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jacky

ANTERIOR CRUCIATE LIGAMENT (ACL) INJURIES

The anterior cruciate ligament (ACL) is the most important ligament for proper functioning of your knee. Its purpose is to maintain stability of the knee joint. As you can see from the anatomy picture below, it runs from the shin bone (tibia) up to the thigh bone (femur).

The ACL is often injured in active individuals. People that are in high intensity sports or have jobs that require a significant amount of activity are prone to tearing (rupturing) this ligament. Unfortunately, there are rarely varying degrees of injury to the ACL. In general, the ACL either withstands the trauma or is completely torn.

How do I know if I've hurt my ACL?

You may be able to predict if you have injured your ACL based on the background and/or history of your injury. If you have any of the following signs or symptoms, you may be highly suspicious that you have injured your ACL:

• Injured your knee while cutting, twisting, landing, jumping, etc. in sports or work
• The injury occurred without "colliding" with another person
• Felt, heard, or sensed a "pop"
• Had a significant amount of swelling (effusion) in the first 24 hours after the knee injury
• Knee feels like it's not stable or may "give way"
  

At this point, your knee should probably be evaluated by an athletic trainer, physical therapist, and/or orthopedic surgeon. The primary diagnostic test that is used to determine the extent of injury to the ACL is called the Lachman's test.
If there is increased movement with this test and a feeling that there is no "stopping point", then you may assume that you have torn your ACL.
You may be sent for a Magnetic Resonance Imaging (MRI) test of your knee, which may or may not be necessary. Below is a photo of an MRI scan with a torn ACL.

This picture is provided courtesy of Medical Multimedia Group.

Surgery

If you wish to remain active in sports, recreation, or have an active occupation, then it is recommended that the ACL be surgically repaired. Without an intact ACL, the knee may be unstable and repeated "giving way" episodes may cause injury to the surrounding structures (i.e. ligaments, cartilage, etc.)
We recommend the following physical therapy goals be met before preceeding with surgery:

• You should have full straightening (extension) of your knee.
• You should have normal tone/contraction of your thigh (quadricep) muscle.
• You should have no swelling (effusion) to your knee.
• You should be able to walk normally.
• You should have minimal pain.
• You should have no pain/injury to the ligament on the inside of your knee (medial collateral ligament).
  Types of Surgeries
  
  
  
  There are basically three types of ACL reconstruction surgeries. The first type is the patellar tendon-bone autograft, which means that the surgeon takes a piece of your patellar tendon and uses it as your new ACL. The second type of surgery uses "quadrupled" hamstring tendon autografts or allografts (semitendinosus and gracilis). In the second type of surgery, the physician uses two tendons on the backside of your knee and doubles them up to become your new ACL. The third type is the use of an allograft, i.e. a tissue taken from a cadaver.
  
  Research on Surgery Types
  There is a plethora of ACL research in the medical literature. Medical search engines such as PubMed ([url]www.pubmed.gov)[/url] or PEDro ([url]www.pedro.org.au)[/url] may be used to find ACL information.
  Duquin et al (J. Knee Surg. 2009 Jan:22(1):7-12) reported survey results from 993 American Orthopaedic Society for Sports Medicine physician members. Reconstruction surgery using bone-patellar tendon-bone (BPTB) autograft was most commonly preferred (46%), followed by hamstring tendon autograft (32%) and allografts (22%). Five years earlier, BPTB grafts were more frequent and hamstring tendon and allografts were less frequent (63%, 25%, and 12%, respectively).
  Searches for outcomes comparing BPTB and HG reconstruction surgery appear to suggest that both techniques work well. Surgery choice must be individualized and will depend on several patient and surgeon factors.
  
  ACL Surgery Videos
  Videos of ACL reconstruction surgery may be seen at websites such as Google Video ([url]http://video.google.com)[/url] or YouTube ([url]www.youtube.com).[/url] Type in a search phrase such as "ACL Reconstruction" or "ACL Surgery".
  
  After Surgery
  After surgery, you will have a dressing applied to your knee and you will return to your room. Your knee will be placed in a continuous passive motion (CPM) machine (see picture below).
  
  Orthologic Lite Lift CPM Machine
  This device will move your knee back and forth in a very slow, controlled manner to aid with your range of motion, swelling and pain.
  
  You will also be issued a cold therapy unit that will circulate chilled water through an appliance placed on the top and around the sides of your knee (see picture below).
  
  Gameready Cold Therapy Unit
  The cold therapy will help with your pain and swelling.
  
  The usual hospital stay is approximately 24 hours. Before you leave the hospital, a physical therapist will show you how to walk with crutches and you will be required to wear a post-operative brace (see picture below).
  
  Donjoy ELS Post-Operative Brace
  The brace will be locked so that your knee will be fully straight. Your supervised rehabilitation will begin 48 hours after surgery.
  
  Rehabilitation
  Supervised rehabilitation usually involves following an ACL protocol agreed upon by the surgeon and physical therapist/athletic trainer. We recommend the use of either one of the following two protocols listed below:
  

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