LET’S TALK ABOUT ACL INJURIES

With the increasing demand and awareness of Sports and Sports injuries, everyone around seems to be knowing and talking about ACL. What makes it so highly talked about is the incidence, reconstruction, prolonged rehabilitation and return to play. However, little is known to them which makes them spread false or insufficiently correct information regarding the same. 

So, let’s talk about ACL!

The Anterior Cruciate Ligament commonly termed as the ACL is the strongest ligament in the knee providing an attachment to the femur and tibia giving it good anteroposterior stability.

Injuries to the ACL account for approximately 40% of knee injuries across Sports making it one of the highly talked about injuries amongst athletes; both elite and recreational.

However, a non-athletic population is also at risk of developing an ACL injury primarily in cases of trauma 

What causes the ACL to rupture?

The risk of ACL ruptures is typically experienced by sudden twisting motion, hyperextension or a blow to the knee. Some of the common causes are:

• Sports injuries

• Trauma

• Hyperextension and twisting

• Sudden changes in direction

• Muscular imbalances

• Improper landing techniques

• Previous injuries to the lower limb

• Unstable surfaces

• Genetics

• Gender

Who is at risk of injuring the ACL?

Bearing in mind the mechanism, ACL injuries are bound to occur in any individual at any age and point in time. Nevertheless, researchers suggest a gender-biased incidence of the injury based on the anatomical, biomechanical and hormonal factors. Studies suggest a three times greater incidence of ACL injuries in females compared to males. Females are seen to have weaker Hamstrings strength which offers poor stability during deceleration motion thereby increasing the likelihood of ACL ruptures. Moreover, increased laxity, valgus stresses, and increased quadriceps angle tend to increase the chances of injury in females.

This raises the concern and needs to include strength training, stability and proprioceptive training in females as a preventive strategy. 

How does one know they might have injured the ACL?

Considering the orientation of the ligament, it is most likely to be injured in pivoting, cutting and planting(landing). The athlete tends to hear a “POP” sound followed by immediate swelling, pain, irritability and instability in the knee. Weight bearing on the leg tends to give a sharp pain and inability to place the foot or walk depending on the severity of the injury. In a few cases, a genetic history of ACL also predisposes the risk of the injury

However, only 1 or 2 signs and symptoms mentioned are enough to indicate an ACL injury.

What should one do if he suspects the ACL rupture?

ACL injuries are bound to occur anywhere. It could be on or off the field, during training sessions or as simple as while performing daily activities of living. Continuing the activity immediately post-injury increases the chances of further damage. Hence, before seeing the concerned professional like a Physiotherapist, Physician or Sports Medicine doctor, here are a few steps you could follow:

• Stop the activity

• In cases of severe pain and swelling, protect the knee by stabilizing it

• Offload the weight on the leg

• Ice the knee 

• Seek professional help

What confirms the ACL injury?

Trained professionals like Sports Medicine doctors, Orthopaedic doctors and Physiotherapists are appropriate professionals who can rule out the possibility of ACL injuries and approach the further line of treatment. A clinical assessment and radiological investigations offer a confirmed diagnosis of the injury. MRI has a specificity of 95% and a sensitivity of 86% making it the primary and confirmatory choice of investigation to diagnose ACL pathology. A correlation of this finding along with clinical assessment allows one to decide on a conservative or surgical treatment approach. 

One needs to understand that ACL injuries are completely treatable and recoverable. Both conservative and surgical treatment approaches have success stories. Nevertheless, it is highly individualistic. Return to sport also varies depending on the individual’s progress and outcome. 

Rehabilitation post-ACL injury is extremely crucial no matter which treatment approach is chosen. 

So, don’t take it for granted.