What causes ACL injury?
An ACL injury occurs when it’s put under stress, outside the ligaments ability to cope. This often happens when landing from a jump where the body was twisting in the air, or a sharp cutting movement during sprinting. For this reason, ACL tears are very common in cutting and jumping sports like netball and soccer.
What is the ACL?
Your ACL (anterior cruciate ligament) is a major supporting ligament in the knee. The ACL ligament is made up of tough fibres called collagen. These small fibres are grouped together like the strands of a rope to form a cord. It is found deep inside the knee, between two moving condyles. Together with the PCL ligament they are called cruciates because they form the shape of an ‘X’ or cross inside the knee.
The ACL ligament helps prevent giving way of the knee during rotation. It is usually put under tension with cutting movements like side-stepping or when landing from a jump.
How do I know if I’ve ruptured my ACL?
ACL tears (or ruptures) are usually felt immediately and patients may describe hearing a distinct ‘popping’ sound. Often this sound can be heard from meters away. The knee usually swells within thirty minutes, indicating bleeding inside the joint.
Most commonly, ACL injuries can be a clinical diagnosis by a GP or physiotherapist. The questioning during interview will give the clinician an accurate idea, and there are tests with good reliability to detect any ruptures. If in doubt, MRI scans are the gold standard for diagnostic imaging. These are free in Australia for acute knee injuries when referred by a GP.
When will I need surgery?
ACL injuries have seen a huge change in management over the last ten years. Historically, surgery was recommended to reduce the chances of osteoarthritic change and improve knee stability. However, research has shown you have equal chances of degenerative changes with or without ACL surgery. There is also no increased risk of further injury if you opt to manage your knee without surgery.
Even though we understand that a good portion of people will manage well without surgery, there are not any reliable tests at this stage to identify who will cope well. The best advice is to trial a period of three months of ACL rehabilitation first to see how the knee responds. If there aren’t any episodes of giving way, then surgery and the prolonged recovery may be able to be avoided.
Some exceptions to the above rule do exist. If you plan on returning to high-level cutting sports like soccer, rugby or netball, then an ACL reconstruction would be recommended, regardless of how stable the knee feels. If you want surgery over trialling conservative management, then this is taken into consideration and a decision can be made between you and your surgeon.
What does surgery involve?
Surgery options can change depending on where you are in the world and which surgeon performs your operation. The standard procedure in Australia is a hamstring graft with a tape-locking screw to secure the graft.
The procedure involves the surgeon drilling two holes where the ACL attached into the bone. A tendon is harvested near the hamstrings and folded four or five times to make it thick and strong.
From here the tendon is passed through the two holes and secured with some screws that lock into the holes. The outside marks are then stitched and slowly bone will grow around the screws to hold them in place.
ACL rehabilitation involves a period of progressive exercises that focus firstly on knee range, then on knee strength and balance with higher level tasks. The idea is to get your knee functioning as closely to pre-injury level as possible.
Whether you are having surgery or not, all ACL deficient knees will need a period of knee rehabilitation. Early on the rehabilitation will involve simple bending and straightening exercises to help with knee movement and mobility.
As the rehabilitation progresses your therapist will add more strength-based and balance exercises to help the knee recover. The balance exercises help the knee to identify where it is in space, without having the ACL ligament to relay some of that information.
The last aspect of rehabilitation is getting the knee ready for more high demand such as cutting, jumping and hopping. At any stage during this rehabilitation if the knee gives way or feels really unsteady, then surgery may be the option you need.
Click Physiotherapy is perfectly positioned to help you through online physiotherapy as we can offer tailored exercise programs that track your progress daily. Our qualified physiotherapist can assess you over video conference, asking you to perform tasks that will give us an idea of your strength.
From here we can craft and adjust an exercise program through regular video conference’s. We send this exercise program to you and you always have access via a convenient, easy to use, phone app. Communication with your therapist is always open through this app which allows text-based contact whenever you need it.
As your rehabilitation progresses, you can take us with you to your training environment – either on the field or at your local gym. Our video consultations can be performed wherever, so that we can adjust your exercise program to your own environment.
We will track your adherence to exercise and follow your progress through questionnaires that can be sent through the same app. This information can then be relayed to your doctor or specialist so all the key players remain in the loop with regards to your knee injury.
For more information, please read our blog titled, ‘In Pain? 3 Reasons why you should choose online physiotherapy‘.
Can I prevent ACL injuries?
There have been exercise programs created and made available to the public which focus on neuromuscular and strength training. These are evidence-based and aimed at reducing the number of acute knee injuries.
One program called the FIFA 11+ has a variety of training exercises that you can perform on a regular basis – like before training sessions. To access that program please click on this link.