The anterior cruciate ligament (ACL) is located in the center of the knee, which controls the rotation and forward movement of the tibia (shin bone).
ACL rupture is a common sports-related injury but can also occur in road traffic accidents, falls and work-related injuries occurring during changing the direction rapidly and during a jerky action like landing from a jump or stopping suddenly.
It is more commonly seen in female athletes.
An ACL injury is often associated with damage to articular cartilage, meniscus or other ligaments.
GRADES OF INJURY
ACL tear can be classified into three grades:
|Grade 1||Grade 2||Grade 3|
|Pathology||Minor tear around the ligament||Single Bundle tear but not completely torn||-Fibres of the ligament are completely torn
-Ligament completely torn into two parts
|-Increased anterior translation around the knee joint
-No end field
-Difficulty in walking
-Knee buckling +
|MRI Findings||-Fluid around the ligament||-Fluid around the ligament
-Partial disruption of the ligament fibers
|-Complete disruption of fibers|
An ACL tear is usually sudden and is regularly seen in high thrust sports. It often occurs:
The rate of ACL injuries is three times higher in females than in males
The risk of re-tearing a previously repaired ACL is 15% more than the risk of tearing a normal ACL.
The risk of an ACL tear in the opposite knee is also higher once the injury has occurred in the first.
Due to the active lifestyle & high participation in sports activities, the age group of 15-45 is a vulnerable group for an ACL tear
Initial management after an injury to the knee can help in reducing pain & swelling. This can be achieved by the R.I.C.E. model of self-home care of the injury:
Surgery is generally recommended if the patient wishes to get back to sports but it is not absolutely necessary to have this ligament reconstructed. Treatment for an ACL tear depends on the patient’s need. Non-surgical treatment is maybe effective for patients who have low functional demands such as the elderly. Nonsurgical options include:
In general, this surgery is very successful, and it does stop the knee from repetitively dislocating and makes it feel stable.
The damaged Ligament is removed & is replaced with a segment of the tendon. This replacement tissue is known as Graft.
Sockets or tunnels are drilled into the thighbone and shinbone to accurately position the graft, which is then secured to your bones with screws or other fixation devices.
It is divided into 3 phases:
-To reduce swelling
-To maintain muscle power
-To maintain blood circulation
–Knee flexion/extension in sitting
–Knee bending in prone
–Weight transfers in standing
-Educating the patient about the rehabilitation protocol
-Mentally preparing the patient for the procedure
-Quadriceps exercises to reduce swelling
-Knee Swinging for early return of function
-To improve posterior stability of the knee
2.Prone hang exercise
-Knee bending exercises:
1.Passive knee bending
-Strengthening Exercises: Once 100 degrees of flexion has been achieved you may begin to work on muscular strength.
This can be achieved by: