ACL INJURIES
The anterior cruciate ligament (ACL) is one of the primary passive stabilizers of the knee. It is located deep within the knee capsule and connects between the femur (thigh bone) and tibia (shin bone). The role of the ACL is to prevent excessive anterior tibial translation and to provide rotational stability.
The ACL is most commonly injured in a non-contact fashion (usually from planting and twisting, landing awkwardly, or hyperextension), but can also occur with direct force to the knee. ACL injuries are most prevalent in the 15-25 age range and affect more females than males.
Key Point: ACL Prevention Programs should be implemented at a young age. These should involve strengthening, balance, and plyometric activities to help young athletes learn proper mechanics, improve joint stability, and improve motor reactivity and control.
An ACL injury will result in a quick onset of swelling, loss of range of motion, feelings of giving way or instability, and tenderness along the joint line. The injury can initially be assessed with ligamentous testing and confirmed with MRI.
Typical treatment for ACL tears involves surgical reconstruction. There may be other factors that influence this, such as age, activity level, prior injury, co-existing injuries (such as meniscus tear or other ligament tear), and the patient’s goals.
There are several types of ACL grafts that doctors and patients will chose from.
Autografts are taken from the patient’s own tissues, usually involving the semitendinosus (hamstring) tendon, quad tendon, or patellar tendon. Autografts tend to have more stability over time despite the secondary surgical site. Each tendon graft has its own advantages and disadvantages and selection should be made on an individual basis.
Allografts are tissues taken from a cadaver, typically using strong tendons such as the Achilles or patellar tendon. These eliminate the need for a secondary surgical site, but may have higher failure/re-tear risks.
Recovery from ACL injury starts as soon as the injury occurs. It is important to start physical therapy as soon as possible to minimize muscle atrophy, improve range of motion, control excessive swelling, and improve motor performance. Research shows that physical therapy prior to surgery can improve outcomes after surgery. Following surgery, it is recommended to wait 10-12 months before returning to full sports activities. While this may sound like a long time, research shows that returning sooner is correlated with higher re-tear rates. Furthermore, it is crucial to undergo sport specific testing and strength testing to determine readiness to return to sports.
For more info on exercises and return to play tests, check out our Instagram @basecamppt.
Plus, learn more about BFR in our previous blog to see how it can help before and after surgery!
Learn More:
Cunha J, Solomon DJ. ACL Prehabilitation Improves Postoperative Strength and Motion and Return to Sport in Athletes. Arthrosc Sports Med Rehabil. 2022 Jan 28;4(1):e65-e69. doi: 10.1016/j.asmr.2021.11.001. PMID: 35141537; PMCID: PMC8811524.
Hadley CJ, Rao S, Tjoumakaris FP, Ciccotti MG, Dodson CC, Marchetto PA, Hammoud S, Cohen SB, Freedman KB. Safer Return to Play After Anterior Cruciate Ligament Reconstruction: Evaluation of a Return-to-Play Checklist. Orthop J Sports Med. 2022 Apr 18;10(4):23259671221090412. doi: 10.1177/23259671221090412. PMID: 35464900; PMCID: PMC9019333.
Nessler T, Denney L, Sampley J. ACL Injury Prevention: What Does Research Tell Us? Curr Rev Musculoskelet Med. 2017 Sep;10(3):281-288. doi: 10.1007/s12178-017-9416-5. PMID: 28656531; PMCID: PMC5577417.