What are they?
A torn ACL is a significant injury, especially for sports players. The Anterior Cruciate Ligament (ACL) is a band of fibrous tissue connecting the thigh bone (femur) to the shin bone (tibia). The primary functions are to limit twisting (rotational) forces through the leg, and to prevent forward movement of the tibia on the femur. ACL injuries occur frequently in sports involving pivoting and sudden deceleration e.g. football, basketball, netball, soccer, gymnastics and downhill skiing.
How does it happen?
The majority of ACL tears occur in non-contact situations when a person lands from a jump, pivots or decelerates suddenly. ACL tears also occur in contact sports when the knee is forced to rotate, the shin is forced backwards; or incorrect fall out technique with binding release skiing..
Signs and Symptoms:
- Severe pain, which can be vague in location
- Inability to continue playing
- Audible noise at time of injury such as a pop or snap or the feeling something has moved place
- Sudden onset of swelling (within 1-2 hours of injury)
- Giving way of the knee post-injury
- Restriction of movement (in particular extension)
- Depending on damage to other structures, there may also be pain medially and laterally.
What to do in the first 24hrs:
The knee will often swell rapidly in the first 1-2 hours. The initial phase of treatment should be:
- Referral to a physiotherapist or a Sports Doctor
- If walking on the leg is too painful, crutches may be necessary.
How will physiotherapy help?
If your physiotherapist is the first person to see you post-injury they will take a thorough history of how the injury happened, and then assess your knee. Often however, there is a large amount of swelling post ACL rupture, which can make it difficult to accurately assess the integrity of the ACL. Accurate manual assessment can often be done immediately post injury or later once the swelling has gone down. However based on your injury history and best possible assessment of the ACL and other structures, your physiotherapist should be able to diagnose what damage has been done.
If your physiotherapist suspects an ACL rupture they may refer you for further assessment and investigation to your GP, a sports doctor or to an Orthopaedic surgeon. An MRI will often be done to look inside the knee and determine the extent of the damage.
Surgical or non-surgical treatment?
The optimal management of an ACL rupture is debated. However there is excellent evidence that shows an extensive rehabilitation is vital. A decision on whether to follow surgical or non-surgical management is usually made based on a number of factors:
- The age of the patient
- Instability– at rest and in function
- A concurrent meniscus tear
- Associated injuries (MCL)
- The patients desire to return to jumping and pivoting
- The patient’s occupation (e.g. fireman, policeman)
- Adherence with a comprehensive rehabilitation program post operatively. A decision is made between the orthopaedic surgeon and the patient and reflects what will be best for the patients needs.
Returning to sport and daily life?
Returning to sport and activities of daily life is varied from patient to patient. For the general population it usually takes around 9-12 months to return to sports that require changes of direction. In some cases the prognosis is more optimistic with recovery being much shorter (6-9 months). Returning to normal daily activities varies but most patients start to feel a lot better after 10-14 days. Patients often report that they get better and better with each day, once their pain starts to subside. The rehabilitation is extensive but necessary to restore the knee to full function post injury/surgery. Your physiotherapist will guide you throughout your rehabilitation.