ACL Injury
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July 18, 2021ACL Injury
ACL Injury
Have you heard the dreaded ‘POP’ or “SNAP” deep in your knee during a sporting game? That is the sound of the infamous ACL injury!
The anterior cruciate ligament (ACL) runs diagonally in the middle of the knee and forms an “X” with the posterior cruciate ligament. It is a major ligament of the knee and prevents forward translation of the tibia, valgus forces (increased inward angulation) and increases rotational stability of the knee.
ACL injuries can be classified as atraumatic or traumatic. Most commonly, in this Sydney clinic, we see traumatic ACL injuries.
The most common mechanism of a traumatic ACL injury can include:
- Hyper extension of the knee
- Sudden deceleration
- Sudden pivoting / “cutting” motions / change of direction
- Landing from a jump incorrectly
- Direction collision or contact
Here at City Physio, we commonly diagnose and treat ACL injuries faced by athletes. In the clinic, we are often the first point of contact post injury and we are equipped with a number of tests that can accurately diagnose the injury. Often with ACL injuries, there can be associated injuries such as meniscal/ cartilage tears and other ligament sprains and we usually refer for an MRI to investigate the extent of your injury.
ACL injuries are commonly classified in different grades, based on the severity:
- Grade 1: The ligament is mildly damaged, and is stretched, however still allows stability of the knee
- Grade 2: often noted as a “partially torn” ACL – and will include more extensive damage to ligament fibres
- Grade 3: complete rupture of the ACL ligament – the ligament has been split into two pieces and the knee joint is unstable
ACL Injury Treatment
The good news is that ACL injuries can be managed successfully through either non operative measures or surgical interventions.
Conservative management has been historically associated with ongoing instability, lower return to sports rates and / or subsequent injury. However more recent studies support non- operative management in certain population groups who demonstrate adequate coordination and strength that can compensate for the ligamentous stability. Moreover, other studies have also shown that on follow- up MRI there are some ACL ligaments that heal. Here at City Physio, we can identify people who may be appropriate to trial this form of management. We identify areas that require strengthening to optimise stability at the knee and implement a rehabilitation program accordingly. A conservative management program generally takes 3+ months and we use a battery of tests to establish readiness for return to activity.
Surgical intervention, also known as an ACL reconstruction is the alternate and more common option, whereby the ligament is reconstructed using a tendon graft (hamstring, allograft or patella tendon). This new graft is placed across the knee and secured in the femur and tibia by screws. The goal of early treatment is to reduce swelling, restore range of motion, increase strength and stability, and then towards the late stage of treatment, to progress into a return to sports specific program. Treatment at our Sydney physio clinic will consist of manual therapy and an exercise prescription. At best, people return to sport after 9 months of rehabilitation however this is dependant on strength, muscle bulk and ability to perform sport’s specific tasks with adequate control.
Research has demonstrated there is no difference in the risk of osteoarthritis between patients who have had surgical intervention ACL reconstruction and non-operative management (Tsoukas et al, 2016). This decision on surgical vs non-operative is dependent on the patient and their end goal.
Our physiotherapists here at City Physio can take you through a step to step guide ACL rehabilitation program, both pre and post op, to help excel your recovery and get you back to your prime!
