The ACL (anterior cruciate ligament) is a ligament enclosed within the knee, attaching at the medial portion of the lateral femoral condyle (thigh bone) and anterior tibia (shin bone). The ACL provides stability to the knee, preventing the tibia from sliding forward relative to the femur and more importantly, provides rotational stability for pivoting.
ACL injuries are common and can occur in pivoting movements (change of direction or jumping) or less commonly, in contact injuries. ACL injuries are often accompanied by a “giving way” and a crack or pop sensation with knee swelling soon after. Many ACL injured patients feel pain initially but then are able to continue running in straight lines with symptoms only recurring in changing direction.
Risk factors for ACL injuries include:
- Genetic factors influencing bony geometry,
- Certain movement strategies,
- Previous ACL injury (left or right!) and
- Females are at slightly greater risk than males.
There are several clinical tests available to physiotherapists which can be used to diagnose the presence of an ACL tear. ACL tears are often managed with surgery where a piece of the patient’s native tissue (commonly hamstring or patella tendon) is used to reconstruct the ACL during arthroscopic surgery. There is some debate as to whether surgery is necessary in every case and decisions on whether or not to reconstruct can be influenced by the patient’s perceived commitment to thorough rehab, goals for future activity/sports participation, current movement strategies, concomitant injuries and age.
Successful rehabilitation from ACL reconstruction requires a thorough, progressive approach to restoration of flexibility, strength and motor patterning/movement strategy retraining for at least 9 months even though the strength of the graft will continue to regain its prior strength through “ligamentisation” for up to 2 years.
Many of the Capital Clinic Physiotherapists have experience in first hand diagnosis and rehabilitation of ACL injuries and would welcome the opportunity to help you manage your knee injury.