ACL Tear

Overview: what is ACL?

ACL or anterior crucial ligament is one of the 4 ligaments in the knee joint. It is a flexible band of tissue that gives stability to the knee, holds the bones and the cartilages together. The ACL controls the tibia (shinbone) and prevents it from sliding before the femur bone. An ACL tear or injury is common in athletes.

What is an ACL tear?

ACL tear occurs when the ligament stretches too much. The tear is partial (only affects part of the ACL) or complete (affects the whole ligament).

ACL tear occurs during sudden movement or landing, sports activities, jumping, direction change, skiing, automobile accidents, etc.

During the injury, you may hear a snap or a pop sound and experience pain. The pain varies to the degree of injury. Immediately, you may notice some swelling in the area. Icing the area or splinting reduces the swelling.

Treatment depends on the severity of the ACL tear. Treatment includes rest and rehabilitation exercises. For severe symptoms, doctors recommend surgery to remove the torn ligament.

Types of ACL injuries

An ACL injury is classified into 3 categories:

Grade I

This is a mild sprain. The ACL ligaments are stretched but there is no tear. Patients experience mild symptoms and pain. Knee mobility is stable but limited. There is mild tenderness, swelling, and some limitations in knee mobility. Symptoms are relieved with anti-inflammatory medications, rest, and ice packs. Patients can move with crutches. There is no need for surgery.

Grade II

In grade II, there is a partial tear in the ACL ligaments. The symptoms are quite similar to grade 1, but patients may experience more pain and limitations in mobility. As the ligaments are partially torn, the joint is slightly unstable. This affects mobility during activities. All grade II injuries do not require surgeries. Reconstruction surgeries depend on the patient’s symptoms, age, activity level, and fitness goals.

Grade III

It is common among athletes. It happens if the ACL ligaments are completely ruptured or torn. The symptoms are more severe. There is immediate swelling, pain, and in some cases stiffness. The knee is unstable. Treatment generally requires reconstructive surgery. Once there is full extension, the swelling gradually decreases.

ACL tear symptoms

Symptoms include:

• Heard a popping sound indicating a tear.
• Swelling and pain. The pain and swelling generally subside within a day. But the knee is still unstable. If you want to return to sports or rigorous activities, there are risks of damaging the cartilages.
• Joint tenderness.
• Range of motion loss.
• Feeling unstable.
• Discomfort during movements.
• Severe pain.

What causes ACL tear?

ACL tear occurs due to:

• Landing awkwardly from a height.
• Suddenly changing the direction.
• A collision.
• Suddenly slowing down while running.
• Twisting the knee.
• Injuring the knee.
• Overextending the knee joint.

Sometimes ACL tears damage other cartilages and ligaments of the knee.

Who are at risks of ACL tears?

ACL tears are common knee injuries. People who are at risk of ACL tears include:

• Athletes who jump, run, switch directions a lot, make sudden starts or stops.
• Volleyball, football, soccer, and basketball players.
• Climbers and mountaineers.
• People who do strenuous jobs like climbing or jumping from heights.
• Females and women athletes.

Are women at greater risk of ACL tears?

Statistics reveal women are more vulnerable to ACL tears. Experts believe there are a few factors contributing to it:

The female anatomy

The intercondylar notch is a groove located at the base of the femur. It is smaller in women compared to men. It stabilizes the knee joint. This is possibly a reason that the narrow notch may restrict the ACL movement.

Women’s hips are wider and the alignment can affect the inward knee movements. This can stress the ACL ligaments while jumping, turning, or landing.

Body movements

Women move differently from men. The knees are more flexible and susceptible to strains. The inward knee movements can hurt the adjoining tendons, ligaments, and muscles. Also, women lack the muscle strength to absorb the pressure while landing or jumping.

Hormones

Experts believe that the periodic hormonal imbalance during a woman’s menstrual cycle makes her prone to ACL injuries. The progesterone and estradiol hormones are low during the menstrual cycle. This increases the risks for ligament laxity and ACL injuries.

Diagnosis

Physical examination

Doctors perform a physical examination of the affected leg. The patient bends the hips or moves the knees in certain directions. The doctor puts the hand on the affected knee and looks for abnormality.

X-ray

An x-ray is recommended to detect broken bones during the ACL injury.

MRI scan

An MRI takes images of the ACL tear along with damaged tissues and broken bones.

Arthroscopy

This is a procedure where the surgeon makes a small incision in the skin. A small tool with a lighting system called an arthroscope is inserted. It projects images of the joint. The surgeon examines and repairs the torn ligament.

Treatment options

Treatment depends on the symptoms.

R.I.C.E therapy

Follow the R.I.C.E therapy immediately after an ACL tear.

R (rest) – rest the injured leg.

I (ice) – apply ice to reduce swelling.

C (compression) – compression. Use an ace bandage.

E (elevate) – elevate the legs. Use crutches to reduce weight from the knee.

Medications

Doctors suggest anti-inflammatory medications and over-the-counter medicines for swelling and pain. For severe pain, doctors often inject steroid medications into the knees for relief. Doctors also suggest wearing knee braces to provide extra support during running or sports activities.

