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Your anterior cruciate ligament (ACL) is located in your knee. The ACL is one of the main ligaments in the knee that connect the femur to the tibia. It runs from the front of the knee diagonally across to the back of the knee. The ACL prevents forward movement of the femur on the tibia, and also provides rotational stability to the knee. The ACL is one of the most commonly injured ligaments in the knee. ACL injury often occurs in conjunction with damage to the medial meniscus (cartilage) and medial collateral ligament (MCL). There may also be an impact fracture or bony bruising of the femur or tibia. ACL injuries are most often seen in individuals that participate in soccer, basketball, rugby and skiing.
It is estimated that 70% of ACL injuries occur from a non-contact mechanism, while the remaining 30% occur from direct contact with another player or object. Injury tends to occur when there is a sudden deceleration, combined with cutting, pivoting or side stepping. Other injuries can occur when landing awkwardly from a jump or direct impact from the side.
A number of studies have shown that ACL injuries are more common in females than males. This is thought to be due to increased ligament laxity (possibly because of oestrogen levels), poor neuromuscular control, differences in muscle conditioning and pelvis to knee angle which is greater in females.
When ACL injuries occur, players may report feeling a pop in their knee, followed by a feeling of the knee giving away. Immediately there is increased pain and swelling around the knee, which increases over the next few hours. The knee continues to feel unstable and give way, especially with going up or down stairs. Range of motion is reduced and the knee may also lock, if there is associated damage of the medial meniscus.
An ACL injury can be diagnosed by your physio following detailed subjective questioning regarding method of injury and examination of location of pain, swelling and knee range of motion. A number of tests are also carried out on the knee to test stability of the knee and laxity of the ACL. This diagnosis is then confirmed with an MRI scan. An MRI scan is also important to ascertain whether there is associated bony damage of the tibia or femur.
If left untreated, those with a complete ACL rupture may continue to experience swelling, knee discomfort and instability in their knee. They are also at risk of increased wear and tear in the knee, due to the lack of stability. However, in those that are not hugely active, non surgical treatment may be more appropriate. ACL injuries are often managed with surgical repair using a hamstring or patellar tendon graft. Recovery time post injury can range from 6-12 months depending on patient progress and the nature of the sport/activity they wish to return to. During recovery time, physio treatment will assist in improving knee range of motion and decreasing swelling post surgery. Extensive rehabilitation addressing quad, glut, hamstring and core strength, knee proprioception and flexibility must be carried out in order to achieve 100% recovery. Rehab should be specific to the sport or activity you wish to return to.
Improving lower limb strength and endurance, working on agility, balance and neuromuscular control and timing can assist in decreasing the risk of ACL injury.