Apex Sports Clinic

ACL TEARS

Let’s understand ACL Tears

What are ACL Tears ?

Anterior cruciate ligament (ACL) rips are injuries affecting one of the main ligaments in the knee joint, the ACL. When rotating, cutting, and jumping, the ACL is essential for maintaining knee stability. When it tears, the knee may become unstable, hurt, swell, and be difficult to move.

ACL Tear

Anterior cruciate ligament (ACL) rips are injuries affecting one of the main ligaments in the knee joint, the ACL.

What are the causes ?

Sports-related activities are the main cause of ACL rupture, while other factors also play a role. Sudden stops, pivots, and direction changes in sports like football, basketball, soccer, and skiing place a great deal of stress on the knee joint and raise the possibility of an ACL injury. Tears to the ACL can also result from direct trauma, like a fall or collision. A ligament tear can also result from non-contact activities such making sudden direction changes or landing awkwardly after a jump. ACL injuries can also be caused by weak or imbalanced muscles surrounding the knee, which puts additional strain on the ligament when moving.Furthermore, genetics may be involved, as certain people may be more susceptible to ACL tears than others because of things like ligament laxity or the structure of their knee joint. Additionally, a history of knee injuries may weaken the ligaments, increasing their vulnerability to rupture. All things considered, ACL tears are complicated injuries impacted by a person’s unique qualities, activity levels, external forces, and biomechanical variables.

What are the symptoms you might experience ?

Pain:

Severe pain at the site of the injury, which varies in intensity according on the size of the tear.

Swelling:

Inflammation and fluid buildup cause swelling around the knee joint, usually occurring a few hours after the injury.

Instability:

Feeling of instability in the knee, particularly when twisting or changing direction is involved.

Reduced Range of Motion:

Pain and edema make it difficult to fully extend or bend the knee.

Popping Sensation:

Some persons may experience a popping sound or sensation at the site of the injury, signifying a ruptured ligament.

Walking Difficulties:

Pain and instability in the affected leg may make it difficult to walk or bear weight on it.

Tenderness:

The knee may feel sensitive to pressure, especially in the area where the torn ligament is.

Let’s explore the Treatments options

Surgery

ACL Reconstruction – Anterior Cruciate Ligament (ACL) reconstruction is a common surgical procedure used to repair a torn ACL, a critical ligament in the knee that provides stability during movement. The surgery typically involves the use of graft tissue to replace the damaged ligament. This graft can be sourced from various locations:

1. Autografts (from the patient's own body):

Hamstring Tendon Grafts: Tendons from the patient’s own hamstrings are used. The semitendinosus and gracilis tendons are commonly harvested because they provide strong and suitable tissue for ACL reconstruction. The hamstring tendons are doubled or quadrupled to create a robust graft.

Patellar Tendon Grafts: A section of the patellar tendon, along with a small bone piece from the kneecap (patella) and the tibia, is used. This method is known for its strength and stability, often favored in high-demand athletes.

Quadriceps Tendon Grafts: Less commonly, the quadriceps tendon can be used. This involves taking a portion of the tendon along with a small piece of bone from the patella.

2. Allografts (from a cadaver):

Cadaveric Grafts: Tissue from a deceased donor, such as Achilles tendon or patellar tendon, is used. Allografts are beneficial because they reduce surgical time and eliminate donor site morbidity (pain and complications at the tissue harvest site). However, they carry a slight risk of disease transmission and may have slower incorporation into the patient’s body.

The procedure itself involves several key steps:

STEP 1

Preparation: The surgeon cleans and prepares the knee area. If an autograft is used, the donor tissue is harvested first.

STEP 2

Arthroscopic Access: Small incisions are made around the knee, and an arthroscope (a small camera) is inserted to provide a clear view of the internal structures.

STEP 3

Graft Placement: Tunnels are drilled in the femur (thigh bone) and tibia (shin bone) to allow precise placement of the graft. The graft is threaded through these tunnels and secured with screws or other fixation devices to hold it in place.

