The anterior cruciate ligament (ACL) is one of the two major ligaments in the knee, the other being the posterior cruciate ligament (PCL).These ligaments perform the vital function of connecting the large femur bone of the thigh to the lower leg bone called the tibia.
The ACL’s main purpose is to maintain the overall stability and support of the knee, the largest joint in the body. The ligament is positioned just behind the kneecap and holds the leg and thigh bones in place preventing the leg bone from slipping forward and rotating during pivoting movements. The ACL is supported by the thigh, buttock and very importantly the hamstring muscle groups.
Ligaments are tough bands of tissue that connect various bones together within your bodies. Although they are very strong too much stress on them due to intensive sports or overloading during a sudden twisting movement can cause them to stretch too far, possibly even to snap. If the ligament snaps, that is a complete rupture, we use the technical term ‘’he did his ACL”.
Athletes who suffer an ACL injury will usually experience a sharp burning sensation and severe pain in the knee. It is also likely that no weight or pressure will be possible to sustain on the knee when suffering an ACL injury.
Symptoms may include:
Sometimes blood might pool in the knee joint (known as a haemarthrosis) as a result of the injury indicating a high probability that the ACL is ruptured.
The most common is a combination of bending while at the same time twisting or rotating the knee, a common movement in some sports.
Other known movements that can cause ACL injury include:
These injuries are common in rugby players, football players, basketball players, skiers, gymnasts, and other athletes.
Ligament injuries are sometimes difficult to diagnose in the early stages of an injury but if they are not treated soon after the incident then ACL injuries may cause more severe problem months or years later.
Commonly an X-rays or MRI (Magnetic Resonance Imaging) scan will be required to assist in the diagnosis of an ACL the injury and help determine between a partial or complete rupture. In the past a ligament injury could potentially end the career of an athlete but treatment options are now more sophisticated and successful in helping a return to sport.
For an ACL injury there is surgical and non-surgical treatment options. Athletes or people who work in labour intensive jobs who are more demanding on their knees would likely benefit most from ACL reconstruction surgery.
For less active people leg strengthening exercises of the gluteals, quadriceps and the hamstrings are required, as well as possibly wearing of a support brace for a period of time. This route is unlikely to restore the same level of stability as surgery however most people who receive good physiotherapy rehabilitation can achieve excellent levels of function.
The surgical option usually involves taking a graft of another ligament and then used to replace the original ACL, fixing in place using a screw, glue, or a staple. During the recovery period the new ligament is eventually ‘accepted’ by the body in replace of the original ACL.
Advice on pain relief, reduction of swelling, restoring mobility, bracing, strapping as well as the development of an appropriate strengthening programme for the supporting muscles of the knee can be supplied by your Chartered Physiotherapist. These techniques can help prepare the knee for surgery, if required, as well as support post-op rehabilitation.
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