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August 29, 2008  
EDUCATION CENTER: Knee Conditions
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  • ACL Injury

    Description

    Reviewed by Dr. Peter Simonian

    A ligament is a tissue anywhere in the body that connects one bone to another. Four ligaments stabilize the knee joint and connect the femur to the tibia: the Posterior Cruciate Ligament, the Medial and Lateral Collateral Ligaments, and the Anterior Cruciate Ligament, or ACL. This report details what occurs when your ACL tears, either completely or partially. An injury to the ACL or any other ligament is known as a "sprain," or, more commonly, a "tear" when it is most severe.


    The ACL runs from the back of the femur, or thighbone, to the front of the tibia, or shinbone, and prevents the tibia from moving too far forward. The most common mechanism of injury to the ACL is a twisting or cutting motion, which stretches or tears the ligament. The injury can happen in one of three "grades":

    • Grade 1, in which the ligament is stretched, but not torn.
    • Grade 2, where the ACL is partially torn.
    • Grade 3, in which the ACL is completely torn and instability, or looseness of the joint, occurs.

    Depending upon the level of activity of the individual, an orthopedic surgeon may recommend operating or pursuing conservative methods to manage the ACL tear. An ACL tear is often accompanied by a tear of the Medial Collateral Ligament or meniscus.


    Symptoms

    Suggestive of an ACL injury are:
  • Fall to the ground
  • Popping sound
  • Pain in the knee
  • Immediate onset of swelling
  • Instability of the knee—a feeling of looseness within it or that it can't be "trusted"


    Or if the knee is:
  • Bruised
  • Stiff
  • Difficult to move
  • Swollen

    Cause and Risk Factors

    Causes
  • Sudden deceleration
  • Awkward landings
  • A twisting injury. When the foot is planted and the body turns, the ACL is most susceptible to injury.
  • A direct blow to the leg from the front, such as a low tackle
  • Other injuries or accidents (such as an auto accident)


    Risk Factors
    "Cutting" (fast running and quick lateral movement) sports present the greatest risk for ACL injury (and other ligament injuries within the knee). Football, skiing, basketball, soccer and other sports are high-risk sports for ACL injuries. Also, previous ACL injuries or other serious knee injuries can be considered as risk factors for ACL damage.


    Treatment

    Immediate Action
  • Call your doctor. An ACL tear is a serious injury that may require surgery.
  • RICE (Rest, Ice, Compression and Elevation) is the best thing for most injuries for the first two to three days. If a doctor decides surgery is necessary, he or she will not perform it until the swelling from the injury goes down.
  • An ace bandage may provide comfort and prevent swelling.
  • Use crutches, if necessary.

    See your doctor if:

  • You feel a popping sensation when you move your knee—this may require immediate treatment.
  • The pain is too much to bear.
  • You have sprained your knee more than once.
  • You have knee pain, swelling or stiffness which lasts more than a few days.
  • Your knee feels weak or wobbly.

    Procedures
    If a doctor suspects an ACL tear, he or she will likely order an MRI to evaluate the ACL and to look for other injuries of ligaments and cartilage in the knee. A doctor may order X-Rays to check for fractures in the knee. The doctor will also give a thorough knee examination to determine the laxity (looseness), strength, and pain points within the joint. Not all ACL injuries require surgery. See your physician to discuss options appropriate for your age and level of activity. Depending on desired level of activity and degree of involvement in sports, non-operative management may be adequate. However, a doctor has many methods of repair should ACL repair surgery be necessary. A doctor may employ any of the common methods to reconstruct the torn ACL, including, but not limited to, replacing the ACL with a graft made of tendon from the central quadriceps tendon, hamstring tendon, patellar tendon, or a graft of an ACL of a cadaver donor. ACL tears are not usually repaired using suture to sew it back together.


    Prevention

    Certain steps can minimize your risk for an ACL injury. Women are more prone to ACL injuries than men in certain sports, and several explanations for this gender difference have been proposed: muscle strength and conditioning, quadriceps-to-hamstring muscle ratio, the effects of estrogen on ligaments and lower extremity alignment that predisposes them to the condition. Certain strength-training programs exist to reduce the risk of ACL tears, especially in women. Proper stretching and protective equipment may also reduce the risk of the injury. If you have incurred an ACL injury or are at high risk for one, avoidance of "cutting" sports will decrease your risk.

    Last updated: 15-Feb-06

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