The primary function of the Anterior Cruciate Ligament (ACL) is to provide stability to the knee joint by restraining the forward sliding and rotation of the shin bone (tibia).
To understand this function, let me quickly explain the anatomy of the knee joint. The femur (thigh bone) sits on top of the tibia (shin bone), and the knee joint allows movement at the junction of these bones.
Multiple knee ligaments are crucial in stabilising the knee joint, preventing it from being unstable and prone to dislocation. The ACL specifically prevents excessive forward sliding of the tibia on the femur.
In addition to its primary function, the ACL contributes to the stability of other movements in the knee joint, such as angulation and medial rotation. It achieves this by connecting one end to the femur and the other to the tibia.
Determining whether an ACL tear requires surgery depends on multiple factors. Some patients with ACL tears can resume regular activities without undergoing surgical reconstruction. Several crucial considerations determine the need for operative treatment for an ACL tear.
These factors comprise the patient's age, activity level (both recreational and occupational), patient expectations, willingness to engage in postoperative rehabilitation, joint stability, and other associated knee injuries (such as ligamentous or meniscal problems).
ACL Reconstruction vs Exercise Management Surgical Approach for ACL Reconstruction
ACL reconstruction surgery typically occurs a few weeks after the injury. Studies show improved outcomes when delaying ACL reconstruction surgery by several weeks post-injury. This delay allows the inflamed knee to heal, reducing swelling, inflammation, and enhancing range of motion. Resolving swelling and stiffness before surgery contributes to better joint function after the procedure.
ACL reconstruction surgery is common. However, it's essential to note that a torn ACL cannot be repaired by simply reattaching the torn ends. Instead, the damaged ligament is replaced with a healthy graft or donor tissue. Recent research has shown that some ACLs rejoin themselves over time where the ligament tissues are in an optimal position, but this seems to occur only in a lucky few.
How is the ACL Reconstruction Performed?
The procedure for ACL reconstruction varies but often involves using a segment of a larger ligament or tendon to replace the torn ACL.
Graft options for ACL reconstruction include:
Hamstring Tendons
Patella Ligament
Peroneus Longus Tendon
Allograft (Donor Tissue)
ACL reconstruction surgery typically lasts 1 1/2 to 2 hours, depending on graft selection and any additional work within the knee joint. Your physiotherapist will guide your postoperative rehabilitation.
What to Do for a Ruptured ACL?
For an ACL tear, we strongly advise seeking professional medical care. Successful rehabilitation options vary based on your age, activity level, and the extent of your injury.
When you injure your Anterior Cruciate Ligament (ACL), the common belief is that surgical ACL reconstruction is the only treatment option. However, emerging evidence challenges this idea. Researchers suggest that ACL surgery might not always be necessary. Instead, every case should be taken on its own merits. Furthermore, opting for a non-surgical approach could sometimes lead to better long-term results.
What is the Non-Surgical ACL Approach?
Trying non-surgical rehabilitation managing an ACL injury typically involves a three-month rehabilitation program guided by a sports physiotherapist. After rehabilitation, your treatment decision depends on various factors to determine if surgery is needed.
What Research Says about ACL Management
Research indicates that some people can resume regular activities without requiring an intact ACL by effectively reducing swelling, improving knee strength, and enhancing neuromuscular control. For those physically active, the current best practice involves a three-month trial of non-surgical rehabilitation—a collaborative decision between you, your physiotherapist, and your orthopaedic specialist.
Steps in ACL Rehabilitation Non-Operative Treatment
The progressive rehabilitation program consists of several phases:
I
Reduce swelling
Regain muscle control of the knee, focusing on Quadriceps, Hamstrings, and Gluteal muscles
Address any walking difficulties
II
Progress with strength training
Introduce Neuromuscular Control activities
III
Advance to a Power program for strength
Begin Straight Line Running
Initiate slow speed changes of direction and jumping training
IV
Continue with strength and power exercises
Progress to dynamic activities, modified versions of the chosen sport, and activity
V
Rigorous stability, strength, power and agility testing across all domains
Prepare for a return to sport
Implement long-term injury risk and performance enhancement programming
When is ACL Reconstruction Surgery Likely?
