Arthroscopic anterior cruciate ligament (ACL) injury and its treatments


What is ACL ligament?

The ligament that is present in the center of our knee is called as anterior cruciate ligament or ACL. Four major ligaments hold the knee together, and the ACL is one among them. The ACL is damaged when it is twisted or injured. It is the site for one of the most common injury of the knee.

About half of the ACL injuries (knee injury) happen along with rupture of other knee structures like meniscus, cartilage and ligament. The ligament injuries are termed as sprains and are categorized into three grades:

  1. Grade-1 Sprain: Ligament is mildly damaged and stretched but retains the ability to keep the knee stable.
  2. Grade-2 Sprain: The ligament is stretched to the level of loosening. It is also referred as a partial tear of the ligament.
  3. Grade-3 Sprain: The ligament is torn completely into two parts, making the knee joint unstable.

What are the common causes ACL injury?

Some of the common causes of anterior crucial ligament injury are:

  • Rapid change of direction
  • Stop suddenly
  • Slow down during running
  • Incorrect landing from a jump
  • Direct contact like tackling in football

According to many researchers, it is found that female athletes are more prone to ACL injury than the males. The experts say that it is due to the difference in the structural integrity of muscular strengths, neuromuscular control, and physical conditioning. The differences in the pelvic and lower extremities may also contribute to the ACL injury.

What are the symptoms of ACL injury?

When you injure your ACL ligament, you may have the following possible symptoms:

  • ‘Popping’ sound from your knee
  • You knee cannot bear the strain from your weight
  • Pain
  • Swelling within 24 hours

It is important to visit your doctor if you have a knee injury and notice the symptoms mentioned above. Though you may observe that swelling may subside on its own by taking rest, the moment you resume any heavy activity, exercise or any sports, the swelling and pain would reoccur. When left untreated, ACL tear can also lead to damage of the cartilage in your knee joint.

When the ACL is injured, you might hear a “popping” noise and may feel your knee give out from under you. Other typical symptoms include:

  • Impact on even a simple motion
  • Pain in the joint
  • Difficulty in walking

How to diagnose an ACL injury?

The diagnosis of the anterior crucial ligament injury can be diagnosed in the following ways:

Physical Examination/Medical History:

When you visit your doctor, a physical examination is carried out to check the symptoms, movement and structure of the injured knee. A comparison is made with the good knee, and medical history is taken.

Diagnostic Tests

The doctor may ask you to do the test to confirm the diagnosis. Some of the important diagnostic tools used are;

  • X-rays: It is advised to rule out if any broken bone is associated with the injury.
  • MRI (magnetic resonance imaging) Scan: MRI gives the clear images of the structures of the soft tissues like ACL.

What are the treatments?

Treatment of ACL injury depends on patient’s requirement. Usually, there are non-surgical and surgical treatments available for anterior cruciate ligament injury. A patient who is active in sports or athlete, or who are placed in the high demands of the knee, would require surgery. The older patients, who are less active, can get back to the normal lifestyle without any surgical procedure.

Nonsurgical Treatment

Elderly patients, who have a low activity level of the knee, can be benefitted by non-surgical treatments. The doctors usually suggest simple treatment if the overall stability of the joint is good. Some of the non-surgical options are:

  • Bracing: Bracing is good to protect the instability of your knee. For better protection, further, your doctor may give you crutches for some days to keep the weight off your leg.
  • Physiotherapy: Once the swelling starts reducing, a rehabilitation program under an expert should be started carefully. This will help restore energy and strengthen the muscle of the knee.

Surgical Treatment:

According to a research article published in the Journal of Operative Techniques in Sports Medicine, it is mentioned that the surgeon should take care of few basic steps before and while doing an ACL reconstruction which includes pre-operative evaluation, selection of the patient, techniques of the procedure, and rehabilitation methods. This has been known to help achieve the expected outcome after the surgery.

There are various types of surgical treatment options available for arthroscopies, like patellar tendon graft procedure, Hamstring graft procedure, Allograft procedure, and ACL reconstruction. However, arthroscopic ACL reconstruction is the one which is suitable for most of the patients’ condition.

Arthroscopic anterior cruciate ligament reconstruction:

Anterior cruciate ligament reconstruction is done to treat the damaged or ruptured anterior cruciate ligament of the knee. It is performed to replace the damaged ACL ligament by an artificial or self-tissue graft.

ACL reconstruction is one of the most common procedure performed by the orthopedic surgeons. Doctors recommend it fo the patients that have a high risk of further damage. This procedure can be carried out either as an open surgery or using an arthroscopic approach.

According to the Journal of Operative Techniques in Orthopedics, during ACL reconstruction, it is important to give careful attention to the details such as graft harvest, notch or hole preparation to prevent complications, and to ensure that a full range of motion and knee stability is achieved.

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