Diagnosis: ACL Injury
Presentation:
ACL injuries are common in sports that involve pivoting and deceleration. Although they can occur without any other knee injury, it is most common for an ACL injury to occur with other ligament tears and meniscus damage. The Patient will normally experience a snap or pop in the knee whilst playing sport. After the injury the knee will remain unstable and tends to “buckle” or “give way”. After suffering an ACL injury a patient may experience severe pain, however some are not aware that the tear has occurred until they try to go back to original activities after the swelling and pain have decreased (Brukner & Khan, 2012).
The Patient will normally experience a snap or pop in the knee whilst playing sport. #performbetter @pogophysio Click To TweetDiagnosis:
The ACL injury can be diagnosed by a physiotherapist; however radiography is almost always used to confirm that the ACL that has been injured/ruptured. The physio will perform some functional tests and also move the knee joint to assess if there is a loose joint, these tests are often very difficult to interpret soon after the injury as the muscles around the tend to spasm and be very tight, so the diagnosis may be delayed for some time. After an initial appointment where an ACL tear is suspected, the patient will then be sent for and MRI to determine the type of tear and the other damage that has occurred in the knee.
Causes:
ACL tears are common in sports and more common in females than males. The ACL is a crucial ligament in the knee that stabilizes the joint during high stress movements. The injury can be caused due to a twist of the knee or force from an object or other player. Sports where ACL tear is a common injury are:
- Snow sports (skiing, snow boarding)
- Football
- Basketball
- Netball
- Rugby
ACL tears are very common in social sports and non-professional competition. Recreational athletes are at a greater risk of the injury as they generally have less knee strength and stability when compared to professional athletes. Playing surfaces may be a cause of injury, where a player twists the knee in a hole on grass field, these hazards are common in recreational sports. Equipment may also be the cause of the injury be it loose, slippery shoes or rugby boots that do not dig into the grass (Murrary, Vavken, & Fleming, 2013).
Treatment:
The treatment of an ACL tear depends on the grade of the tear and the personal preference of the patient. The ACL can tear, but not snap, in this case regular physiotherapy and strengthening exercises are the treatment. Normally the ligament will snap, most commonly detaching bone with it and reducing the stability of the knee. Surgery is an option for these patients and it is highly recommended if the patient wishes to return to a pivoting/twisting sport like football or basketball. Some health professionals will recommend that the ACL is not operated on, this is becoming a more popular option as strengthen exercises can compensate for the lack of stability in the joint. People who opt to not have the ligament re-constructed generally cannot go back to multi directional sport, however sports like swimming, running and cycling are attainable goals if strengthening exercises are effective (Monk et al., 2016)
Daniel O’Connor
Student Physiotherapist
References
Brukner, P. & Khan, K. (2012). Brukner & Khan’s clinical sports medicine (pp. 639-640). Sydney: McGraw-Hill
Monk, A., Davies, L., Hopewell, S., Harris, K., Beard, D., & Price, A. (2016). Surgical versus conservative interventions for treating anterior cruciate ligament injuries (Review). Cochrane Database Of Systematic Reviews, (4).
Murrary, M., Vavken, P., & Fleming, B. (2013). The ACL Handbook. New York: Springer.