Those athletes wishing to return to Level I ACL sports should strongly consider ACL reconstruction.
In cases where individuals struggle to advance through ACL rehabilitation or experience knee instability and giving way, the physiotherapist may recommend consulting an orthopaedic specialist. This step is often necessary for sudden instability, where the knee gives way unexpectedly.
If functional tests show that a person can safely return to sports without an intact ACL, they might be able to skip surgery. Recent evidence suggests that the ACL can heal over time. Surgery might be avoidable if the knee regains its function to handle daily activities and sports demands. Testing reveals that the muscles can sufficiently support the knee without relying on extra sensory input from the ACL.
To explore the possibility of non-surgical management for your ACL injury, contact your local PhysioWorks clinic. An experienced knee physiotherapist will assess your unique case and guide you on whether non-surgical management suits you.
The Crucial Role of Active Rehabilitation in Post-ACL Reconstruction
Post-operative ACL rehabilitation plays a pivotal role in the recovery process following a torn ACL, yet it often receives insufficient emphasis. The diligence with which patients adhere to their physiotherapy rehab influences the long-term performance of their reconstructed knee. While some patients experience a full recovery and can resume their previous lifestyles, many individuals may endure persistent pain, stiffness, and limited joint motion for months or even years after ACL reconstruction surgery. To achieve the best possible outcome, entrusting your ACL reconstruction rehabilitation to a skilled physiotherapist becomes paramount.
Your Sport Matters
In sports, the risk of an ACL (anterior cruciate ligament) injury is higher in Level I sports compared to Level II sports. The classification of sports into different levels is not a standardised system. Generally, it refers to the level of contact, intensity, and risk of injury involved in the activity. We consider Level I sports to have a higher risk of ACL injuries due to the nature of their movement patterns and the amount of contact involved. On the other hand, Level II sports typically have less risk of ACL injuries.
Why is a Level I Sport More at Risk of ACL Injuries?
The reasons why Level I sports are more at risk for ACL injuries compared to Level II sports include:
Contact and collisions: Level I sports often involve direct physical contact with opponents, increasing the likelihood of collisions that can lead to ACL injuries.
Aggressive movements: Level I sports typically require more aggressive and abrupt actions, such as cutting, pivoting, and jumping, which can strain the ACL.
Higher intensity and skill level: Athletes in Level I sports are usually more skilled and perform at a higher intensity, increasing the likelihood of exposure to ACL injury risks.
Playing surface: Some Level I sports are often played on turf or artificial surfaces, which may contribute to ACL injury risk compared to natural grass found in many Level II sports.
It's important to note that while Level I sports have a higher risk of ACL injuries, physical activity carries some injury risk. Athletes should take appropriate precautions, such as proper warm-up, conditioning, and correct techniques, to reduce the risk of ACL injuries. Additionally, seeking medical attention and following rehabilitation guidelines if an ACL injury occurs can help ensure a safer return to sports activities.
What's the Timeline for Returning to Activities after ACL Reconstruction
For athletes, returning to their beloved sports after undergoing ACL reconstruction is of utmost importance. However, the timing and readiness for a return to sport (RTS) significantly impact re-injury risk.
A compelling 2018 study by Kate E. Webster and Julian A. Feller caught our attention. In their research, Webster and Feller aimed to determine the proportion of athletes who returned to Level I sports (activities involving jumping, hard pivoting, and cutting) within one year after ACL reconstruction. Additionally, they compared the return rates based on age and sex while also examining the association between RTS and commonly used outcome criteria.
The study involved 1440 athletes who met specific criteria, such as undergoing primary ACL reconstruction, possessing a normal contralateral knee, having no additional surgery within the first year after reconstruction, and participating in level I sports weekly before the injury. The researchers recorded the proportion of athletes who had resumed level I sports 12 months after surgery. Knee function, laxity, and self-reported outcomes were also assessed.
Your Age Matters
The findings revealed intriguing trends. Athletes aged 25 years and younger exhibited significantly higher rates of returning to level I sports, with 48% achieving this milestone within one year after ACL reconstruction. In contrast, older athletes aged 26-35 years had a return rate of 32%, while those aged 36 years and older had a return rate of 19%.
