The Injured ACL

Posted by SportsMed NQ, 12 September 2014

The Injured ACL

What are they?

The Anterior Cruciate Ligament (ACL) is an important stabilizing structure of the knee. An ACL tear is a significant injury to the knee and is relatively common in the sporting environment. The ACL is a strong band of connective tissue situated within the knee joint and is responsible for joining the thigh bone (femur) to the shin bone (tibia). Its main role is to prevent forward movement of the tibia on the femur, and to limit twisting (rotational) forces through the leg. ACL injuries occur frequently in sports involving sudden deceleration and lots of direction change/pivoting e.g. football, basketball, netball, soccer, gymnastics and downhill skiing.


How does it happen?

The majority of ACL tears occur in non-contact situations when a person lands from a jump, pivots or decelerates suddenly. ACL tears also occur in contact sports when the knee is forced into a compromising position.

Signs and Symptoms may include:

  • Audible noise at time of injury such as a pop or snap or the feeling something has moved place
  • Inability to continue playing
  • Severe pain, can be localised or vague in location (depending on potential damage to neighboring structures)
  • Sudden onset of swelling within 1-2 hours of injury
  • Stiffness or loss of movement in the knee
  • Giving way of the knee


What to do in the first 24hrs:

The knee will often swell rapidly in the first 1-2 hours, it is important to limit the swelling as much as possible as it can increase discomfort, and inhibit joint range and muscle fucntion. The initial phase of treatment should include:

  • Rest – from all weight bearing and aggravating activities
  • Ice – 20minutes at a time, be careful not to cause any ice burns
  • Compression – using a compression bandage or tubigrip
  • Elevation
  • Referral to a physiotherapist or a Sports Doctor

If walking on the leg is too painful, crutches may be necessary.


How will physiotherapy help?

Your physiotherapist will be able to determine the extent of your injury by taking a comprehensive history of how it occurred, and performing a physical assessment. If your physiotherapist suspects an ACL rupture they may refer you for further assessment and investigation to your GP, a sports doctor or to an Orthopaedic surgeon. An MRI will often be performed to fully assess the extent of damage to your knee and to guide your treatment team as to whether or not surgery is indicated. Regardless of whether surgery is or isn’t indicated, your physiotherapist will be vital in the rehabilitation of your knee, guiding through the lengthy process of getting back to pre-injury function.


Surgical or non-surgical treatment?

The optimal management of an ACL rupture is debated. However there is excellent evidence that shows an extensive rehabilitation is essential. A decision on whether to follow surgical or non-surgical management is usually made based on a number of factors:

  • Instability– at rest and in function
  • The age of the patient
  • The physical demands of the patient’s occupation
  • A co-existing meniscal tear or associated injuries (eg. MCL)
  • The patients desire to return to jumping and pivoting activities (sport)
  • Likely adherence to the lengthy post-operative rehabilitation plan


Returning to sport and daily life?

Each patient will have a different experience post-operatively, therefore returning to sport and high level function varies. It usually takes around 9-12 months for the general population to return to sports that require pivoting and direction change. In some cases the prognosis is accelerated with recovery taking 6-9 months, but this is largely dependent on achieving certain goals and rehabilitation milestones. Returning to normal daily activities varies but most patients start to feel a lot better after 10-14 days. Patients often report that they get better and better with each day, once their pain starts to subside. The rehabilitation is extensive but necessary to restore the knee to full function post injury/surgery.


Your physiotherapist will combine their experience and knowledge of the injury/operation to guide you through your rehabilitation, ensuring that you don’t develop any secondary musculoskeletal problems along the way. Two of our senior physiotherapists, Philippe Oui and Kyle Whebell have both had ACL reconstructions and can really relate to the rehabilitation from both the patient and practitioner perspectives.


If you feel you may have injured your knee (even if it is a longstanding injury) and want to see if Physiotherapy can help, feel free to call us for a chat on 47713650. We would be more than happy to book you in for an assessment with one of our experienced physiotherapist and provide you with a rehabilitation plan.


Written by Kyle WhebellKyle-Whebell-2

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