By: Ehren Allen, PT/Certified Manual Therapist
The anterior cruciate ligament is one of the main stabilizing ligaments of the knee. The ACL is a thick band of tissue that connects the femur (thigh bone) with the tibia (weight-bearing leg bone) and its main function is to prevent anterior translation (or forward movement) of the lower leg during functional movements.
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There are three main categories of ACL injuries: Grade I, Grade II, and Grade III.
A tear of a ligament is when some of the fibers of the ligament are are disrupted. A rupture of a ligament is when all of the fibers of the ligament are torn or it is classified as a complete grade III tear.
Choosing whether or not to get surgery due to a Grade II ACL Tear is typically decided between the physician and the patient. If a physician notices a lot of instability in the knee, then surgery will most likely be suggested. Usually ACL injuries where more than 50% of the ligaments in the knee are torn are surgically repaired. This also is dependent upon the patient's activity level, their age, and fitness level.
ACL injuries commonly occur during athletic participation due to in the increased force that occurs during sports-specific movement patterns.
Common mechanisms that result in ACL tears include:
ACL injuries tend to occur frequently in the female athletic population due to differences in body structure. Female athletes frequently exhibit muscular imbalances in the lower body known as quad dominance.
For those with this condition, there is an unequal quad to hamstring ratio that results in weaker posterior leg musculature. Such weakness in the hamstrings can put the female athlete at increased risk of an ACL injury, as the hamstrings are unable to fire efficiently to reduce hyperextension and strain on the ACL.
In addition, female athletes are at greater risk for structural genu valgum (or knock-knees) positioning that can result in increased knee stress when landing during jumping activities. Preventative lower extremity screenings, core stabilization strengthening, and review of proper jumping/landing techniques can all help to reduce the risk of ACL injuries in the female athlete.
Common symptoms of acute ACL injuries include:
Immediate care for ACL tears include the use of anti-inflammatory medications and RICE:
ACL tears are typically treated via 2 methods: rehabilitation and surgical repair. While all patients with ACL tears can benefit from general range of motion and lower extremity strengthening activities following injury, some severe tears require surgical intervention to restore the integrity of the knee joint.
Benefits of surgical repair with post-surgical rehab include: restoring the functional stabilization of the knee to decrease the chance of further injury and resume daily tasks.
Individuals who decline surgical intervention are prone to chronic knee instability, buckling, and giving-way. Those who are ACL deficient are often unable to sufficiently stabilize the knee during functional movements, potentially causing damage to the articular cartilage or meniscus. Over time, this type of residual damage to the joint structures may lead to osteoarthritis.
Grade III ACL tears almost always require surgery in order for them to heal correctly. This is because there is a complete tear in the fibers of the knee ligament causing extreme knee instability.
ACL rehabilitation programs are developed with the following treatment goals in mind: Restoring functional knee stability, restoring full knee range of motion, and improving quad strengthening to support the demands of activities of daily living.
Some of the most important rehabilitation activities to promote lower extremity flexibility and strength include:
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