(Anterior cruciate ligament) ACL Injuries

One of the most common ways people hurt their knees is by injuring their ACL (anterior cruciate ligament). This is one of the bands of tissue that holds the bones together within your knee. It also helps to keep your knee stable. You can stretch or tear your ACL if you make a sudden movement or quick, sharp turn when you’re running or jumping. It’s often painful, and can make it hard to walk or put pressure on the injured leg.

Athletes often get ACL injuries when they stop and quickly change directions while they’re running. People who play soccer, football, tennis, basketball or volleyball, or who do gymnastics are more likely to twist their knees by mistake when they compete than, say, cross-country runners, who simply move forward at a steady pace. Your speed -- combined with the way that you twist or turn your knee -- makes it likely that you’ll stretch or tear your ACL.

ACL injuries are more common among women than men.

Anterior cruciate ligament (ACL) is the ligament lying in the middle of the knee. It prevents the shin bone from sliding out in front of the thigh bone. An anterior cruciate ligament injury is the over-stretching or tearing of the anterior cruciate ligament in the knee. Depending on the severity and the activity level, the tear can be partial or complete. Injuries range from mild, such as a small tear, to severe, such as when the ligament tears completely or when the ligament and part of the bone separate from the rest of the bone.

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The anterior cruciate ligament injuries can happen when you get hit very hard on the side of your knee, such as during a football tackle. This can happen when you quickly stop moving and change direction while running, landing from a jump, or turning. Also, overextend knee joint due to falling or missing a step on a staircase may lead to ACL as well.

ACL injuries often occur with other injuries. For example, an ACL tear often occurs along with tears to others part of knee ligaments and the shock-absorbing cartilage in the knee. This type of injury is common in soccer, skiing, football, and other sports with lots of stop-and-go movements, jumping, or weaving.

Here are two kinds of risk factors of ACL:

Modifiable:

  • High BMI;
  • Jump landing mechanics.

Non – modifiable:

  • Female gender;
  • Notch width;
  • Ligamentous laxity.

Many people hear a popping noise in their knee when they get hurt. But it doesn’t happen to everyone. More common symptoms include:

Pain. If you have a minor injury, you may not feel pain. You may feel sore along your knee’s joint line. Some people have trouble standing or putting pressure on the hurt leg.

Swelling. This is most likely to happen during the first 24 hours. You can reduce swelling by putting ice on your knee and elevating (raising) your leg by propping it up on a pillow.

Trouble walking. If you’re able to put pressure on your hurt leg, you may notice that it’s harder than normal to walk. Some people find that the knee joint feels looser than it should.

Less range of motion. After you damage your ACL, it’s very likely that you won’t be able to bend and flex your knee like you normally would.

Your doctor will want to hear exactly how you injured your knee. He’ll look at both knees to see if the sore one looks different. He may also order any of the following:

Tests. Your doctor may ask you to lie on your back and bend your hips and/or your knees at certain angles. He’ll then place his hands on different parts of your leg and gently shift you around. If any of your bones move in a way that isn’t normal, that could be a sign that your ACL is damaged.

X-ray. Soft tissues like the ACL don’t appear on X-rays, but your doctor may want to rule out broken bones.

MRI or ultrasound. These exams can show both soft tissue and bone. If you have a damaged ACL, it should appear on the images.

Arthroscopy. This literally means to “look within the joint.” During the exam, an orthopedic surgeon makes a small cut in your skin. He inserts a pencil-sized tool that contains a lighting system and lens (arthroscope) into the joint. The camera projects an image of the joint onto a TV screen. Your doctor can see what type of injury you have and repair or correct it, if needed.

It depends on how badly you’ve been hurt. Here are some of the options your doctor may give you:

First aid. If your injury is minor, you may only need to put ice on your knee, elevate your leg, and stay off your feet for a while. You can reduce swelling by wrapping an ace bandage around your knee. Crutches can help to keep weight off your knee.

Medications. Anti-inflammatory drugs can help to reduce swelling and pain. Your doctor may suggest over-the-counter medications or prescribe something stronger. For intense pain, your doctor may inject your knee with steroid medication.

Knee brace. Some people with a damaged ACL can get by with wearing a brace on their knee when they run or play sports. It provides extra support.

Physical therapy. You may need this a few days a week to get your knee back in working order. During your sessions, you’ll do exercises to strengthen the muscles around your knee and help you regain a full range of motion. You may be sent home with exercise to do on your own.

Surgery. Your doctor may tell you that you need this if your ACL is torn badly, if your knee gives way when you’re walking, or if you’re an athlete. A surgeon will remove the damaged ACL and replace it with tissue to help a new ligament grow in its place. With physical therapy, people who have surgery can often play sports again within 12 months.

Interest in reducing non-contact ACL injury has been intense. The International Olympic Committee, after a comprehensive review of preventive strategies, has stated that injury prevention programs have a measurable effect on reducing injuries. These programs are especially important in female athletes who bear higher incidence of ACL injury than male athletes, and also in children and adolescents who are at high risk for a second ACL tear.

Researchers have found that female athletes often land with the knees relatively straight and collapsing inwards towards each other, with most of their bodyweight on a single foot and their upper body tilting to one side; these four factors put excessive strain on the ligaments on the knee and thus increase the likelihood of ACL tear. There is evidence that engaging in neuromuscular training (NMT) to counter those factors and emphasize proper landing technique can reduce risk of ACL injury, particularly in young female athletes.

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