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Anterior Cruciate Ligament Injury

Overview

The anterior cruciate ligament (ACL) is a thread-like structure that connects the thigh bone (femur) and the leg bone (tibia) in the front part of the knee and maintains knee stability. ACL injuries can develop into partial or total sprains or tears.

ACL injuries are often caused by sudden changes in movement or direction while playing sports, pivoting (twisting) with a planted foot, landing awkwardly from a jump and twisting the knee, or direct blows. ACL tears may develop into knee osteoarthritis despite surgical intervention.

  • Knee popping  
  • Severe knee pain
  • Movement difficulties
  • Swelling in knee
  • Decrease in range of knee motion
  • Knee instability or collapsing with weight-bearing

  • Anatomical and hormonal characteristics of females.
  • Playing sports, such as soccer, football, basketball, gymnastics, and skiing.
  • Inadequate muscle strength and conditioning.
  • Wearing ill-fitting shoes or using poorly maintained sports equipment.
  • Playing on artificial turf.

  • Clinical tests: Physicians perform certain tests to assess the ACL (Drawer/Lachman/Pivot shift) and meniscus (McMurrays).
  • Magnetic resonance imaging (MRI): Recommended gold standard in diagnosis and can identify other pathologies or collateral injuries.

  • Strengthening core and leg muscles with a focus on the hips, lower abdomen, and hamstrings.
  • Ensuring proper techniques and correct knee position during jumps and landings.
  • Improving movement patterns and establishing safe techniques for pivoting.

Non-surgical treatment

  • Rest and limb elevation for early stages when the swelling is prominent.
  • Ice pack application to reduce inflammation.
  • Immobiliser to help reduce inflammation and pain associated with motion.
  • Rehabilitation is recommended for low-demanding patients and those who have partial ACL tears to strengthen the front (quadriceps) and back (hamstrings) thigh muscles.

Surgical treatment

Arthroscopic ACL reconstruction is the gold standard ligament construction method for surgical treatment. It is not a complex joint repair surgery and is recommended based on:

  • Patient’s age and requirements: Younger patients would benefit more because of their high demands.
  • Associated injuries: Patients with associated meniscus (knee shock absorber) injuries would benefit more from surgery.

Procedure:

  • Autograft (patient’s tendon): The physician harvests a graft (thread-like tendon) from just below the knee (hamstring), thigh (quadriceps), or ankle (peroneus).
  • Surgery: 2–3 small holes are drilled in the knee through which the camera and instruments are inserted, and the surgery is performed by observing a TV monitor.

After surgery:

  • The patient is asked to bear full weight and walk using a walker with a knee brace.
  • A physiotherapy programme is initiated to help the patient achieve a full range of motion at the end of the 6-week follow-up through a muscle strengthening programme.
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