With tens of thousands of ACL tears happening every year, it is one of the most common injuries that affects active young people in the UK and elsewhere. Sports Med London offers surgical treatment and supportive physiotherapy by qualified and experienced professionals for the injury.
ACL – An Important Ligament
The ACL or, to give its full name, the anterior cruciate ligament, is one of the knee’s most important ligaments. The ACL passes backwards, upwards, and outwards from the front of the shin bone and within the knee, and it attaches to the inner side of the thigh bone.
The ligament’s main functions are to stop your shin bone from sliding or popping out in front of your thigh bone, and, along with other ligaments, to keep your knee stable when you move it.
A Common Sports Injury
As mentioned above, ACL tears are one of the most common sports injuries. A typical ACL injury sees the knee twisted forcefully while the foot is kept firmly on the ground, which causes a sudden change in direction. Other ways in which ACL tears happen include:
- Bending the knee far forwards or backwards suddenly
- Stopping running or walking suddenly
- Not landing properly when you jump
- Bumping into or colliding with someone or something
What Happens When The ACL Tears?
A loud popping sound is one of the first things you notice when your ACL tears. Next, blood will make your knee swell rapidly.
You will probably feel unsteady on that leg, and you may find it difficult to bear your own weight. You may even need someone to help you to walk to a seat. The feeling of instability will continue after the swelling goes away, and your leg will give way frequently.
Medical Help For ACL Tears
The medical help you can receive for ACL tears at Sports Med London begins with a consultation. You will have the chance to tell our specialist what happened and explain the symptoms you have experienced. The doctor will examine your knee and perform a test such as an MRI scan.
An ACL tear is a serious knee injury that seldom happens alone – it is usually accompanied by other injuries in the knee joint. You might receive surgical or non-surgical treatment for the injury. Examples of treatment include:
- Rest, ice, compression, and elevation (RICE)
- Physical therapy
- A knee brace
- ACL reconstructive surgery involving grafting tissue
Reconstructive surgery usually is followed by a physiotherapy programme to help get you moving again.
Read on for more detailed information about ACL tears.
What is the ACL?
The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee. It passes within the knee from the front of tibia (shin bone) backwards, upwards and outwards (laterally) attaching to the medial (inner) side of the lateral femoral condyle of the femur (thigh bone). It prevents the tibia from sliding out in front of the femur. It also acts with other ligaments of the knee to stabilise the knee in rotation.
What causes an ACL injury?
An ACL injury typically is a pivoting injury that occurs when the knee is forcefully twisted with the foot planted (fixed) on the ground. The ACL often tears with an abrupt change in direction, but may occur when a deceleration force crosses the knee. It may also occur with forceful hyperextension (the knee suddenly going beyond straight) or forceful flexion ( the knee suddenly bending excessively) such as falling onto a flexed knee. Activities involving changing direction rapidly, stopping suddenly, slowing down abruptly while running or suddenly stopping, incorrect landing from a jump, and direct contact or collision, such as a football tackle can also cause injury to the ACL. Common sports in which an ACL may be injured include football, netball, basketball, skiing and rugby.
During an ACL injury you might feel a tear or hear a “pop”. The knee tends to swell rapidly as it fills with blood (haemarthrosis) and often feels unstable with difficulty in weight bearing. Most people are unable to resume the activity and may require help off the “pitch”. As the swelling subsides patients may complain of ongoing instability, the knee feeling “disconnected”, “wobbly” or “not right” with regular giving way.
How is an ACL injury diagnosed?
Diagnosing an ACL tear is made by a patients symptoms and mechanism of injury, performing a physical examination of the knee and diagnostic tests typically an MRI scan. Rarely X-rays, stress tests of the ligament and occasionally arthroscopic assessment are performed in specific circumstances.
How is an ACL injury treated? Surgical vs Non-surgical management
An ACL tear (rupture) is a significant knee injury and is often associated with other intra-articular injuries. Treatment options include both non-surgical and surgical methods and are tailored to a specific individuals needs. Factors considered include activity levels, sporting involvements and goals, medical fitness and to a lesser extent age.
Initial treatment consists of controlling pain and swelling through rest, ice, compression, and elevation (RICE protocol). Physical therapy is often recommended to improve knee motion and strength. For a short period a knee brace may be needed to help immobilise the knee.
Some patients may be able to regain a functionally stable knee without surgery by improving their proprioception (reflexes and joint position awareness) and strengthening their thigh and calf muscles. However conservatively managed patients may continue to avoid certain rotational activities and may be unable to return to their pre-injury level of exercise or sport. Those involved in pivoting sports or with a particularly active lifestyle may require surgery to safely return to sport/activity. The clearest indication for surgery is in patients with the knee frequently giving way. Recurrent episodes of instability may potentially damage the articular cartilage (shiny surface ), menisci (shock absorbers) or other ligaments within the knee resulting in poorer long-term outcomes. The usual surgery for an ACL tear is an ACL reconstruction which replaces the torn ligament with a graft (tissue taken from another place). This may be from the same patient (autograft) and usually is either the hamstring tendons, bone patella tendon or the quadriceps tendon. Allograft (taken tissue from a donor who has passed away) may be also be used with advantages and disadvantages for both. This should be discussed with your surgeon in detail before surgery. In a very small group of patients with specific indications the ACL may be repaired by reattaching it to the femur or tibia if it has detached (pulled off). This requires a specific skill set and should be discussed with your surgeon to see whether this is appropriate or applicable.
ACL reconstructive surgery is performed with an arthroscope (special camera via keyhole surgery) using small incisions. The ruptured ligament is removed and tunnels (holes) in the bone are drilled to accept the ACL graft. This graft which replaces the patient’s old ligament is prepared to take the form of a new tendon and passed through the bone tunnels. The new tendon is then fixed into the bone with special mechanical devices to hold it in place while the ligament heals into the bone (usually 3-6 months).
The wound is closed with absorbable sutures and a dressing is applied.
As surgical techniques have improved significantly over the last decade, complications are reduced and recovery much quicker than in the past.
Following ACL reconstruction, a rehabilitation program with physiotherapy is started to help you to ultimately return to sport and a wider range of activities. Many patients are able to begin a phased return to contact sports by 9 months post-surgery. This is dictated by patients meeting milestones and under the supervision of the surgeon and specially trained physiotherapist.