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What exactly is that “pop” people hear when they know they’ve done something seriously wrong to their knee? It’s usually the infamous, terrifying sound of tearing their anterior cruciate ligament (ACL). What exactly is an ACL? “The ACL is one of the four main ligaments in the knee and is the primary stabilizer,” (1). Your ACL is directly in the middle of your knee and connects the femur (thigh bone) and the tibia (shin bone). It prevents your lower leg from extending too far in any direction.
There are many ways people tear their ACL, but the two main causes are either from direct contact or non-contact, usually from cutting. If you play a contact sport like soccer or football, the momentum from tackles forced directly on your knee might cause extension too far backwards/forwards or bilaterally causing enough tension to tear the ligament. More typically, the ACL is torn simply by self-movement and improper distribution of body weight. Non-contact tears include “changing direction rapidly, stopping suddenly, slowing down while running or landing from a jump incorrectly,” (2). Unfortunately, it’s quite easy to tear the ligament with any slightly awkward movement or even just planting your foot wrong. “When the ACL tears, it’s usually because the athlete rotated his [her] hips at the wrong moment, multiplying the forces on the ACL, (3).”
The early symptoms of knowing you tore your ACL include:
• A “popping” noise during the exact moment of injury
• Knee swelling within six hours of the injury
• Extreme pain when trying to go full weight barring
• Tenderness along the joint line and a loss of full range of motion.
Despite the signs, the only way to truly know if you’ve torn your ACL is to have an MRI to examine the organs and tissue deep inside your body. Here at The Center for Athletic Performance and Physical Therapy, our trained therapists can perform a few “knee tests” on the affected area to determine the stability of the knee, advising if an MRI would be worth the time, money and effort. Worst-case scenario, if the unthinkable did happen and you find yourself with a torn ligament, there are a few different recovery possibilities to chose from.
Anyone who wishes to remain active or continue to compete in agility sports will have to look into the option of surgery. “Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on, “ (2). The overall length of recovery from surgery can range anywhere from a full six to eight months. Proper range of motion needs to be implemented before any weight bearing exercises can be preformed. Once that is achieved, then the muscles around the knee need to be strengthened through physical therapy and the regrowth of the ligament needs to completely heal.
However, not all people need to return to an active lifestyle and that’s fine! Although the ACL cannot heal itself without surgery, you will still be able to partake in everyday leisurely life. “The reason a knee without an intact ACL gives out occasionally is that it’s lost that stabilizer, and although it does not give out every single time, you never know when it will and when it won’t,” (1). The easiest option for a quick solution is to wear a brace that will aid in reducing any instability. But, to get the knee to a condition close to its pre-injury state, physical therapy is the best option. A rehabilitation program can help strengthen the muscles that help support the knee and regain motion all while becoming educated on how to prevent instability. It will be a long-term commitment either in the PT office or on your own, but it will be worth it and ensure that further injury does not occur.
References
1. SOURYAL, TAREK O. “ESPN Feature on ACL Injuries, ACL Tear, ACL Surgery, ACL Injury, Dallas Texas Sports Medicine, Dallas Mavericks.” ESPN Feature on ACL Injuries, ACL Tear, ACL Surgery, ACL Injury, Dallas Texas Sports Medicine, Dallas Mavericks. Web. 7 July 2015.
2. “Anterior Cruciate Ligament (ACL) Injuries-OrthoInfo – AAOS.” Anterior Cruciate Ligament (ACL) Injuries-OrthoInfo – AAOS. American Orthopaedic Society for Sports Medicine. Web. 7 July 2015.
3. Palmer, Brian. “Why Are Athletes Always Tearing Their ACLs?” Slate. 4 May 2012. Web. 7 July 2015.