Your Gender Matters
When comparing return rates by sex, male athletes in the younger age brackets (≤25 years and 26-35 years) demonstrated significantly higher return rates than their female counterparts. However, after the age of 36, no sex-based differences in RTS were observed.
Your Symmetry Matters
The study also shed light on the significance of specific recovery indicators. Athletes, regardless of age, had twice the odds of RTS if they achieved limb symmetry index scores of 90 or higher and three times the odds of RTS if they attained International Knee Documentation Committee (IKDC) scores of 95 or higher.
Everything Matters!
In conclusion, the study showed that nearly half of the younger athletes (aged ≤25 years) returned to a level I sport within 12 months after ACL reconstruction. Younger athletes were more likely to meet criteria indicating satisfactory functional recovery and readiness for RTS. These findings underscore the importance of considering age when establishing thresholds for recovery indicators.
This research underscores the critical importance of meticulously assessing an athlete's readiness to return to sports after ACL reconstruction. By factoring in age, sex, and specific recovery indicators, healthcare professionals can provide tailored guidance and support to optimise the RTS process and reduce re-injury risk.
What to Do If You Have a Ruptured ACL?
If you experience a ruptured ACL, seeking guidance from a qualified physiotherapist is highly recommended. The success of your rehabilitation depends on various factors, such as your age, activity level, the extent of the injury, and the specific sporting demands you plan to resume.
Please consult your healthcare professional or physiotherapist for more information on ACL injuries, the need for surgery, posterolateral corner injuries, and knee ligament injuries. They can provide personalised advice and recommend the most suitable action for your situation.
Reference: Webster, K. E., & Feller, J. A. (2019). Return to sport after anterior cruciate ligament reconstruction: Evaluation of age, sex, and readiness to return criteria. Orthopaedic Journal of Sports Medicine, 6(8), 2325967118788045. doi: 10.1177/2325967118788045
Exploring the Potential of ACL Braces as a Treatment OptionJohn Miller2024-03-12T15:54:25+10:00
Exploring the Potential of ACL Braces as a Treatment Option
When addressing ACL injuries, one promising avenue of treatment that has gained attention is using ACL braces. These specialised braces are designed to provide support and stability to the knee joint, aiming to alleviate the effects of ACL insufficiency. Let's dig into the potential of ACL braces as a treatment option and understand how they might contribute to recovery.
The Role of ACL Braces
ACL (anterior cruciate ligament) injuries are notorious for impacting knee stability and overall joint function. Such injuries often necessitate medical intervention and comprehensive rehabilitation.
One of the strategies that has emerged in recent years is the utilisation of ACL braces. These braces are meticulously crafted to help counteract the instability caused by a torn or weakened ACL. By providing external support to the knee joint, ACL braces aim to minimise excessive movement and stress that can further compromise the injured ligament.
Benefits and Considerations
The potential benefits of using ACL braces are multifaceted. Firstly, they can protect the injured knee during activities that might otherwise exacerbate it. This protection is particularly valuable during the initial stages of rehabilitation when the injured ligament is vulnerable. Additionally, ACL braces can contribute to improved proprioception – the body's awareness of its position in space – aiding in restoring natural movement patterns.
However, it's important to note that while ACL braces offer advantages, they are not a standalone solution. And, they may even have some potential downside, such as a higher risk of DVTs.
ACL braces should be considered part of a comprehensive treatment approach, including physiotherapy, exercise regimens, and possibly surgical intervention. The decision to use an ACL brace should be made in consultation with a medical professional who can assess the individual's specific injury, overall health, and treatment goals.
ACL braces may be a particularly valuable treatment option for individuals who have experienced partial ACL tears or mild instability. Athletes, both amateur and professional, who wish to return to their sports after an ACL injury may find the added support of a brace beneficial during their recovery journey. Furthermore, those looking to avoid surgery or are not ideal candidates for surgical intervention might explore the potential of ACL braces as a conservative management approach.
Conclusion
In conclusion, ACL braces present a promising avenue for addressing ACL injuries and supporting rehabilitation. By offering external support and aiding in joint stability, these braces have the potential to contribute positively to an individual's recovery journey.
