Your Guide to Anterior Cruciate Ligament (ACL) Injuries

Introduction

The ACL is probably the most commonly and most seriously injured ligament of the knee. In most cases, the ligament is injured by twisting and falling injuries in sports such as rugby league, soccer, netball, hockey and skiing. If this ligament is completely ruptured (torn) then usually surgery and an extensive rehabilitation program is required.

Anatomy

The ACL is a tough band of tissue located in the centre of the knee that connects the back part of the femur (thighbone) to the front of the tibia (shinbone). The ACL controls forward movement of the tibia on the femur and is the first ligament that becomes tight when the knee is straightened. If the knee is forced past this point this is called hyperextension and the ACL can be torn. Other parts of the knee may be injured with the ACL, such as the medial collateral ligament (MCL), on the inside of the knee, and the meniscus (the cushion between the tibia and femur).

Symptoms

When the ACL is completely torn patients will often have heard a ‘pop’ and usually the knee joint swells significantly within a short time following the injury. There is also instability caused by the torn ligament and the knee feels like it may give way, especially when trying to change direction on the knee. Walking is usually very difficult.

What Happens If I Don`t Fix My Knee?

Persisting giving way and weakness are very likely to cause degeneration, further injuries (which will damage cartilage and other ligaments) and early osteoarthritis. Incomplete rehab will usually stop you getting back to your previous levels of exercise, sport and normal activity.

How Long Does It Take To Get Fully Better?

This is a serious injury and takes 6 months rehab after surgery to return to normal activities, and up to 12 months to return to contact sports.

Phase 1: Optimise and Control Inflammation

Inflammation is the redness and swelling that occurs whenever you injure yourself. Our bodies need inflammation to clean away damaged tissue and start the normal healing process, but we also need to control it. Reducing your swelling is one of the first big goals of your rehab. The time this takes depends on many things such as the severity of your injury, your age, damage to other structures and how quickly you start correct treatment.

Your physio may use R.I.C.E.,  specific massage to release tight muscles and reduce swelling, taping and activity modification to manage your inflammation. Sometimes crutches are needed to reduce the strain on your knee.

Phase 2: Clarify Diagnosis

Often the pain and inflammation that are present with acute knee injuries mean that we can’t do all of the tests we need to for your ACL in your initial treatment. Also, more than one structure in your knee may be damaged, and this needs to be clarified to give you an accurate diagnosis and recovery plan. As your knee settles down we will do further tests that may be needed for your ACL and other structures. If the tests that your physio does with you indicate that you have torn your ACL then they will refer you to an orthopaedic surgeon for an MRI scan to confirm the diagnosis, and surgical repair is usually needed.

Phase 3: Quads Activation/Strengthening

After your ACL injury/repair your quads muscles normally shut down and become very weak. Returning them to their full strength is a vital part of your rehab as it restores your knee control and stability.

This phase often needs to start with you learning how to activate your quads again, and then progresses to strengthening in lying and finally to weight-bearing positions. All exercises are done gently and slowly to ensure that you use the right muscles, at the right time and with your leg in the right position.

Your physio will use very specific exercises and may also use EMG biofeedback and electrical stimulation to ensure your muscles return to correct co-ordination and strength.

Phase 4: Restore Range Of Motion

The next big goal of your rehab is to regain full straightening of your knee. You will need this to be able to walk and move normally again. Once your straightening is back to normal we then work to restore your bending, although this may be delayed a little if you have had a meniscus (cartilage) injury as well as your ACL tear.

Your physio may use techniques including stretches, muscle and soft-tissue releases, specific exercises and joint mobilisations to help you regain your range.

Phase 5: Proprioception Retraining and Functional Strengthening

Proprioception is your body knowing where it is in space. It is a key factor for playing sport and preventing injury because it provides fast reaction times and fine movement control. During your ACL tear/repair your proprioception is significantly reduced, and restoring it is essential for injury-free return to your normal activities and sport.

Integrated with your proprioception retraining is functional strengthening. This phase makes sure that the right muscles are being used in the right combinations to keep your leg in the correct alignment during normal daily activities. Your physio may use wobbleboards, minitramps or discs to retrain your proprioception. Specifically graded exercises will also be used to combine propioceptive input with functional strengthening.

Phase 6: Sports/Ballistics and Advanced Strengthening

This is the last phase of your recovery plan and is essential for getting back to your previous level of performance and preventing re-injury. You need to be able to move at full speed and with full force in training first, before returning to your normal level of sport. Persisting background weakness or poor co-ordination will lead to inferior performance and increased risk of re-injury.

This phase is achieved by doing advanced sports-specific strengthening and high speed movements combined with rapidly changing directions. Exercises are tailored specifically to your activity to ensure correct technique, co-ordination and strength are restored.

Many clients find that seeing one of our Exercise Physiologists, Strength and Conditioning coaches or Personal Trainers is a great way to build strength, ability and confidence for a smooth return to full sporting activity. If Pilates is more your style then our great Sports Pilates program is an ideal way for you to continue to build your stability and strength. As well as being an important part of your rehab program these services can help you lift your sports performance whilst staying safer and reducing your risk of future injury.

For more information or to speak with one of our physio’s to discuss your symptoms please call us on 9280 2322 or contact the clinic.

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