ACL Injury

A Comprehensive Guide from a Physiotherapist’s Perspective

Anterior Cruciate Ligament (ACL) injuries are among the most common and challenging knee injuries. This guide, enriched with a physiotherapist’s insights, aims to deepen your understanding of ACL injuries, including their nature, treatment options, and the vital role of rehabilitation, with an emphasis on the latest research and techniques.

What is an ACL Injury?

The ACL, a key stabiliser in the knee, often incurs injuries such as tears and ruptures. These injuries can cause severe pain, swelling, and instability, severely limiting daily activities and sports participation.

How Do ACL Injuries Occur?

Most ACL injuries in sports occur without direct contact, often during abrupt directional changes. Women are more prone to these injuries, likely due to biomechanical, strength, and hormonal differences.

Sports with High ACL Injury Risks

Contact sports like football, rugby, AFL, basketball, netball, touch, volleyball, and skiing have high ACL injury rates. These injuries can profoundly affect an athlete’s career, influencing decisions about surgery and returning to sports.

Recognising and Diagnosing ACL Injuries

Identifying Symptoms

Symptoms include intense knee pain, a ‘pop’ sound at the injury time, swelling, instability, reduced joint motion, and the knee giving way under stress. Early diagnosis is crucial for effective treatment.

Diagnosis: A Clinical Perspective

Diagnosis typically involves a physical exam and imaging tests like MRI scans. The Lachman test or pivot shift test are common physical assessments, while X-rays are less effective due to their focus on bony structures.

Treatment Approaches for ACL Injuries

Navigating Treatment Options

Treatment decisions depend on age, activity levels, and knee stability. ACL surgery isn’t always necessary. Some patients may find temporary relief as swelling reduces, but this can mask underlying instability issues.

The Role of Rehabilitation

A comprehensive ACL-Deficient Knee Rehabilitation Programme, focusing on strengthening, proprioception, and balance, is essential for those avoiding or delaying surgery. This programme is expertly guided by sports physiotherapists.

Surgical Considerations

ACL reconstruction surgery, involving tendon or ligament grafts, is common. The choice of graft depends on individual factors like age and activity level. New techniques, like double-bundle ACL reconstruction, are emerging, offering more stability. Post-operative rehabilitation is crucial for a successful recovery.

Innovations and New Research in ACL Treatment

Cross Bracing: A New Frontier

Recent studies have introduced cross bracing as a novel non-surgical treatment. This involves immobilising the injured knee at 90 degrees for 4 weeks, gradually increasing the range of motion until brace removal at 12 weeks. This method has shown promising results in promoting ACL healing, with 90% of patients showing evidence of healing on MRI three months post-rupture.

Read more:

• https://medicalxpress.com/news/2023-06-treatment-surgery-acl-rupture.html
• https://pubmed.ncbi.nlm.nih.gov/35381974/

Exercise-Based Rehabilitation: A Cornerstone of ACL Recovery

Recent evidence underscores the importance of exercise-based rehabilitation. This approach focuses on restoring knee function, enhancing muscle strength, and improving joint stability, crucial for both non-operative and post-operative patients.

Key Components of Exercise-Based Rehabilitation

Strength Training

Strengthening exercises, especially for the quadriceps and hamstrings, are vital. They enhance knee stability and support the joint, reducing re-injury risks.

Proprioception and Balance Training

Improving proprioception (the body’s ability to sense movement and position) is crucial. These exercises help patients regain control and coordination of the knee joint.

Agility and Plyometric Exercises

For athletes, agility and plyometric exercises are essential for regaining explosive power and sport-specific movements.

High-Level Balance Retraining

This involves challenging the knee joint under various conditions to improve stability and function in everyday activities and sports.

Functional Training

Tailoring exercises to mimic specific sports or daily activities ensures a safe and effective return to pre-injury levels.

The Role of Physiotherapists in ACL Rehabilitation

Physiotherapists are pivotal in designing and supervising rehabilitation programs. Their knowledge ensures exercises are performed correctly and safely, catering to the unique needs of each patient. Rehabilitation programs should be individualised, considering the injury’s severity, patient’s age, activity level, and specific goals.

Preventing ACL Injuries

Neuromuscular training, particularly for females, proper techniques, appropriate gear, and gradual intensity increases in exercises are key preventive measures. Many sport-specific prevention programs have been established. FIFA 11+ and Netball’s Knee Program are two examples.

Post-Surgical Rehabilitation

Post-surgical rehabilitation, guided by a sports physiotherapist, focuses on restoring knee function and strength. Neglecting this phase can lead to poor outcomes.

Special Considerations for Children and Return to Sports

For children, ACL surgery decisions involve assessing risks like growth disturbances. It is particularly important to seek a knee surgeon’s opinion if meniscal tears also occur at the time of injury. A comprehensive rehabilitation programme addresses both physical and psychological aspects, key to a safe return to sports. Professional guidance minimises re-injury risks.

Conclusion: The Importance of Professional Advice

An ACL injury requires careful management and informed decision-making. Physiotherapists and knee surgeons play a crucial role in treatment and rehabilitation, offering professional guidance tailored to individual needs. Consulting a physiotherapist is essential for effective recovery and a safe return to normal activities or sports. Remember, early intervention and professional advice can significantly influence your journey to recovery.