STEP 4

Final Adjustments: The surgeon ensures the graft is tensioned properly and checks the knee’s range of motion and stability.

Arthroscopic Surgery

Arthroscopic surgery is a minimally invasive surgical technique used to diagnose and treat knee injuries, including ACL tears. This approach involves the use of an arthroscope—a small camera that is inserted into the knee joint through a tiny incision. The camera displays images on a monitor, allowing the surgeon to see inside the joint without making large incisions.

Key benefits of arthroscopic surgery include:

Smaller Incisions: Only a few small incisions (usually less than an inch long) are needed, reducing the risk of infection and minimizing scarring.

Less Pain and Swelling: Compared to open surgery, arthroscopy typically results in less postoperative pain and swelling, leading to a quicker recovery.

Faster Recovery Time: Patients often experience a quicker return to normal activities and physical therapy can begin sooner.

The procedure for arthroscopic surgery includes the following steps:

1. Incisions and Arthroscope Insertion: Small incisions are made around the knee, and the arthroscope is inserted. Saline solution may be used to expand the joint space for better visibility.

2. Diagnostic Examination: The surgeon examines the knee structures, including ligaments, cartilage, and menisci, to identify any damage or abnormalities.

3. Repair or Reconstruction: Specialized surgical instruments are inserted through other small incisions to perform the necessary repairs. For an ACL reconstruction, this includes removing remnants of the damaged ligament, preparing the bone tunnels, and placing the graft.

4. Closure and Recovery: The instruments and the arthroscope are removed, the incisions are closed with sutures or surgical tape, and a bandage is applied.

Both ACL reconstruction and arthroscopic surgery are advanced techniques aimed at restoring knee function, improving stability, and allowing patients to return to their normal activities, including sports, with a reduced risk of future injury.

How to handle Post Surgical Care?

A crucial stage of rehabilitation after ACL reconstruction is post-surgical care, which aims to restore knee strength, stability, mobility, and function. An outline of post-surgical care is provided below:

Right After Surgery:

Pain management: To treat post-operative discomfort, doctors frequently prescribe painkillers.
Immobilization: To safeguard the surgical site, the knee may be momentarily immobilized using a brace or splint.
Cryotherapy: Using cold therapy or ice packs to minimize edema and inflammation is known as cryotherapy.

For Initial Recovery (0–6 Weeks):

Exercises for Range of Motion: Moderate exercises to restore knee range of motion while safeguarding the repaired ligament.

Weight-Bearing: Using crutches to help with the gradual transition from non-weight bearing to partial weight bearing.

Muscle Strengthening: Starting with simple workouts to build up the hamstrings, quadriceps, and calves.

Managed Motion: Managed workouts to enhance equilibrium, proprioception, and neuromuscular control.

For Intermediate Rehab: 6–12 Weeks:

Progressive Weight-Bearing: Moving from using crutches to walking independently by progressively increasing weight-bearing exercises.

Activities for Strengthening: To further strengthen the muscles surrounding the knee joint, progress to increasingly difficult activities.

Proper alignment and sense of pain Training: Including exercises to improve joint awareness, stability, and balance.

Cardiovascular Conditioning: Low-impact cardiovascular workouts that don’t strain the knee joint, including swimming or stationary cycling, to increase general fitness.

Advanced Rehab: 3–6 Months:

Activity-Specific Training: Applying exercises and drills tailored to a particular activity or activities to imitate motions needed for that sport or activities with the help of a professional expert.

Plyometrics: To increase strength and agility, gradually incorporate leaping and plyometric workouts.
Functional testing using parameters including strength, stability, and agility to determine whether a person is ready to resume sports activities.

Sustained Monitoring: Scheduling routine check-ins with medical professionals to assess any issues and keep an eye on developments.

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Dr.Foo Gen Lin_Apex Sports Clinic