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Beyond the ACL
In addition to the ACL, the knee contains the posterior cruciate ligament (PCL), lateral collateral ligament (LCL), and medial collateral ligament (MCL). These are the primary stabilizers of the knee in all planes of motion.
- PCL: Extremely resistant to damage and has a high potential for healing. Surgical reconstruction is rarely required.
- MCL: A robust stabilizer of the knee joint, featuring multiple layers, and it heals well non-surgically.
- LCL: Part of the complex of ligaments stabilizing the knee laterally, protecting against varus stress. This is the least commonly injured knee ligament.
What is the ACL?
The ACL is one of the primary stabilizers of the knee, preventing excessive anterior translation of the tibia and rotational instability during sports and activities involving sudden stops or directional changes. Unfortunately, the ACL is not as resilient as other ligaments. Partial ACL tears are rare; most injuries result in complete rupture, often accompanied by a loud popping sound akin to a whip crack. A fully ruptured ACL does not heal on its own and typically requires surgical reconstruction.
Recently, discussions in orthopedics have revolved around the "discovery" of a new ligament in the knee, the anterolateral ligament (ALL). However, this is not a new finding. The ALL was first described by Paul Segond in 1879 but had been largely forgotten. Advances in joint biomechanics and ligament reconstruction techniques have confirmed the existence of the ALL, which can also be injured and often requires repair.
Why Does the ACL Tear?
Knee ligaments are not the sole stabilizers of the joint; the most crucial stabilizer is the brain. Proper neuromuscular coordination allows us to react appropriately in situations that might otherwise lead to ACL injury. This is why rehabilitation after ACL reconstruction accounts for over 50% of the treatment's success. Simply regaining muscle strength and joint mobility is not enough; developing coordination, dynamic stability, and injury prevention skills is the most challenging and time-consuming aspect.
The increasing popularity of sports has exposed more people to high rotational loads. A lack of proper motor preparation or even an adequate warm-up often results in ACL tears during activities like skiing, football, or squash.
Symptoms of ACL Injury
A torn ACL presents with characteristic symptoms:
- Injury typically involves knee twisting and hyperextension, often accompanied by a distinctive "pop" sound.
- Significant pain and difficulty achieving full knee extension.
- Swelling around the knee joint.
First Aid for a Torn ACL
- Avoid weight-bearing on the injured leg.
- Rest and limit movement.
- Apply ice to the joint.
- Use compression bandages (elastic wraps).
- Elevate the leg above heart level.
- Consult a physician.
Diagnosing ACL Tears
ACL injuries are diagnosed through patient history, clinical knee evaluation, and physical tests. Imaging studies are also helpful:
X-rays: Rule out fractures.
Ultrasound (US) and Magnetic Resonance Imaging (MRI): Identify associated injuries, such as damage to the meniscus or joint capsule, which are often present alongside ACL tears.
Can a Torn ACL Heal Without Surgery?
A torn ACL does not regenerate on its own. However, surgical reconstruction is not always necessary. Many individuals with ACL injuries experience no knee instability during daily activities and work. With proper exercises to strengthen muscles and improve overall body stability, most people can engage in amateur sports like swimming, cycling, or running. For those in physically demanding jobs or sports requiring frequent starts, stops, and directional changes, conservative treatment may be less effective in addressing knee instability.
ACL Reconstruction – When to Operate?
Surgical reconstruction of the ACL is often recommended for young, active individuals and those for whom knee instability affects daily life. Reconstruction is also necessary when associated injuries, such as meniscus damage, cause chronic pain, joint locking, or swelling.
Immediate Surgery: Recommended within 10 days of injury for professional athletes.
Delayed Surgery: For most individuals, surgery is recommended several weeks post-injury, following a period of rehabilitation to restore joint mobility, strength, and endurance.
ACL Reconstruction – The Procedure
The ACL reconstruction process involves several precise steps:
Removing the damaged ACL fragments while leaving a stump.
Creating bone tunnels: Carefully measuring and drilling tunnels in the femur and tibia to anchor the graft.
Introducing the graft: A graft, prepared by another surgeon, is passed through the tunnels and secured.
Checking the graft: Ensuring proper placement and testing for full knee extension.
Closure: Stitches and a dressing are applied.
Rehabilitation After ACL Reconstruction
Rehabilitation is crucial for a successful recovery and involves:
- Day after surgery: Initial rehabilitation under physiotherapist supervision.
- Hospital discharge: Typically within two days post-surgery.
- Stitch removal and follow-up: 10–14 days after surgery.
- Walking without crutches: 3–6 weeks post-surgery.
- Full recovery and return to sports: Approximately six months post-surgery.
Why Choose Rehasport for ACL Reconstruction?
Rehasport offers extensive experience in arthroscopic ACL reconstructions, employing the latest techniques and materials. Using personalized approaches based on patient anatomy, sport-specific needs, and injury severity, we utilize advanced grafts, including patellar tendons, hamstring tendons, or quadriceps tendons. Our procedures incorporate cutting-edge implants to enhance graft durability, such as endobuttons, bioabsorbable screws, and tapes.
In cases where ACL injuries are linked to anatomical abnormalities, such as tibial or femoral bone shapes, or limb alignment issues, we perform corrective osteotomies alongside ACL reconstruction to minimize the risk of future injuries.
Comprehensive Rehabilitation Program
Rehasport’s advanced ACL rehabilitation program, developed through years of experience and collaboration with elite athletes, spans 24 weeks. This program focuses on minimizing pain and swelling, restoring knee joint mobility, and rebuilding muscle strength.
First rehabilitation session: Conducted two weeks post-surgery, following a physician's evaluation.
Functional Biomechanical Assessment (BOF): Performed at 12 weeks to guide the transition to dynamic exercises.
Final Assessment: Conducted at 24 weeks to ensure readiness for full sports participation.
Proper ACL reconstruction and rehabilitation enable a return to high-performance sports and daily activities.
Learn more about ACL reconstruction in Rehasport Poznań.
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References:
- Science Direct - The Knee - "Biomechanical characteristics of the knee joint in female athletes during tasks associated with anterior cruciate ligament injury" - Yasuharu Nagano, Hirofumi Ida, Masami Akai, Toru Fukubayashi - Volume 16, Issue 2, March 2009, Pages 153-158
- Physiopedia - "Anterior Cruciate Ligament (ACL) Injury"
- National Library of Medicine - "Anterior Cruciate Ligament Knee Injuries" - Jennifer Evans; Jeffery l. Nielson.
- Ortho Bullets - "ACL Tear" - Matthew J. Steffes MD, Patrick C. McCulloch MD, Mark Miller MD
