What is an (ACL) anterior cruciate ligament injury?
The cruciate ligaments are found in the middle of your knee joint, forming an “X” configuration as they cross each other to connect the thigh bone (femur) and the shin bone (tibia). The anterior cruciate ligament (ACL) prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.
The mechanisms of an ACL injury include quick changes in direction (pivoting/cutting), stopping suddenly, landing awkwardly from a jump, and direct collisions. Female athletes are more prone to ACL injuries than males due to a number of physiological and biomechanical factors.
ACL injuries are usually complete or near-complete ligament tears, with partial injuries being rare. Over half of ACL injuries are associated with additional damage to the knee such as cartilage damage, meniscal tears and injuries to other ligaments.
What are the symptoms of an (ACL) injury?
At the time of the ACL injury, your knee may have given way and many people feel or hear a “popping” sensation. The deep pain and rapid onset of swelling make it very difficult to carry on with the activity or bear weight on the leg. Once the pain and swelling have resolved your knee can feel unstable and may continue to give way. Returning to pivoting/cutting activities is often impossible. Each giving way episode can cause further damage to your knee.
How is an ACL injury diagnosed?
The symptoms and a careful examination will usually suggest the diagnosis. An x-ray can be useful, but an MRI scan is the investigation of choice.
How is an ACL injury treated?
The treatment of ACL injuries is individualised to each patient based on activity levels and demands, age and associated knee injuries. Initial treatment is aimed at managing the pain and swelling through rest, analgesia/anti-inflammatory medication and ice. Crutches may be used to help mobility and a knee brace can help prevent further instability. As the pain and swelling subside, specific rehabilitation is started to restore motion, function and strength to your knee and leg.
Although a torn ACL will not heal, not everyone requires surgery. Physiotherapy and rehabilitation, however, plays a crucial role for everyone. Less active, usually older, individuals with less demanding activity levels can achieve overall knee stability with a focussed rehabilitation programme. People with higher activity levels and sporting demands usually require surgical intervention to reconstruct the torn ACL.
ACL reconstruction involves replacing your torn ligament with a tissue graft. There are several potential options including hamstring tendons at the back of your knee, part of the patella tendon that runs between the kneecap and tibia, and quadriceps tendon that runs up from the kneecap into the thigh. Donated graft (allograft) may also be used. The advantages and disadvantages of each option will be discussed by the surgeon to choose the best graft option for each individual.
It takes time for the graft to incorporate and function efficiently. Return to sport can take at least 6-months; often longer. Consequently, physiotherapy and rehabilitation are pivotal to the success of the surgery. Although at times you may feel frustrated, commitment to therapy is the most important factor in getting back to the activities you enjoy.
If you or someone you know has suffered an injury or is experiencing pain across their lower limbs or difficulty with mobility and would like a consultant-led review, please contact us. Grosvenor Orthopaedics have extensive experience in the treatment of knee-related injuries with excellent patient outcomes.
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Grosvenor Orthopaedics have extensive experience in the treatment of knee-related injuries with excellent patient outcomes.
KNEE CONDITIONS
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KNEE TREATMENTS
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our KNEE SURGEONS
The Knee Service at Grosvenor Orthopaedic Partners is led by Mr Luke Jones and Mr Chethan Jayadev, both Oxford PhD educated knee surgeons with London Teaching Hospital NHS consultant posts. They provide a comprehensive range of knee procedures as part of a multidisciplinary team of healthcare professionals including highly specialised physiotherapists, all committed to returning you to optimal function.
Our team are well placed to manage and treat a diverse range of knee problems utilising cutting edge diagnostic technology and treatment approaches, both surgical and conservative. Below is an overview of some of the knee conditions we treat but for a more thorough understanding please contact our team here
MR LUKE JONES
Consultant Orthopaedic Knee Surgeon
MR CHETHAN JAYADEV
Consultant Orthopaedic Knee Surgeon
MR MARK WEBB
Consultant Orthopaedic Knee Surgeon
MR SIMON HISLOP
Consultant Orthopaedic Knee Surgeon
What some of our patients say
Mrs MA
Thank you for taking care of me. You went above and beyond and I am so touched and grateful. My knee feels fine now