An ACL injury is the tearing of the Anterior Cruciate Ligament, a major knee ligament. ACL tears are a very common injury to the young athlete. ACL tears occurs more in girls than boys due to their anatomy. ACL injuries also occur in adults from ordinary wear and tear (planting, pivoting, twisting of the knee) as well as trauma/collision.
We see contact and non-contact injuries to the ACL. Once 51% of the ligament is torn, the ligament essentially no longer exists. For the individual to return to sport activity, a reconstruction must be performed.
How Does it Happen?
Approximately two-thirds of all knee injuries are of the non-contact type. This includes landing incorrectly on the knee, cutting and turning maneuvers, and deceleration. Donor tissue must be used to replace the ACL. Three different donor tissues are used: the patellar tendon autograft, the hamstring autograft, and the allograft which is a ligament donated by a cadaver. We see more of these injuries in women due to the anatomical architecture of the lower extremity as it relates to the knee.
At the time of an ACL injury, the patient may hear a loud pop. Additionally, they will feel severe pain and inability to continue activity. Patients will also experience knee swelling that worsens for hours after the injury occurs and weight-bearing instability.
The proper treatment approach to a torn ACL begins at the time of diagnosis by the physician. This will determine whether surgery is needed or not. If surgery is the chosen approach, then physical therapy will be prescribed to first. Physical therapy will calm the damaged knee and regain ROM, proper mobility of the patella, decrease swelling and pain, and regain as much strength as possible. The goal of therapy is to allow the surgeon to operate on a cool and calm knee thus offering the best outcome post-operatively.
Preoperative treatment usually takes approximately three weeks during which time the above mentioned goals are met. We use a variety of modalities including ice, electric stimulation, laser, ultrasound, and exercise as well as manual techniques like mobilization and massage. Patients are instructed in knee sparring ADL (activities of daily living), ways to protect the knee during daily life. They are also instructed in balance activities to increase the patient’s awareness of the position of the knee when performing activities. Patients are given a home exercise program, which also acts to educate them for after surgery.