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What is an ACL?
Full form of ACL is Anterior Cruciate Ligament. It is one of the most important ligaments of the knee. ACL provides stability to the knee joint and the leg when doing activities like Running, Jumping etc. The ACL ligament is actually a small tissue in between the thigh bone and the leg bone which runs in a cross fashion along with another ligament known as PCL.
So what happens when you have an ACL tear?
With increased interest and participation in sports in Mumbai in schools and colleges, numerous people suffer from a twisting injury to the knee. Sports like football, soccer, volleyball, skating et cetera are more prone to knee injury like an Anterior cruciate ligament tear or an ACL tear. After a knee injury, one might get a swelling of the knee within a few hours, and have painful knee movements as compared to the normal knee. An orthopedic consult becomes a must. The orthopedic doctor will look for knee movements and function of the knee joint and will assess stability of the knee joint. Usually the orthopedic doctor can reach a diagnosis with clinical examination alone but sometimes the doctor may order some tests like Xray, CT scan and a MRI scan.
X Rays are usually done to rule out a fracture in the knee. The x-rays cannot see soft tissues like the ligament so usually a MRI scan is ordered. The MRI scan uses a magnetic field to see all tiny soft tissue details inside the knee like the Anterior cruciate ligament ligament and other ligaments and cartilage like meniscus etc.
Treatment of an ACL Tear:
What is the initial treatment in case of a knee ligament injury like an Anterior cruciate ligament injury? Immediate treatment if given to the person, pain and swelling can resolve much quickly. Treatment usually goes along the lines of R.I.C.E. ( Rest, Ice, Compression, Elevation)
Rest: The injured leg is to be splinted in a long knee brace which doesn’t allow folding of the knee joint to occur. Also use of a walker or a walking crutch is recommended to offload the leg.
Ice: applications of Ice or ice packs to the injured leg and the knee can reduce the swelling and pain in the injured knee and leg significantly.
Compression: The injured knee has to be put in a compression with an elastocrepe bandage to reduce the swelling.
Elevation: The injured leg if elevated on a pillow or two will help reduce swelling to the knee and leg and will eventually ease the pain. The person has to lie down and leg propped up in a pillow.
Does ACL Tear need surgery?
The orthopedic doctor upon examination and reading MRI scan will suggest a surgery for the ACL tear in knee if there is
- Complete tear of the ACL ligament.
- There is instability in the knee and you have a feeling of looseness in the knee.
- You are involved in active sports or an active life with high demand and outdoor work.
- There are other injuries inside the knee along with the ACL tear.
The ACL reconstruction surgery is the surgery which is done for the tear of the ACL in the knee. It is done by an Arthroscopic Surgeon like Dr Milind Merchant who is trained to perform such a ligament repair surgery via a key hole in the knee. To perform this ACL Reconstruction surgery, the Surgeon removes the torn and damaged ACL and replaces it with a piece of the tendon which is similar to the ligament. This is known as the “ graft”. The surgeon will also check the entire knee joint for other damages and if any are corrected.
The knee after surgery is placed in a brace and a rehabilitation programme for recovery is started. ACL Reconstruction Rehab generally is done by a sports physiotherapist. A successful recovery needs a dedicated and proper rehabilitation without which chances or failure and retear increases.
Now we will try to answer a few questions routinely asked by patients to Dr Merchant during consultations.
Most Patients with an ACL Reconstruction surgery can return to normal walking and office work by one month to month and a half. They still would need supervised physiotherapy for further 3 to 4 months.
There is no fixed amount of time required for an athlete or sports person to return to play. A longer and well planned return to play is better to prevent repeat tear of ACL in same or Opposite knee. At Least 6 to 8 months of well done Sports specific rehabilitation after an Arthroscopic ACL reconstruction is absolutely necessary. Your Arthroscopy Specialist Dr Milind Merchant, Physical Therapist and your coach can judge your ability to perform a sport based on various tests of the knee like stability, strength etc.
- hearing a loud pop or feel a "popping" sensation after the knee injury
- Developed much swelling after knee injury
- Repeated injury in the same knee?
- knee getting "lock" or feel blocked when you're moving it
- Feeling of falling down or knee is unstable or unable to support your weight?
ACL tear by itself alone will not be a problem for walking. But the instability or feeling of weakness in the injured knee may be felt if doing brisk walking or light jogging also. Persons who have an ACL tear generally also have a meniscus tear inside the knee which can cause a pain in the knee while walking.
ACL Surgery is done by Arthroscopy method. This method involves making key holes in the knee joint and insert cameras, instruments through these holes and perform the surgery. The recovery by such a key hole surgery is very short and relatively involves very less pain. Modern methods of anaesthesia today make surgery experience very comfortable. Moreover after operation, patients are encouraged to walk with a walker the very next day and discharged to home soon thereafter.
There is no threat to life or anything. An ACL Tear with instability if left untreated leads to damage of cartilage and cushions in the long run and eventually leads to early joint damage of the knee known as Osteoarthritis of the knee.