However, it's essential to recognise that ACL braces should be used with a comprehensive treatment plan tailored to the individual's unique circumstances. Consulting with your knee physiotherapist or surgeon is crucial to determine the suitability of ACL braces and to develop a holistic approach to healing and regaining optimal knee function.
When considering ACL braces or any other medical treatment, seeking personalised advice from a healthcare expert is paramount to making informed decisions that align with your specific needs and goals.
When Can You Get Back to Sport?John Miller2024-01-13T20:23:06+10:00
When Can You Get Back to Sport?
Your safe return to sport hinges on decisions made by your sports physiotherapist, doctor, or surgeon. They'll factor in your tissue healing progress and how well you've advanced in your rehabilitation journey. Rushing back into sports prematurely can hamper healing, extend recovery time, and lead to prolonged pain.
Your physiotherapist's goal is to expedite the process using hands-on treatment methods, progressive exercises, and, notably, strength, functional, sport-specific, and agility drills that simulate your sport. On occasion, protective bracing or taping might facilitate an early return to sport.
As a general guideline, it's worth noting that most soft tissue and bone injuries typically require a minimum of six weeks for scar tissue to mature or bones to complete their healing process. Consequently, adopting a cautious approach becomes crucial. It's highly advisable to engage in a conversation with your sports physiotherapist, surgeon, or sports physician. This way, they can effectively liaise with your coach and ensure a well-informed decision regarding your return to sport.
Sudden onset of knee pain typically follows a clear instigating event and can be associated with injury to one or multiple structures in and around the knee. Bone, joint capsule, cartilage, ligaments, tendons and muscles can all be affected. For this reason, it is vital to ensure your condition is professionally assessed so that you can treat it appropriately. Several types of acute knee injuries are described below.
The anterior cruciate ligament is injured during a pivoting manoeuvre whilst the knee is bent, such as when changing direction whilst running. Pain, difficulty weight-bearing, an audible popping sensation and rapid onset of swelling are often experienced. It is also common for the meniscus to be injured in this manner.
Less prevalent conditions are fractures of the tibial plateau, the weight-bearing surface of your shin bone, and osteochondritis dissecans. Fractures of the tibial plateau require large forces, such as when falling whilst skiing or horse riding, and there is an inability to bear weight through the affected leg. Osteochondritis dissecans occur in adolescents and involve injury to the bone beneath the cartilage due to a lack of blood supply. This can be accompanied by pain, swelling and locking of the knee if a loose fragment of bone gets caught between the joint surfaces.
As you can see, knee injuries and their treatment vary considerably, so please consult your knee physiotherapist or doctor for their opinion on your knee pain.
How Do You Know If You Need A Doctor or Physio For A Knee Injury?
Knee pain or knee injuries can be a common occurrence whether you’re a seasoned athlete, weekend warrior or infrequently active. If you’ve sustained a knee injury and need to see someone, you may be unsure where to start – a physiotherapist or the doctor?
Here are some points to consider when deciding who to see first.
When Should You Consult Your Doctor First?
Please consult your doctor if you have any broken skin or bone injuries. If you require wound care, your doctor is the expert. Likewise, if your normal bone alignment appears distorted from trauma or you have extreme and unrelenting pain, you should immediately go to a doctor or the emergency department. They will be able to assist you with prescribed pain relief and further investigation of your injury. You should also visit your doctor if you have any warmth, redness and swelling around your knee with pain unrelated to movement. These are potential infection symptoms that require urgent medical attention.
In non-urgent knee conditions, your doctor will assess your knee in the clinic. They will use their professional expertise to determine if you require some prescribed pain relief, referral to a physiotherapist, surgeon, imaging or another medical specialist. Some doctors have additional training in musculoskeletal and sports injuries, which is very beneficial in assessing and managing knee injuries.
Luckily most cases of knee pain respond to non-surgical and non-urgent care to restore normal knee function. Knee rehabilitation is where your highly skilled knee physiotherapist can assist you.
When Should You See Your Physiotherapist?
