ACL Injury

Dr. Rajalakshmi VK (AIIMS)MBBS

December 17, 2019

June 04, 2022

ACL Injury
ACL Injury

Anterior Cruciate Ligament or ACL injuries are by far the most common knee injuries among athletes as well as the general population. Football and kabaddi players are particularly prone to this type of knee injury. Though non-athletes can also get this type of injury through sudden movements that strain the knee, or if they twist their knee or take the impact of a fall on their knees.

ACL comprises strong fibrous tissues that connect the thigh bone (femur) to the shin bone (tibia). In addition to stabilizing the knee joint, the ACL prevents the shin bone from sliding too far forward when we walk or run. In other words, the ACL stops the knee from over-extending. The ACL also plays a key role in any rotation movement of the knee, like turning or pivoting.

Located in the front of the knee, ACL is just one of four different types of ligaments in this joint. The others are Lateral Collateral Ligament on the outside of the knee, Medial Collateral Ligament on the side facing your other leg and Posterior Cruciate Ligament at the back.

The most common symptoms of an ACL injury are severe knee pain, swelling that occurs shortly after sustaining an injury, and a feeling of instability. A lot of patients also report hearing a "pop" the moment they hurt their knee.

Doctors typically use the Lachman test to check for ACL injury. They may also X-ray or MRI the leg to confirm the diagnosis. MRI or magnetic resonance imaging machines are scanning devices that take hundreds of pictures of small sections of the body, to produce a magnified and clear picture.

ACL injuries can vary in intensity and symptoms: while some injuries require rest, others need surgery and a rehabilitation programme to make a full recovery.

Factors that increase the risk of an ACL injury include being female, playing high-impact sports like football and wearing wrong-sized shoes!

Causes of ACL Injury

Sports involving repetitive athletic movements for a longer duration and sudden stops and turns see more cases of ACL injury. These include sports like football, basketball, badminton and tennis. These are sports where athletes have to run, jump, stop and change direction quickly, causing the knee joint to be under constant pressure. Sudden movements like rotating or while you pivot can also lead to ACL injury.

Although the injury is mostly caused while playing non-contact sports like the ones mentioned above, there are several cases of ACL injuries even while playing contact sports with a direct impact or blow to the knee. One example of this is kabaddi, where the scissor hold is one of the major causes of knee ligament tears.

The most common causes of injuring the ACL are general stress, inflammation and tendonitis, in that order. Overuse of the ligaments in your knee may also cause the injury. Sudden or acute injury can also lead to a full ACL tear. According to a 2012 study published in the Journal of Athletic Training, women are nine times more likely to tear their ACL than men.

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Symptoms of ACL Injury

Symptoms of Anterior Cruciate Ligament injury include:

  • Pain when you bend your knee or while walking
  • The knee is swollen and tender to the touch
  • You hear or feel a "popping" sensation in the knee
  • You are unable to move the knee to its full range of motion
  • You are unable to support your body weight on the injured knee

Visit a doctor immediately if you have recently injured your knee and notice any of these signs.

Diagnosis of ACL Injury

The Lachman Test and the Pivot Test are common and accurate tests to determine an ACL injury to your knee, while an MRI can give a clearer indication of the extent of damage to the ligament.

To perform the Lachman Test, the doctor will ask you to lie down on your back. Next, he/she will hold your leg above and below the knee and try to move the shin up and down. A healthy ACL will restrict this movement, and the doctor will feel a resistance beyond a certain point. A torn ACL will allow a greater range of movement with less resistance.

For the Lateral Pivot Shift Test, also known as the Macintosh test, the doctor will ask you to lie back. Next, he or she will hold your heel and turn your foot slightly inward. The doctor will then bend your knee and straighten it a few times. If this produces a clicking sound, or if the patient feels a "giving way" sensation, it may indicate a torn ligament.

An X-ray or MRI are done with the help of the appropriate scanners. Remember to remove all metal ornaments before going for an MRI, which uses a giant magnet.

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Treatment for ACL Injury

While rest and applying ice may reduce swelling as a result of minor ACL injury, more severe situations like a tear in the ACL can require surgery, prolonged rest and extensive physical therapy.

A tear in the ACL severely hinders your ability to move around, and the go-to method for recovery becomes an Anterior Cruciate Ligament (ACL) Reconstruction Surgery, which is a fairly common procedure. Patients make a full recovery from the surgery and are able to resume their daily activities in most cases.

Risk factors for ACL Injury

While anyone can get an ACL injury at any time, there are some factors that can increase the risk:

  • Women are more likely to get ACL injuries. Medical practitioners say this could be because of the difference in muscle strength between men and women and hormonal imbalances.
  • Playing sports that require jumping, swift turns and running can increase your risk. These include football, basketball, gymnastics, badminton and kabaddi.
  • Playing on artificial grass or hard surfaces.
  • Ill-fitting footwear and sports equipment like skis with binds that don't close properly.

Prevention of ACL Injury

It is always a good idea to warm up before performing an exercise or playing a sport. Here are some pointers you should keep in mind to avoid ACL injuries:

  • Always wear the right footwear while playing a particular sport or performing a physically strenuous exercise.
  • Wear a knee brace, if you have frequent aches and pains in the knee.
  • Include exercises for the hamstring and stretches for the whole leg into your weekly routine.
  • Incorporate more stretching movements just before playing a sport.

ACL reconstruction surgery is only required in severe cases. Usually, physical therapy, rehabilitation and strengthening programmes are enough to recover from minor injuries and to keep the ligaments in good health.

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Complications of ACL Injury

Injuries to the Anterior Cruciate Ligament increase the risk of osteoarthritis later in life. It is important to work with physiotherapists and continue to exercise the knee even after recovering from an injury.

ACL reconstruction surgery is fairly common. And though rare, infection after an ACL surgery can be quite serious. Do keep your follow-up appointments with the doctor, if you have had knee surgery.

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