Anterior Cruciate Ligament Injury - Causes, Symptoms & Treatments

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The dreaded anterior cruciate ligament (ACL) injury is the bane of footballers worldwide. However, it’s not just footballers who are prone to the injury, as it can affect anyone. An ACL is characterized by (a complaint of) wobbly knees and pain on the outside or back of the knee. So what may at first seem like a harmless strain could be a more serious knock to this delicate ligament; it may require dedicated treatment and care! But don’t panic! Read on to learn how to help your kid overcome the injury, its treatment and causes.

What Is The Anterior Cruciate Ligament?

The Anterior Cruciate Ligament is a ligament that runs diagonally from the knee and connects the thighbone (femur) to the shinbone (tibia). Together with three other ligaments, the ACL ensures the knee bones (thighbone, shinbone, and kneecap) stay together and stable (1).

What Is An Anterior Cruciate Ligament Injury?

An ACL injury can range from a minor tear to rupture, an avulsion or a complete separation of the ACL from the rest of the knee joint. Although, ACL injuries are common among athletes in impact sports like soccer, basketball, and skiing, they’re not unheard of in a non-athletic setting. An ACL injury can occur if you stop abruptly or change direction while running, or even miss a step on the staircase. Most ACL injuries occur along with other injuries like damage to the MCL (Medial Collateral Ligament) or LCL (Lateral Collateral Ligament). Women athletes are more prone to an ACL injury than their male counterparts. That’s because of anatomical differences in the pelvic bone structure, an increased Q angle, and a smaller ACL. Some researchers believe that changes in hormonal balance (effects of estrogen on ligaments) also increase a woman’s risk of an ACL injury.

  • Typically, ACL injuries are graded from 1 to 3 according to severity- with Grade 1 considered to be a minor sprain and Grade 3 considered to be a major tear.
  • A Grade 1 sprain occurs when the ACL is slightly stretched, but the knee joints remain stable.
  • A Grade 2 sprain or partial tear occurs when the anterior cruciate ligaments become loose- this is a rare occurrence.
  • A Grade 3 sprain is a complete tear wherein the anterior cruciate ligament snaps into two, and the knee joints become wobbly.
  • Ideally ACL tears are rarely partial-they’re either complete or near complete.

Causes Of An Anterior Cruciate Ligament Injury:

As we mention above, an ACL injury typically happens among athletes playing high impact sports, but it can affect anybody performing rapid movements like jumping, pivoting twisting, etc. The problem with identifying an ACL injury is that symptoms often seem similar to other knee injuries. Some of the important causes of the injury include:

  • Getting hit on the knee or the side of the knee.
  • Abruptly stopping or changing direction while running, jumping, or turning.
  • Overextending the knee especially when kicking a soccer ball.
  • Around 70% of ACL injuries occur through non-contact mechanisms mentioned above while 30% of injuries occur due to direct contact with other players.

Symptoms Of An Anterior Cruciate Ligament Injury:

The symptoms of the injury range from mild swelling to intense pain. Some of the common symptoms of an ACL injury include:

  • Hearing a popping noise during the injury along with intense pain or a feeling where the knee feels immobilized.
  • Swelling (within 6 hours of the injury) accompanied by pain (especially when you apply pressure on the injured leg). Sometimes the swelling disappears but leaves you weak and tired. You may even end up aggravating the problem when trying to return to normal activities.
  • A wobbly feeling where the knee seems to give away followed by discomfort when walking.

Treating An Anterior Cruciate Ligament Injury:

Depending on the extent of the injury, age and lifestyle of the patient, the doctor may advice surgical or non-surgical treatment. The process begins by evaluating the patient through a series of tests. The doctor may order an X-ray or MRI scan to look for injury to the knee ligaments. He may also prescribe special tests like the Lachman’s test and the pivot shift test to check for the extent of damage to the anterior cruciate ligament. Some of the key features to decide on the course of treatment include:

  1. Nonsurgical treatment is sometimes referred for a partial tear (Grade 2 sprain). But as we earlier discussed, it largely depends on the age and lifestyle of the patient. Nonsurgical treatment includes progressive physical therapy and rehabilitation.
  1. Nonsurgical treatment is also referred to patients who do not have instability symptoms and those who’re involved in low impact sports, or those who’re willing to give up playing high impact sports. As for non-athletes, patients who lead a sedentary lifestyle with very little scope for manual work may not need nonsurgical treatment. Children with an open growth platelet may not need surgery.
  1. Physical therapy involves Range of Motion (ROM) exercises to increase strength and reduce inflammation. Rehabilitation could take from 6 months to a year and involves strengthening programs to protect and strengthen the new ligament.
  1. Surgical treatment is suggested for patients with a complete ACL tear. It is also suggested for patients with a partial tear but with instability symptoms. Sewing an ACL rupture is rarely successful; hence the common practice is to replace the ACL with a tendon from another area of the leg.
  1. Common grafts include patellar tendon autograft, hamstring tendon autograft, quadriceps tendon autograft, and allograft.
  1. Patients with surgical reconstruction are known to resume to daily activities without difficulty.
  1. The problems of not considering surgical ACL reconstruction are many- it could lead to secondary knee problems, and is especially true in cases where the ACL injury is combined with other knee injuries like damage to the menisci or the articular cartilage.
  1. Until the patient completely recovers from the treatment, he is recommended to be on crutches to move around without pain (2).

Preventing An Anterior Cruciate Ligament Injury:

ACL injuries can be prevented by following techniques prescribed by the sports coach. Most sports programs include techniques that help athletes prevent ACL injuries and to reduce stress on the knee.

Did you or anyone in your family suffer from an injury to the anterior cruciate ligament? Were your experiences any different from the ones we’ve mentioned above? Share your story with us. Leave a comment below.