Anterior Cruciate Ligament Injury/Tear

ACL TEAR

Anterior Cruciate Ligament Injury/Tear

Anatomy:    

Causes of ACL Tear:

                        The Anterior Cruciate Ligament can be injured in several ways:

1.       Changing Direction rapidly.

2.       Stopping suddenly.

3.       Slowing down while running.

4.       Landing from a jump incorrectly.

5.       Direct contact or collisions, such as football or rugby tackle

 Mechanism of Anterior Cruciate Ligament injury:

 

Classification:

                       About half of all injuries to the Anterior Cruciate Ligament occur along with the damage to other structures in the knee, such as cartilage, meniscus or other ligaments.

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

Ø  GRADE 1 Injury: The ligament is mildly damaged in Grade 1 injury. It has been slightly stretched, but is still able to help keep the joint stable.

Ø  GRADE 2 Injury: A Grade 2 injury stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Ø  GRADE 3 Injury: This type of injury is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, ant the knee joint is unstable.

ü  Types of ACL Tear:

  

Symptoms:

Ø  When you injure your Anterior Cruciate Ligament, you might hear a “popping’ noise.

Ø  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 return to sports , your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (MENISCUS) of your knee.

Ø  Loss of full range of motion.

Ø  Joint line tenderness present.

Ø  Discomfort while walking.

Diagnosis:

·         Lachman test – positive.

·         X-Ray - will not show any injury to your Anterior Cruciate Ligament, X-Rays can show whether the injury is associated with a broken bone.

·         MRI Scan – MRI shows better images of soft tissues like Anterior cruciate ligament.

Treatment:

             ACL tear can be treated by either non-surgical or surgical method.

v  NON-SURGICAL TREATMENT: In non-surgical treatment, progressive physical therapy and rehabilitation can restore the knee to a condition to its pre-injury state and educate the patient on how to prevent instability. This may be supplemented with the use of hinged knee brace. However, many people who choose not to have surgery may experience secondary injury to the knee due to repetitive instability episodes.

ü  Non-surgical management of isolated ACL tears is likely to be successful or may be indicated in patients:

1. with partial tears and no instability symptoms.

2. Who do light manual work or live sedentary lifestyles.

3. Whose growth plates are still not open (children).

v  SURGICAL TREATMENT: Surgical treatment is usually advised in dealing with combined injuries. ACL tears are not usually repaired using suture to sew it back together, because repaired ACLs is generally replaced by a substitute graft tendon.

The tendons commonly used to replace the ACL include:

1.      Patellar tendon autograft (autograft comes from the patient).

2.      Hamstring tendon autograft .

3.      Quadriceps tendon autograft .

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