Injuries involving the anterior cruciate ligament (ACL) of the knee are incredibly common these days. They are particularly prevalent amongst professional athletes and given the required time away from sport, they are certainly well covered in the media. Here are a few pointers surrounding injury mechanisms, assessment procedures and rehabilitation options if you have suffered a suspected ACL injury.
ACL ruptures usually occur with non-contact, pivoting injuries where the foot of the affected leg remains stuck to the ground. Typical examples include during a mistimed side step during a soccer match while wearing studded boots, or when falling during skiing at low speeds, when the ski bindings fail to release. Typically there is a cracking sound, immediate pain and swelling. The time it takes for pain to subside varies greatly between individuals. Many people who have suffered an ACL injury fail to recognise its significance initially because they are quickly able to walk, and even run is straight lines, without pain. They quickly find, however, that an unidentified ACL injury will give rise to sensations of instability or “giving way” during twisting or pivoting movements.
ACL injuries often occur in combination with damage to other structures, such as the medial meniscus or medial collateral ligament, so it is fair to say there is a big variation of presenting symptoms between one person to the next; from slight discomfort through to bellowing pain and disability.
If you have injured your knee and suspect an ACL tear, it is important to follow the RICE rules for acute injuries. They are: rest (avoid painful activities), ice (20 minutes every couple of hours is the current convention), compression (using a Tubigrip or compression bandage) and elevation (above the level of your heart if you can). Then get yourself in with your physio for a thorough assessment.
Management for an ACL injury involves a visit to your physiotherapist who can test your knee for ligament deficiencies. If an ACL tear is suspected, you will usually be referred to an orthopaedic surgeon, who specialises in ACL reconstruction procedures, for further assessment and opinion. Sometimes the surgeon may ask for you to have an MRI scan, however in some instances the diagnosis can be obtained confidently with clinical testing.
If an ACL rupture is confirmed, the surgeon will discuss your options with you. Some people are able to fulfil their desired activities without the need for surgery, however today’s conventional approach is to look toward reconstruction surgery if your lifestyle is likely to involve any twisting-type activities. These can include anything from playing backyard soccer with the kids to competing at the Rugby World Cup. Your physio will be around to ensure you regain all of the required strength and flexibility to return to the activities you love whether you decide to undergo surgery or not. The most common reconstruction procedures require up to 12 months before return to play is recommended.