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ACL injury

Ligaments, Meniscus & Muscles​

  • Ligaments : They are soft connective tissues which connect bone to bone.

Function : It helps to stabilize the joint.​

-The knee is held in place by four large ligaments. It  is smooth , tough tissue which covers the ends of the bones within the knee.

  • Meniscus: It  is smooth , tough tissue called articular cartilage covers the ends of the bones within the knee. They are two in number.

​Function : It helps to distribute the body Weight evenly within the knee joint.

It acts as shock absorber for the knee joint.

  • Muscles : It supports the knee and control the movements.

- Quadriceps and Hamstrings which work in coordination with each other.

What is the ACL?​

The Anterior Cruciate Ligament is one of a pair of ligaments in the centre of the knee that form a cross. The average length of the ACL is approximately 4 cm. It acts like a very thick rubber band and can return to its normal shape after stretching within certain limits.

Function of the ACL

  • Seen more in young people especially in females than Males due to the changes in the hormone level between the two genders. This is because they may increase joint laxity and extensibility of the soft tissues surrounding the knee joint.

  •  The ACL stops the forward movement  of the leg especially when the knee is slightly bent, e.g. twisting   It stops sideways movements of the knee joint, e.g. tackled from the side and provides sensory feedback from the nerve fibers within the ligament, therefore improving balance e.g. running on uneven surfaces.

Mechanism of Injury

  • There are several ways in which an ACL can be injured. When an ACL is injured it is often associated with hearing a pop or cracks it ruptures. The causes of an ACL injury can be contact or non-contact:

  1. Non-contact : (70% patients) A sudden stop combined with a direction change while running,pivoting or landing from a jump, extreme hyper extension (excessive straightening) or hyper flexion (excessive bending) of the knee.

  2. Contact: (30% patients) A direct blow to the outside of the knee or lower leg.

  • Grades of Injury:

Grade 1 : 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 : 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 : 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

Associated injuries with ACL include tears involving

  • PCL injury

  • Meniscus tear

  • Avulsion fracture of tibial bone

  • MCL tear

Symptoms                                          

At the time of the injury and since, you may have experienced:

  • Pain

  • Swelling

  • Giving way- The knee may feel loose and unstable (buckling).

​​

Conservative Management :

In some cases depending on the type and grade of tear following treatment is adviced.

Rest

Ice

Splints

Rehabilitation

Surgical Procedure:

  • The operation to reconstruct the anterior cruciate ligament (ACL) involves replacing it with another ligament type graft tissue which can be taken from around the knee.

Post Operation:

  • Operated leg will be kept straight in a leg knee splint, with bandaging underneath.

  • An ice-pack and a Continuous Passive Motion (CPM) machine will be applied once you are awake to achieve 0°- 60° of flexion (bend) at the knee.

Post-Operative rehab:

  • On the following day your Physiotherapist will reassess you and commence active knee flexion (bending) and extension (straightening) exercises ankle pumps, static quadriceps.

  • You will be taught walking along with help of walking aids and transition will be made in accordance with the weight bearing allowed from crutches to stick.

What we offer at Your Physio?

  • 1:1 ratio of physio and patient is offered at our set up.

  • According to patients status and functional goals (sports, job)phase wise the treatment is accelerated.

  • Every patient is given treatment in phases (I, II, III)

  • Your Physio gives lots of emphasis on home regime which is called Home Exercise Program (HEP) which saves 10-15% treatment time and facilitates patient to achieve the targeted goals.

Pre-habilitation :

  • Patients are taught exercises and trained before surgery according to the status of the patient.

Conservative and Post surgical Rehabilitation

Phase I: Mobility, Flexibility and Strengthening

Phase II: Balance, Endurance, Speed and power

Phase III: Back to play

  • Agility and load management

By- Dr. Purva Sonegaonkar and Dr. Sheetal Mundhada