ACL (Anterior Cruciate Ligament) Tears

The first step in diagnosing an ACL tear is taking a detailed medical history. The knee specialist will ask about how the injury occurred, the symptoms experienced, and any previous knee injuries. This information helps the knee specialist understand the context of the injury and its severity.

A physical examination of the knee is conducted to assess the extent of the injury. The knee specialist will look for signs such as swelling, bruising, and tenderness. Specific tests, such as the Lachman test and the anterior drawer test, are performed to check the stability of the ACL. These tests involve moving the knee in certain ways to see if abnormal movement indicates a tear.

To confirm the diagnosis and determine the severity of the ACL tear, imaging tests are often required:

• X-rays: X-rays are used to rule out any bone fractures that might have occurred along with the ACL injury. Although X-rays do not show soft tissues like ligaments, they are useful for detecting bone-related issues.
• MRI (Magnetic Resonance Imaging): An MRI is the most definitive imaging test for diagnosing an ACL tear. It provides detailed images of the knee’s soft tissues, including the ligaments, tendons, and cartilage. An MRI can reveal the extent of the ACL tear and any other injuries, like meniscus or other ligament damage.

Non-surgical treatments may be sufficient for less severe ACL tears or people who are not highly active. These treatments focus on:

RICE Method

The RICE method is a standard initial treatment for ACL injuries. It includes Rest, Ice, Compression, and Elevation, each important in managing pain and swelling.

• Rest: Rest is recommended to prevent further injury and to initiate healing. Avoiding activities that put additional stress on the knee helps minimise further damage to the ligament.
• Ice: Applying ice to the knee reduces pain and swelling. Ice should be applied for 20 minutes every two hours during the first 48 hours after the injury. This helps constrict blood vessels and reduce internal bleeding and swelling.
• Compression: An elastic bandage or compression wrap can help control swelling and support the knee. Compression aids in reducing swelling by preventing the accumulation of fluids in the knee joint.
• Elevation: Keeping the knee elevated above the heart level helps decrease swelling by allowing fluids to drain away from the injured area. Elevation is most effective when combined with rest and ice.

Physical Therapy

Physical therapy is an important part of healing that does not involve surgery. As part of an organised rehabilitation programme, knee exercises are used to make the knee stronger, more flexible, and more stable. The knee specialist shows patients specific exercises that build the muscles around the knee, especially the quadriceps and hamstrings, which help keep the knee stable.

Wearing a Knee Brace

A knee brace can give your knee extra support and stability, especially during physical activities. Braces help keep the knee from getting hurt again and let people slowly return to normal activities.

Medications

Over-the-counter pain relievers and anti-inflammatory medications can help manage pain and reduce swelling. Sometimes, the knee specialist may prescribe stronger medications to control pain.

Corticosteroids for ACL Tears

Corticosteroid injections are used to reduce inflammation and pain from ACL (Anterior Cruciate Ligament) tears. These injections provide immediate relief by decreasing swelling and discomfort, making it easier for patients to engage in physical therapy. However, corticosteroids do not promote tissue healing and are best used as part of a broader treatment plan.

Hyaluronic Acid for ACL Tears

Hyaluronic acid injections help manage ACL tear symptoms by lubricating and cushioning the knee joint. This treatment improves mobility and reduces pain, especially if the ACL tear is accompanied by osteoarthritis. While it doesn’t heal the torn ligament, it enhances joint function and comfort.

Platelet-Rich Plasma (PRP) for ACL Tears

Platelet-rich plasma (PRP) therapy involves injecting concentrated platelets from the patient’s blood into the injured ACL. This stimulates tissue repair and regeneration, promoting healing and reducing pain and inflammation. PRP supports the restoration of ligament strength and function, offering a promising alternative to surgery.

For more severe ACL tears, particularly in active people or athletes, surgery may be recommended. Surgical treatment involves reconstructing the torn ligament using a tissue graft.

ACL Reconstruction

ACL reconstruction is the most common surgical procedure for treating ACL tears. This surgery involves replacing the torn ligament with a graft, which can be sourced from the patient’s own body (autograft) or from a donor (allograft). Common autograft sources include the patellar tendon, hamstring tendon, or quadriceps tendon. The surgeon secures the graft in place using screws or other fixation devices, allowing the new ligament to integrate and stabilize the knee over time.

ACL Repair

In certain cases, particularly with partial tears or tears near the ligament’s attachment to the bone, ACL repair may be a viable option. This procedure involves suturing the torn ligament back together. ACL repair is less common than reconstruction and is typically considered for specific patient populations, such as younger individuals or those with specific tear patterns.

Augmented ACL Reconstruction

Augmented ACL reconstruction combines traditional reconstruction techniques with additional supportive measures. One such method is the use of a synthetic scaffold to support the healing process and improve the integration of the graft. This approach aims to enhance the strength and stability of the repaired ligament, potentially leading to better long-term outcomes.

Non-surgical rehabilitation involves strength and flexibility exercises to stabilise the joint. This includes:

• Strengthening and Flexibility Exercises: These exercises target the quadriceps, hamstrings, and calf muscles to improve muscle support and maintain knee flexibility, which include leg presses, squats, and lunges. Flexibility exercises stretch knee muscles to maintain and improve range of motion. Hamstring and quadriceps stretches are the most common flexibility exercises.
• Balance and Proprioception Training: Balance and proprioception exercises improve the body’s ability to sense the position of the knee joint, preventing further injuries. These exercises often involve balance boards or stability balls. These activities train the neuromuscular system to adapt to posture changes.
• Functional Training: Functional training aims to restore the knee’s ability to handle real-life physical demands. It includes exercises such as step-ups, lateral movements, and agility drills.

After ACL surgery, rehabilitation follows a planned routine to ensure healing and function. The post-surgical rehabilitation process generally includes several phases:

Initial Phase

In the initial phase, the focus is on reducing pain and swelling while gradually increasing the knee’s range of motion. Gentle exercises, such as heel slides and quad sets, are introduced to maintain muscle activity without straining the knee.

Intermediate Phase

As healing progresses, the rehabilitation program introduces more intensive strengthening and flexibility exercises. The goal is to restore the full range of motion and build muscle strength around the knee. Activities such as stationary biking and swimming may be incorporated.

Functional Phase

The functional phase emphasises regaining full function and preparing for a return to sports or daily activities. This includes more dynamic exercises like running, jumping, and agility drills. Patients also engage in sport-specific training tailored to their activity level.

Final Phase

The final phase focuses on a gradual return to pre-injury activities. The knee specialist assesses the knee’s strength, stability, and function to determine readiness for a safe return to sports or demanding physical activities.