Dr. Dharmapal G. K. The Best Orthopaedic Surgeon in Bengaluru

Anterior Cruciate Ligament (ACL) Injuries

Suffering from knee pain

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Anatomy

Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection.

Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.

 
normal knee anatomy

Normal knee anatomy.  The knee is made up of four main things: bones, cartilage, ligaments, and tendons.

Description

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

 
complete tear of the ACL

Injured ligaments are considered “sprains” and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

Cause

The anterior cruciate ligament can be injured in several ways:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.

Symptoms

When you injure your anterior cruciate ligament, you might hear a “popping” noise and you may feel your knee give out from under you. Other typical symptoms include:

  • Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
  • Loss of full range of motion
  • Tenderness along the joint line
  • Discomfort while walking

Doctor Examination

Physical Examination and Patient History

During your first visit, your doctor will talk to you about your symptoms and medical history.

During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.

Imaging Tests

Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. This study creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL.

FAQ

ACL [anterior cruciate ligament] is an important knee joint stabilizing structure which bridges the thigh bone and shin bone.

It is basically a sports related injury which happens in contact sports like football, basketball, kabaddi and also it is commonly seen in bike related accidents.

ACL along with providing stability to the knee, protects menisci and articular cartilage from damages thereby preventing osteoarthritis.

ACL does not heal by itself because of lack of blood supply.

Knee instability, occasional pain, loss of quadriceps strength.

In an ideal situation like young and active patients, arthroscopic ACL reconstruction surgery is the answer. But in middle aged individual with less active lifestyle and with preexisting arthritis of knee joint it can be managed conservatively

Obviously yes, of course age is just a number, studies have shown successful results are even achieved in 60 yr. old patients.

Untreated and symptomatic ACL tears lead to secondary meniscal tears and cartilage damages which will progress to osteoarthritis.

It depends on the percentage of ligament involved and the kind of physical demand the patient has.

There are conflicting debates, in our hands early ACL reconstructions have given good results. Also, in coexisting pathologies like meniscus tears, cartilage injuries, multi ligament knee injuries earlier the better.

All the patients will be guided through a customized physiotherapy program to achieve excellent results which will be started at the earliest.

Generally, the following day after surgery with crutch assistance for upto 3 weeks. Beyond 3 weeks patient can walk without assistance.

After diagnostic arthroscopy, torn ACL is debrided, anatomical tunnels are created in femur [thigh bone] and tibia [shin bone] to receive the prepared graft tissue and will be secured in the bony tunnels with implant devices in both the ends of femur and tibia

Commonly hamstring tendon and bone patellar tendon is used, also quadriceps tendon, peroneus longus tendon can be used depending on the co-existing ligament injuries.

Anatomical single bundle ACL reconstruction, Double bundle ACL reconstruction, All-Inside ACL reconstruction are possibilities as of today.

ACL repair is a revived concept of earlier times. With improved technology and proper case selection as in young patients, femoral peel offs and bony avulsion if done in 3 weeks of time we can expect good results.

In case of sitting job – 2 weeks, Jobs which demands walking – 4 to 6 weeks.

For a non-contact sport like badminton, table tennis it is about 4 months.

Jogging in 4 months,

Contact sports like football, basketball, cricket in 6 months.

Yes, with adequate conditioning programs, sports specific approach.

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