Anterior Cruciate Ligament (ACL) Injury

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What is Anterior Cruciate Ligament (ACL) Injury?

Anterior Cruciate Ligament (ACL) injury is a condition characterised by damage to the anterior ligament. The cruciate ligaments serve to connect the bones of the lower leg and the bones of the upper leg. The severity of ACL varies, from a mild sprain (minor tear) to severe sprain (complete tear). Severe ACL injury occurs when the femur and shinbone are damaged.

The severity of ligament rupture can be classified as:

  • Grade 1 – The anterior ligament has been slightly stretched, but can still keep the joint stable. There are few mildly damaged and swollen ligament fibers
  • Grade 2 – Occurs when the ligament is stretched and becomes loose. There has been a partial tear of the ligament. The damaged ligament may heal without surgery. However, it has limited functionality with minimal instability.
  • Grade 3 – This is a complete ligament tear that requires a surgery.  The ligament has split into two pieces and the knee joint is unstable. It is often very difficult to support even with a stick.

Causes of Anterior Cruciate Ligament (ACL) Injuries

ACL sprains often occur during sports activities that involve stopping suddenly, changing directions, and jumping. Usually, you can hear a loud noise when an ACL sprain occurs. Sports that can trigger an ACL injury are football, basketball, skiing, dancing, rugby, tennis and floor exercises.

Consultation with an Orthopaedist 

Diagnosis

In patients with ACL injury, they usually experience knee pain, knee instability, or knee swelling. Your doctor will conduct a detailed interview regarding the symptoms experienced, your medical history, and your occupation and daily activities.

The doctor will also perform a physical test to detect any knee dislocation, assess the strength, stability, movement, swelling and hardening of the knee joints. The doctor will also check the joint fluid in the knee as well as perform anthropometric and arthroscopy tests.

The doctor will perform a physical examination to check on joint fluid in the knee – if symptoms of redness, warmth and swelling are found, the doctor will perform joint aspiration to sucks fluid from the knee. Joint aspiration serves to:

  • Identify the presence of inflammation in the knee
  • Identify a tear in the ligament — can be indicated by the presence of blood in the joint fluid
  • Identify a fracture in the bone — characterized by the presence of fat clots in the joint fluid
  • Perform anthropometric test to assess knee motions using a sensor attached to the knee

Arthroscopy is a test done by inserting a small camera through an incision in the knee to observe the inside of the knee. Arthroscopy can also be used as a surgical procedure to treat ACL injury.

Additional tests such as  X-rays, CT scans, MRI and ultrasound may be required to identify the severity of ACL sprain and provide a more accurate diagnosis.

Symptoms of Anterior Cruciate Ligament (ACL) Injury

Signs and symptoms of anterior ligament rupture include:

  • A loud “pop” sound during the rupture of the anterior ligament
  • Knee joint pain
  • Swelling of the knee
  • Knee instability; a sensation as if your knee is popping out of your body
  • Limited knee motions

Treatment for Anterior Cruciate Ligament (ACL) Injury

The immediate treatment for ACL injury is to implement the RICE method (Rest, Ice, Compression, and Elevation).

“Rest” means resting the injured area for 1-2 days to prevent the condition from getting worse.

“Ice” means applying a cold compress to the injured area. The cold compress should be applied for 10 minutes immediately after injury for 3 days. Cold compresses help reduce pain and prevent bleeding.

“Compression” means attaching an elastic bandage to the injured area to reduce swelling and maintain the knee in the right position. Make sure the compression technique is done not too tight, but also not too loose.

“Elevation” means positioning the injured limb higher by providing support to the lower part of the calf. This serves to reduce the swelling of the sprained area. 

There are 3 types of treatment options for ACL injuries, namely pharmacological therapy, physical therapy and surgery

Pharmacotherapy

For mild cases of ACL injuries, the doctor will prescribe medications to reduce pain and prevent swelling. The doctor will also recommend resting the injured knee and advise you to wear crutches when walking.

Physical Therapy / Medical Rehabilitation 

Medical rehabilitation aims to reduce pain, improve muscle strength, restore ROM (Range of Motion), and enable patients to carry out their daily activities normally. The medical rehabilitation process consists of 3 phases:  the acute phase, the healing phase and the functional phase.

Acute Phase, this phase focuses on the tissue healing process, reducing pain and inflammation. The therapy is done through ROM (Range of Motion) exercises as long as you do not feel any pain in the injured area. This exercise serves to prevent muscle atrophy.

Healing phase, this phase focuses on restoring active and passive movement functions according to ROM (Range of Motion), increasing muscle capacity, restoring knee stability and restoring the injured knee. This exercise lasts for 2 weeks to 8 weeks after the sprain occurs. Exercises such as walking and jumping help train the flexibility of the knee joint.

Functional Phase, this phase aims to restore functionality of the knee joint. This exercise focuses on increasing strength and endurance in the lower extremities. Exercises are carried out continuously and repeatedly to prevent repeated injuries and restore the knee’s strength to help you get back to doing sports activities. This phase lasts from 8 weeks to 6 months.

Surgery

Surgery treatment is necessary for ACL injury above 50%. The reconstruction surgery can be done through arthroscopy by inserting a small camera through an incision in the knee. This treatment method helps minimise the pain, reduce length of hospital stay, and speed up recovery. 

Surgical procedure for ACL injury is done by replacing the ligament graft with a section of tendon from another part. The recovery period may take 6 months before you can resume playing sports. 

Treatment Cost for Anterior Cruciate Ligament (ACL) Injury

The treatment cost for bone-related injuries is often determined after the doctor understands the patient’s condition. Smarter Health can help you find specialist doctors and hospitals within your treatment budget.

Prevention of Anterior Cruciate Ligament (ACL) Injury

Preventive measures to reduce the risk factors for anterior ligament rupture include:

  • Avoid wearing metal plate shoes.
  • Avoid wearing high heels 
  • Avoid sports that involve too much physical activity and circular movements
  • Strengthen thigh muscles and leg muscles by doing light exercises
  • Practice jumping and bending knees through exercises to get used to jump-and-bend motions

Home Care for Patients Diagnosed with Anterior Cruciate Ligament (ACL) Injury

Caring for a family member with an ACL sprain may not be an easy task. You must be able to manage a healthy lifestyle such as maintaining a healthy diet, exercising regularly although limiting strenuous activity, and reminding the patient to do regular physical therapy to strengthen muscles. 

Start implementing a healthy lifestyle by consuming healthy foods. You will maintain your ideal weight if you maintain a balanced diet. Ideal body weight will prevent the knee from having to support too heavy a weight.

You should remind the patient to do regular physical therapy to train the muscle abilities and increase the ability of Range of Motion (ROM) in the knee joint. Avoid strenuous exercises that can trigger recurrent injuries. 

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