About
What is an ACL?
Anterior Cruciate Ligament (ACL) is one of the strong bands of tissue that helps to connect the thigh bone (femur) to shinbone (tibia). It is an important stabilizer of the knee joint that is essential for day to day activities.
How do ACL tears occur?
ACL injuries most commonly occur during sports that involve sudden stops or changes in direction, jumping and landing — such as basketball, football, kabaddi, cricket & wrestling. It is also common to see this injury after a fall from a two wheeler following a road traffic accident
Symptoms & Investigations:
People who have an anterior cruciate ligament (ACL) injury often complain of feeling a "pop" in their knee at the time of injury and experience a ‘giving way’ sensation on bearing weight. Within a few hours of the ACL injury, nearly everyone develops swelling around the knee, caused by bleeding from injured blood vessels.
After the initial swelling has improved, most people are able to bear weight but feel instability/slipping of joint on the affected knee. Pivoting movements where the entire body weight is placed on the affected leg, can cause the feeling of instability.
Investigations:
Plan x rays are important to note bony avulsions/ fractures associated with ligament injuries.
Cornerstone investigation to diagnose ACL injuries. With an advanced imaging system 3T MRI, diagnosing these injuries are explicated well.
Figure: Shows a normal ACL on MRI(right) and a torn MRI(left).
Treatment
Do all ACL tears require surgery?
Complete tears of the ACL may cause repeated giving way of the knee especially during pivoting movements. Repeated giving way can lead to wear and tear of the cartilage lining of the knee leading to early osteoarthritis. Hence an Arthroscopic ACL reconstruction is recommended for improving the stability of the knee.
Partial tears of the ACL with no giving way sensation can be treated by non-surgical methods with physiotherapy and exercises. c
How is the ACL reconstructed?
In this procedure the torn ligament is replaced by the new ACL graft. This graft is basically a tendon graft harvested from the back of the thigh. This tendon is doubled and shuttled across the tunnels made in the thigh bone and the leg bone and fixed using a button and a screw.
This entire procedure is performed employing a minimally invasive arthroscopy/ key hole technique.
When is return to work/sports possible after an arthroscopic ACL reconstruction?
The sports medicine trained physiotherapist will rehabilitate all the patients who had underwent ACl reconstruction, to get back to your work/sports. Weight bearing is started partially with elbow crutch support the day following surgery which is gradually progressed to full weight bearing at 3-4 weeks. Patients can return to the office/desk job by 1 month. Sporting activity can be resumed at 7-8 months following surgery after adequate strength and agility training.