An anterior cruciate ligament (ACL) is one of the important internal ligaments of the knee joint. The anterior cruciate ligament or anterior cruciate ligament limits the tibia’s forward movement and the femur’s backward movement. It controls the movements of the knee and prevents excessive movements in the knee. Knee ACL injury refers to the tearing of the anterior cruciate ligament of the knee. which reduces the stability of the knee.
This injury is more common among athletes and is more common in sports that require standing or changing direction suddenly, including basketball, soccer, tennis, and volleyball. Among sports injuries, 88% of injuries are related to the anterior cruciate ligament. The anterior cruciate ligament (ACL) is one of the four main ligaments of the knee, which prevents the forward movement of the tibia and its internal rotation.
The type of shoes, physical preparation before activity (warming up), gender, age, etc. are important factors in the damage of this ligament.
According to the research conducted, this injury usually occurs in the middle of the competition or at the end of the competition, after landing, sudden changes in the direction of movement, or collision with other people.
The symptoms of this injury are pain, swelling, and lack of stability in a standing position. Knee cruciate ligament tear has different degrees and will be different based on the severity of symptoms and limitations.
Anatomy of The Knee
The knee is one of the largest and most important joints in the human body, tasked with the important job of connecting the upper leg (femur) with the lower leg (tibia or shinbone) to facilitate motion. At its most basic definition, one may consider the knee to simply be two leg bones joined together by muscles, ligaments, and tendons. But the knee is much more than the sum of its parts. Indeed, it’s the precise, nimble, effortless way that the joint’s composition works in unison to create movement that makes the knee such a crucial component of the human anatomy.
Three bones meet at the knee joint:
- The thigh bone (femur)
- The leg bone (tibia)
- The patella (patella). Your patella is located in front of the joint and provides protection.
Grades of ACL Injury
In general, the severity and degrees of damage to the anterior cruciate ligament include:
- Grade 1: There is a slight tear. There is no instability and the rate of bleeding is low.
- Grade 2: There is bleeding and the tear is incomplete. There is some instability due to the incomplete tear.
- Grade 3: Fibers are completely torn apart (complete tear).
Mechanisms and Causes of the Anterior Cruciate Ligament Injury
According to the studies conducted, the ACL ligament tear occurs when an impact to the upper end of the tibia causes the tibia to move forward or the knee moves strongly backward (knee hyperextension).
The most common mechanism of anterior cruciate ligament rupture is knee external rotation with knee valgus. The place of rupture may be in the area where this ligament connects to the lower end of the thigh, the upper end of the tibia, or in the middle.
Other factors that are effective in ACL tear are:
- Quick change of foot direction
- sudden stop
- Landing incorrectly when jumping on a bent knee
- A sudden lowering in running speed
- A direct hit to the knee
- Decreased hamstring muscle strength
Evaluating these factors and identifying harmful factors can reduce the possibility of injury.
Symptoms of an ACL Injury
Symptoms of an anterior cruciate ligament (ACL) injury include:
- Usually, at the time of injury, a sound was heard from the knee, and immediately the person has severe knee pain.
- Within 24 hours the knee will be swollen. If no action is taken, swelling and pain will usually resolve on their own.
- The feeling of weakness and instability in the knee of the injured person, as well as the patient’s acknowledgment of emptying the knee while walking.
- Inability to put body weight on one point, without pain.
- Decreased knee range of motion
- limping when walking
- Hemarthrosis) Blood accumulation in the joint
If these symptoms are not treated in time and the person wants to continue the activity, the knee will be unstable and this instability will bring the risk of damage to the knee meniscus and arthritis.
Causes of Anterior Cruciate Ligament (ACL) Injuries
The anterior cruciate ligament can be damaged in different ways:
- Sudden change of direction
- sudden stop
- Slow down when running
- Landing from a jump improperly
- Direct contact or impact like a tackle in football
Various studies have shown that female athletes have a higher incidence of anterior cruciate ligament injuries than male athletes. It is said that the cause is differences in physical conditions, muscle strength, and muscle nerve control. Other suggested causes include differences in hip and lower limb (leg) alignment, increased laxity of ligaments, and the effect of estrogen on ligament properties.
Treatment of Anterior Cruciate Ligament (ACL) Injuries
The treatment of cruciate ligament injury will vary depending on various factors, including the patient’s lifestyle and the individual’s activity level. In many cases, the treatment of this type of injury includes non-surgical and surgical treatment.
- Rest: The goal is to immobilize and avoid putting weight on the affected side.
- Ice: aim to reduce pain and swelling
- Bandage: the purpose of reducing swelling and immobilizing the knee
- Keeping the knee up: the goal is to reduce swelling and prevent blood circulation disorders
- Using a knee brace: the goal is to increase the stability of the knee and prevent extra movements
- Use of medicine: Aim to reduce pain and inflammation
In the next stage, rehabilitation and physiotherapy play an essential role in improving symptoms and increasing performance. The main goal in rehabilitation and non-surgical treatment is to gain joint range of motion and strengthen the knee muscles. using:
- Cold therapy
- Electrical stimulation
- Therapeutic Exercise
- Laser therapy
- Manual therapy
Along with the rehabilitation of some injections such as PRP, ozone therapy can also help. If the anterior cruciate ligament tear is severe or is accompanied by damage to other knee tissues such as the meniscus, surgical treatment is performed.
Surgery Is Done in Two Ways
Repair method: which is usually not successful and does not bring good results.
Reconstruction method: In the reconstruction method, different types of grips are used, which have better results.
The most common grips used in this surgery are:
- Patella tendon graft:
- Hamstring tendon graft (HTG)
- Transplantation of quadriceps tendon
Physiotherapy and rehabilitation and using a knee brace to increase stability and protect the knee after surgery is an important part of surgical treatment.