Your physiotherapist can assist you in diagnosing your knee injury and promptly commencing treatment. Physiotherapists are highly trained in the clinical diagnosis and management of knee injuries, sports and musculoskeletal injuries.
Your physiotherapist will also customise your rehabilitation to optimise your recovery and assist you in returning to full function as fast as possible. Throughout the rehabilitation, your physiotherapist will maintain clear communication with your GP, if you have one, and provide updates as you progress. If they feel that a second opinion, such as an Orthopaedic Surgeon assessment is warranted, they will direct your management accordingly.
If required, your physiotherapist may immobilise you or fit a knee brace to support and protect your knee during the acute stages of injury. Plus, they may refer you for imaging if your clinical presentation warrants additional diagnostic testing.
Your Decision
Whether you consult your doctor or physio first is entirely your decision. Either way, you don’t need a referral to see your doctor or a physiotherapist. But, if you require an appointment with a surgeon or diagnostic imaging, you will require a referral.
If you are unsure, please call us at PhysioWorks. One of our knee physiotherapists will assist your decision process based on your concerns.
How Much Treatment Will You Need?John Miller2023-11-10T23:35:24+10:00
When Should You Commence Physiotherapy?
In severe cases, it is best to commence physiotherapy as soon as possible. However, it does vary from case to case. Your physiotherapist has some nifty tricks to improve your pain straight away.
If you are unsure what to do, please call us for advice. We’ll happily guide you in your time of need. Often a bit of reassurance is all that you will need.
How Much Treatment Will You Need?
After assessing your injury, your physiotherapist will discuss the injury severity with you and estimate the number of treatments needed. No two injuries are ever the same.
Your treatment will include techniques and exercises to regain your:
joint, ligament and soft tissue mobility
muscle strength, power and speed
balance and proprioception
prevention tips
performance improvement.
What If You Delay Treatment?
Research tells us that symptoms lasting longer than three months become habitual and are much harder to solve. This can lead to nastier conditions. The sooner you get on top of your symptoms, the better your outcome.
All injuries are different, and little variations can significantly improve your recovery rate. Stiff joints or muscles may need some range of movement exercises. Other injuries may require massage or particular strengthening exercises.
Seek professional guidance promptly for your best outcome.
It's easier to see how lifting a heavy load in an awkward position can cause back pain. However, simple movements like leaning forward to pick up a teacup or bending to brush your teeth can also hurt your back. Many people are vulnerable to repeated lower back sprains and strains due to poor local joint control.
Why Does Back Strain Occur?
The main reason is inadequate muscle activation of the deep core stability muscles. These small muscles are located next to the joints and control excessive slides and glides. When these muscles don't work correctly, the joint can slide too far and strain its supporting ligaments, causing pain.
High-Risk Factors of Back Pain
Certain actions and habits increase the risk of back pain, including:
Sudden forceful movements
Lifting heavy objects
Twisting the back
Coughing or sneezing
Prolonged sitting with poor posture
How to Improve Core Stability
The good news is you can quickly correct poor core stability to prevent back pain. Strengthening your deep core stability muscles is key. Here are some exercises recommended by physiotherapists:
Plank: Hold your body in a straight line from head to heels. Engage your core and hold for 30 seconds to 1 minute.
Bird-Dog: On all fours, extend one arm and the opposite leg while keeping your back straight. Hold for a few seconds, then switch sides.
Bridge: Lie on your back with knees bent. Lift your hips towards the ceiling, squeezing your glutes and core.
These exercises help activate the deep core muscles and improve their function.
Recent Research on Core Stability
Recent studies highlight the importance of core stability exercises in reducing lower back pain. A 2024 study published in the Journal of Clinical Medicine found that patients who performed core stability exercises experienced significant reductions in back pain and improved functional movement .
Conclusion
Back strain can occur from simple daily activities, not just heavy lifting. Poor core stability is often the culprit. By strengthening your deep core muscles, you can prevent back pain and improve your quality of life. For a personalised assessment and exercise plan, consult your physiotherapist.
What to Do?
If you experience back pain, seek the advice of your physiotherapist. They can accurately assess your core activation and provide a tailored exercise program. Remember, prevention is better than cure. Regularly performing core stability exercises can prevent future back strains.
