuries. Proper techniques when performing twisting or cutting movements and when jumping and landing are also important to help reduce chance of ACL injury. And as always, common sense precautions like proper stretching before sports and proper footwear will help reduce chance of injury.
Contact the Advanced Healing Institute today if you would like to schedule a consultation and treatment. We are dedicated to helping our patients find effective relief from ACL sprains and other painful knee conditions.