Physical therapy

Muscle-strengthening exercises help regain strength and range of motion. Patients can do the exercise at home.

Surgery

Doctors recommend surgery when the ACL tear is severe and disrupts the patient’s normal life. Athletes also get reconstructive surgeries to return to their profession. Surgeries remove the damaged ACL ligament and replace it with tissue that grows. Surgery is followed by physical therapy.

Preparation

Preparation tips before surgery:

• Be ready with your diagnostic test results.
• Clear your doubts about the surgery, risks, and aftercare instructions.
• Prepare yourself before the surgery. Follow heathy lifestyle. Eat nutritious foods. This makes recovery faster.
• Make arrangements at home. After surgery, your movements will be limited. Arrange for meals and someone to help you with your daily household chores.
• Buy crutches.
• Relax the mind from stress.

Procedure

In ACL surgery, the goal is to replace the damaged ligament. The surgeon replaces it with a healthy tendon. A tendon connects the muscle to the bone and helps regain a complete range of motion.

The tendon when placed in the knee is known as a graft. Grafts can be of 3 types:

• Autograft – the tendon is taken from the other parts of the patient’s body like the knee, thigh, or hamstring.
• Allograft – the tendon is procured from someone else’s body like a deceased donor.
• Synthetic graft – instead of a tendon, the surgeon uses synthetic materials like Teflon or carbon fiber.

How is the procedure done?

Arthroscopy

Surgeons do arthroscopic surgery to reconstruct the torn ligament. Small cuts are made around the knee. The surgeon then inserts an arthroscope with a camera through the incision. The surgeon makes two holes or tunnels. The surgeon places one graft above the knee and one below the knee. Screws keep the grafts intact. It takes months for the new ligament to grow.

The procedure is done with regional anesthesia or general anesthesia. Patients go home after some rest.

BEAR (Bridge-enhanced ACL repair)

Unlike arthroscopy, BEAR does not replace the torn ACL ligament. The ACL heals naturally. Surgeons insert a special small sponge between the torn ACL ligaments. Then they inject the patient’s blood into the sponge and stitch the loose ends. This provides support. After some time, the torn ligaments heal.

When should you go for surgery?

The choice of having surgery depends on the severity of the symptoms and the patient’s lifestyle. If the ACL tear is affecting normal walking or daily activities, surgery is recommended. Patients who have received non-surgical treatments for ACL tear can continue with their normal lifestyle, go to the gym, do swimming, exercise, etc. Athletes and patients who do intense physical labor may need ACL reconstruction surgery to regain their normal lives.

Seek emergency care if the knee has turned blue or cold. This may indicate a joint dislocation or blood vessel injury.

What is the recovery time for ACL surgery?

Recovery generally takes 6-9 months.

Surgery options

ACL reconstruction surgery is an outpatient procedure. Some patients may need to stay in the hospital for 24 hours for observation. The procedure is minimally invasive and is done in an outpatient facility or a hospital.

Small clinics

Pros

• Low costs.
• Faster discharge.
• One-to-one service.

Cons

• Lack of proper amenities.
• Low success rates.

Big hospitals

Pros

• High success rates.
• Latest technology and equipment.
• A large team of hospital staff.

Cons

• High costs.
• Lack of personalized care.

Cost of surgery

ACL reconstruction costs in India depends on:

• Type of graft used during surgery.
• Hospital charges.
• Charges for the surgical team.
• Surgeon’s fees.
• Extra charges for emergencies.

Post-op care and things to keep in mind

• Immediately after surgery, patients must take ample rest.
• Put ice on the wound site for pain and swelling.
• For movements, use braces or crutches.
• Start a rehabilitation program to strengthen muscles and improve range of motion.
• Physical therapy includes gentle weight-bearing exercises, muscle strengthening, and simple range-of-motion exercises.
• For athletes, after 12-16 weeks, sports activities like hopping, jumping, agility drills, etc., are added.

Complications

ACL surgery risks include:

• Wound site bleeding.
• Blood clots.
• Shock.
• Infections.
• Anesthesia reactions.
• Knee pain.
• Disease transmission from allografts (grafts procured from a deceased donor).
• Lack of range of motion.
• Improper healing of wound site.

Prevention

• Training programs to strengthen the muscles and improve resilience against orthopedic injuries.
• Improve balance by strengthening the ankle, knee, feet, and leg muscles. This prevents sudden bending or twisting of ligaments that cause ACL tears.
• Stretch and warm-up before intense sports or activities. This reduces stiffness in the body muscles and ligaments.
• For improving balance, wear proper footwear. Awkward motions put a shock to the knee joints causing ACL tears. Appropriate athletic gear absorbs the shock and protects the leg muscles.
• Consult an orthopedic specialist about strains and muscular weaknesses.

Best option

ACL reconstruction surgery is a minimally-invasive procedure but requires precision and accuracy. Goficure provides healthcare services in elective surgeries. Their team of experts give guidance and assist patients in getting consultation with top doctors. They provide a complete medical package from booking appointments to postoperative care.

Why choose goficure?

• Consultation with top surgeons and doctors.
• Fast treatment and recovery.
• Affordable costs.
• Doctor-patient confidentiality.
• Trustworthy diagnosis.

References