ACL (ANTERIOR CRUCIATE LIGAMENT) TEAR

The anterior cruciate ligament (ACL) is one of the four most crucial ligaments of the knee joint which stabilizes it while connecting the thigh bone (femur) to the shin bone (tibia).

It is the most commonly injured knee ligament during sports, hence possesses great clinical significance in Sports Medicine.

An ACL tear is graded 1 to 3 according to the severity of the sprain and can occur due to a variety of sports activities.

Grade 1 Sprain with mild damage due to “slight stretch” but a stable knee joint

Grade 2 Sprain (rare) with a “partial tear” of the ligament

Grade 3 Sprain (most common) with a “complete tear” of the ligament breaking it into two pieces

Popping Sound: The most common thing that occurs to the patient as soon as an ACL tear happens is a “popping sound”.

Pain and Swelling: Knee swelling occurs within 24 hours of injury and may resolve on its own but further physical activities can cause severe damage and can leave the knee joint unstable.

Restricted Movement: The joint loses the full range of motion.

Tenderness: Walking is painful and there is tenderness along the joint line.

Knee Lock: The patient is unable to fully extend the knee.

Walking Difficulty: Knee giving way while walking

After a general examination of the injury and performing some special tests, the doctor may ask for any of the following to guide you about the best treatment options

• X-ray
• MRI
• Ultrasound
• Arthroscopy

Surgery is not always the first thing one should have in mind about the treatment of an ACL tear. Several non-surgical interventions are there which can be employed to treat an ACL tear, which include:

• First Aid (RICE model = Rest, Ice, Compression, Elevation)
• Medications (pain killers, steroids)
• Knee brace
• Physiotherapy

However, according to the severity, the doctor advises surgery followed by physical therapy for some time.

ACL Reconstruction Surgery is considered as the gold standard for the treatment of ACL Tear as it yields excellent results and full knee stability.

When?

The doctor suggests a surgery if:

• The patient is an athlete and wants to continue the sport.
• More than one ligament or the meniscus in your knee is also injured
• The injury is causing the knee to buckle during everyday activities and the patient is young.

How?

• Preparations: The doctor after all the necessary investigations counsels the patient for surgery and might ask to stop some medicines like aspirin around a week before surgery to avoid the risk of bleeding.
• Anesthesia: Usually general anesthesia is given and the doctor advises to stop eating and drinking water from a night before surgery.
• Arthroscopy: ACL reconstruction is usually done through arthroscopy which is a minimally invasive procedure. Small incisions are made; one to hold a thin, tube-like video camera (arthroscope) and others to allow surgical instruments to reach the joint space.
• Grafting: The surgeon removes the damaged ligament and replaces it with a portion of tendon which is a tissue similar to a ligament that connects muscle to bone. This replacement tissue is called a graft that comes from another part of your knee or a tendon from a deceased donor. The graft is secured to the bones with screws and other instruments which helps a new ligament to grow soon.
• Rehabilitation and Recovery: Following the surgery, the doctor advises some pain-killers and physical therapy after which the patient fully recovers in a period of months.

Complications

• Knee osteoarthritis (even after surgery)
• Growth Plate Injuries (in young children)
• Bleeding and/or Blood clotting
• Continued knee pain, stiffness, or weakness
• Disease Transmission (if the graft is from a cadaver)
• Infection
• Restricted range of motion
• Improper healing if the graft is rejected by your immune system.

Plasma Rich Protein (PRP) is naturally derived substance which utilizes blood component (plasma) of the patient and is reinjected on the site of treatment.

This is a modern technique to treat some common orthopedic conditions yielding fast recovery and perfect results

The complete details of the advantages of PRP therapy are given here

As ACL tear mostly occurs in sportsperson, a sports medicine physician would always advise them to have

• Training: Appropriate techniques and positions to avoid such incidents during jumping and landing especially in female athletes who are at high risk of these injuries.
• Exercise: Exercises to strengthen muscles, legs, hips, and core.
• Gear: Appropriate footwear and padding for the sport to help prevent injury.