Anterior Cruciate Ligament Injury

ACL injuries commonly occur as a non-contact twisting or pivoting motion in athletes.  They can also occur if the knee is twisted awkwardly or with certain contact injuries.  Such an injury most often occurs in sports that involve abrupt stops and changes in direction, such as tennis, football, soccer and basketball. It may also occur as a result of an automobile or skiing accident. Many ACL ligament tears also result from commonplace accidents like falling off a ladder or missing a step on a staircase.

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Risk Factors for an ACL Injury

Women are more likely to experience an ACL tear than men, even when they are engaging in the same activities. This is because women have a strength imbalance in their thighs, with the quadriceps, the muscles at the front of the thigh, being more powerful than the hamstrings, the muscles at the back.

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Symptoms of an ACL Injury

Signs of an ACL injury:

• Popping sound at the time of the injury

• Immediate pain and swelling 

• Instability or giving away sensation of the knee

Patients who are suspected of having ACL injuries should seek medical attention promptly to avoid further joint damage.

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Diagnosis of an ACL Injury

A physical examination for an ACL injury includes evaluation of swelling and tenderness, especially in comparison to the unaffected knee. It also involves moving the knee into different positions to assess ACL injury and to rule out injury to other structures. Following the clinical exam, a suspected ACL injury can be confirmed with an MRI which allows for detailed visualization of internal structures of the knee. 

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Treatment for an ACL Injury

Once the diagnosis of an ACL rupture has been made, a discussion about treatment options is then had.  This includes non-operative and operative options.  In either case, the initial treatment is aimed at reducing pain and swelling as well as increasing range of motion.  This is accomplished with a course of physical therapy.  Only after swelling has been reduced and range of motion restored can operative reconstruction of the ACL be recommended.

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While not all ACL injuries require surgery, leaving the ligament torn or damaged puts the patient at risk for recurring episodes of knee instability. It may also increase the likelihood of developing tissue damage or arthritis over time.  For athletes who want to return to high-risk sports, surgical reconstruction is typically recommended.

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Ligament tears cannot be repaired by simple reattachment and require reconstruction. This is accomplished using another ligament as a graft.   Graft options are a topic of heavy research currently, but the best graft options have been found to be taken from the patients own body.  These graft options include, patellar tendon, quad tendon or hamstring tendons.  Each graft option has its advantages and disadvantages and should be discussed with your surgeon.  At times, the graft may be taken from a deceased donor.

Post-surgical physical rehabilitation is always necessary to restore strength, function and stability to the knee and will help guide the patient back to the activities they are aiming for.