• Anterior Cruciate Ligament Injury

    (ACL Injury)

    Definition

    An anterior cruciate ligament (ACL) injury is a tear in the ACL ligament. The ACL is located in the middle of the knee joint. It connects the lower leg bone to the thigh bone. It stabilizes the knee by preventing the thigh bone from sliding too far forward at the knee.
    Anterior Cruciate Ligament Injury
    ACL injury
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Most ACL tears occur during noncontact injuries, such as:
    • Planting the foot and cutting
    • Pivoting
    • Landing on a straight leg
    • Making a sudden stop
    The ACL can also be injured from a direct blow to the knee.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition.
    • Sex: female
    • Muscle imbalance between the quadriceps and hamstrings (weaker hamstrings)
    • Weak quadriceps and hamstrings
    • Playing sports that require sudden changes of direction and deceleration (such as, soccer, skiing, basketball)
    • Incorrect technique for cutting, planting, pivoting, or jumping

    Symptoms

    When the ACL tears, you may hear a popping sound. As you stand, the knee will probably give-way immediately, and it will be difficult to walk on the affected leg. There is usually moderate pain and swelling of the knee joint, although in the first several hours, this may be minor. It will, however, worsen over the first two days, and then begin to subside.

    Diagnosis

    The doctor will ask about your symptoms and how you injured your knee. A physical exam will be performed.
    Tests may include:
    • MRI—a test that uses magnetic waves to show the structures inside the knee joint
    • Arthroscopy—a thin, lighted tube inserted through a small incision in the knee to look at the structures inside the knee

    Treatment

    Treatments include:

    Knee Brace

    You may need to wear a knee brace while recovering from your knee injury. The brace may also be needed when you return to your sport. This may be needed whether or not you have surgery to reconstruct the ligament.

    Surgery

    Surgery may be needed to fully restore function of the knee. The decision to have surgery should be made after discussion with your doctor about your athletic needs, age, and associated factors.

    Physical Therapy

    • Range of motion exercises—The therapist will assist you with moving your knee through its full range of motion. Stretching is a part of this treatment.
    • Strengthening exercises—Due to its lack of use, the affected leg muscles will shrink and lose strength. Therapy will help you regain strength in the thigh muscles, especially the quadriceps and hamstrings.

    Prevention

    ACL tears are often due to noncontact injuries. Precautions can be taken to prevent them.
    • When jumping and landing, or turning and pivoting, your hips and knees should be bent, not straight
    • Include warm-up exercises to prepare the knee for your sport
    • Plyometrics, a form of jumping exercises, can be used to train and strengthen the leg muscles for jumping and landing.
    • Strengthen both the quadriceps and the hamstrings
    • Keep the quadriceps and hamstrings flexible by stretching regularly

    RESOURCES

    American Academy of Orthopaedic Surgeons http://www.aaos.org

    Women's Sport Foundation http://www.womenssportsfoundation.org

    CANADIAN RESOURCES

    Canadian Orthopaedic Association http://www.coa-aco.org/

    Canadian Orthopaedic Foundation http://www.canorth.org/

    References

    ACL Injury: Does It Require Surgery? American Academy of Orthopaedic Surgeons website. Available at: http://www.aaos.org . Accessed June 18, 2008.

    Cheatham SA, Johnson DL. Current concepts in ACL Injuries. Phys Sportsmed . 2010 Oct;38(3):61-68.

    Griffin LY, Agel J, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg . 2000;8:141-150.

    Wells C. Women, Sport & Performance . Champaign, Ill: Human Kinetics;1991.

    7/6/2009 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Prodromos CC, Han Y, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23:1320-1325.

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