If you’re sports fan you have most certainly heard of the anterior cruciate ligament (ACL) in the knee. When professional athletes suffer ligament injuries which require surgery, this ligament is probably the one involved. ACL tears are among the most common knee injuries seen at Agility Orthopedics. These injuries are usually sustained while playing sports such as basketball, football and skiing. What is in ACL, and how is it injured? How is the injury treated? Perhaps most important, how can be prevented?
A Look inside the Knee
The term ligament refers to the tough band of fibrous tissue that holds the bones together at the joint. The knee has 4 main ligaments. These are the posterior cruciate ligament, the medial collateral ligament, the lateral collateral ligament and the anterior cruciate ligament. Each of these ligaments is important for maintaining the stability of the knee joint. The anterior cruciate ligament is called anterior because it is in front of the PCL. It is called a cruciate because it forms a cross-shape with the PCL. The ACL is important for preventing too much twisting between the thigh bone and the leg bone. This is what tends to get injured in sports that involve a lot of cutting and twisting of the legs.
There are 2 causes of an ACL tear. The first is a non contact injury, in which no one else is involved. The athlete may just be running down the field, make a cutting maneuver and tear the ligament. The second is a contact injury, such as a blow to the knee from an opponent while playing a sport. The majority of ACL tears are non contact injuries. When an ACL is torn, there may be a popping sound. There is usually pain and swelling, which can be moderate at first. Within a few hours, however, the symptoms may worsen. Many ACL injuries are never diagnosed because after a few days the knee begins to feel better again. In fact, the ACL is not essential for most daily activities and people may go for years without ever realizing the severity of their injury. If, however, they participate in activities that require cutting and twisting, like basketball, they may experience the knee “giving out” under them. This can be dangerous because they may injure the knee again and more severely this time! To avoid this you should seek the advice of an orthopedic surgeon if your knee becomes swollen and stiff for several days after athletic activity.
Women are more susceptible than men to ACL injuries. Statistics show that women are 3-5 times more likely to suffer an ACL injury than men. There seem to be several reasons for this including the fact that women have less space for the ACL in the knee, they tend to move differently than men and they have different hormones at work. Research has been done to see whether woman can be trained to protect her ACL’s when they play sports in some studies suggest that this may be possible. This provides hope that we may be able to reduce the number of ACL injuries in women through education.
What about Treatments?
The first goal after ACL injuries to get the knee feeling normal again. This means reducing the swelling and stretching the knee to get rid of the stiffness. This usually takes 4-6 weeks. Physical therapy is often used to make this process go quickly and smoothly. At Agility we have added a physical therapy department to our office to make those services readily available to our patients.
The ACL cannot heal on its own. To restore its function, surgery is necessary. Whether or not surgery is right for you is a personal decision that you need to arrive at with your orthopedic surgeons guidance. No one must have ACL surgery; it really comes down to your lifestyle. If you like playing sports that involve cutting activities like tennis and volleyball and you don’t want to give those activities up, you probably need to have the surgery. If you’re a teenager or young adult, I usually recommend surgery because you don’t want to limit your options in life at such an early age. But if you are older and like non-cutting activities like running biking and swimming, you may not need to have surgery.
For those who have surgery the techniques have improved over the years to make the experience a more positive one. Smaller incisions are used and less painful techniques are available. My patients go home on the day of the surgery and can begin walking right away with crutches. I allow full motion of the knee and give you exercises to do right away. Then I get you into physical therapy as you connect again with the therapist who you worked with before surgery. Within a week, most people are walking well. I don’t allow cutting sports for 6 months, not because you won’t feel like you can play sports but because it just takes a while for the healing process to occur.
I hope this article has provided you with useful information about ACL injuries. If they occur, the latest surgical options are available to you at Agility Orthopedics. If you have suffered such an injury or you are having knee trouble but are unsure of the cause, our staff is available to get you back on your feet quickly and to keep you moving!