ACL tears

Are you an athlete that has been having a lot of knee pain?  Did you hurt your knee playing football, soccer, basketball or while jumping or cutting?  It is possible that you might have a knee injury known as a torn ACL.  To better understand what an ACL is, and to learn about the sings, symptoms and treatments, keep reading.  Knees are complex parts of the body, and the ACL is a common site of injury.  So what is the ACL and why is it important.

The ACL is the anterior cruciate ligament.  A ligament is a strong band of tissue that attaches bone to bone.  It is like a short, strong piece of rope.  This ligament attaches the shin bone (the tibia) to the thigh bone (the femur) and its function is to stabilize the knee joint.  The picture below is a side shot of the knee.  The front of the knee is to the left.  The back of the knee is to the right, the ACL is labeled and connects the femur and the tibia.

How injury occurs?

ACL injuries are classified into two categories: contact and non-contact.  Contact injuries occur when an external force, like a football player, causes the ACL to tear.  Contact ACL injuries most commonly occur from a blow to the outside of the knee pushing it inward, or from a head on hit to the front of the knee with the foot planted.  With contact injuries, you could also experience a tear in the meniscus or other ligaments.  Non-contact tears occur without external forces.  This type of injury tends to happen during rapid acceleration/deceleration motions or during a cutting/twisting motion.  These motions occur in most sports, and thus many people are susceptible to having this injury.  Certain people are more prone to this kind of injury.  Young female athletes have seen a recent increase in cases.  Girls often grow quickly, faster than their body can keep up with.  Weak hip and leg muscles increase the risk of ACL tear.  Girls have wider hips then boys and this changes how movements impact the joints, particularly the knee.  The muscular timing is also a contributing factor.  Muscular timing affects our coordination, helps us perform the movements we want to.  Athletes need proper instructions on how to properly shoot a basket, or kick a ball, and they also need proper instructions on how to prevent an ACL injury.

Signs and Symptoms

An ACL tear happens fast.  The knee will feel like it’s giving out and usually occurs during a cutting/turning motion, or landing on a straightened leg.  The person may feel or hear a pop in the knee.  It is very painful and there will be swelling around the knee.  It will be harder to bend and straighten the knee, and will be difficult to walk on it.  If this sounds like you, go to a Doctor of Physical Therapy.  The physical therapists can do some physical exam tests to determine if you have an ACL tear.   If they think you might have a tear, they will refer you to an orthopedist.  The orthopedist will probably do an MRI, which is the gold standard to determine an ACL tear.


If it is determined that you have an ACL tear you can discuss with your orthopedist what your course of action should be:  should you reconstruct the tear or go through physical rehabilitation without surgery?

Whether or not you elect to have surgery it is recommended to have physical therapy.  The knee joint will have swelling, there may be some bruising and you can expect some muscle stiffness and soreness.  Early on, therapy will be focused on reducing the swelling and pain, as well as regaining muscle control and knee motion.  The physical therapist may instruct you to ice your knee to reduce swelling.  During therapy you will exercise your legs and the muscle contractions work to pump the fluid (swelling) up out of your leg.  The physical therapist may gently massage the fluid towards the body trying to reduce the swelling.  Strength loss begins to happen after 2 days of inactivity and therapy will also try and maintain as much strength as possible.  Therapy may utilize electrical stimulation to increase the quad muscle contraction.  The therapist will work closely with you during this stage of the rehabilitation.  Gradually therapy will start to increase how much weight you put on the knee joint, and the muscular forces applied to it.

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By this point you should be able to fully straighten and bend the knee.  The strengthening exercises will be more demanding and core stabilizing exercises will be included.  For proper movements in the extremities, the person has to have a stable core.  The balancing and weight bearing exercises will be more difficult.  You may find yourself balancing on one leg on a foam pad.

As the exercises start picking up, strengthening exercises will target the quads and hamstrings.  These muscles are on the front and back of the thigh.  The speed of motions will still be controlled but the weight will be increased.  Your therapist will begin the cuing on proper technique during the movements.  The differences are subtle but important in determining the success of the rehabilitation.

As you come down the home stretch of the rehabilitation period you can expect to be running again and able to jump without any discomfort.  You will continue to progress the strengthening and balancing exercises.  Therapy will start to reintroduce sport specific tasks and exercises.  They will work with you giving feedback on the movements you are performing and any further corrections to be made.  The unofficial final exam of physical rehab is comparing the performance of the injured knee versus the non-injured knee.  To determine this the therapist will have you perform some single leg hopping tests.  The goal would be to have above a 90% similarity between the two.

With a successful rehab the vast majority of individuals are able to resume their sporting activities.  The rehab time is pretty specific but the return to sport varies on an individual basis depending on many factors.  At the time, the rehab feels like it is moving slowly, but when looked at in context of an individual’s life, one missed season is not that bad.  For those fantasy footballers, you can expect to pick up that player again next season.

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  1. Pingback: Maclin’s road to recovery after ACL injury - Total Performance

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