Anterior Cruciate Ligament Injury

Anterior Cruciate Ligament InjuryDescription, Causes and Risk Factors:Alternative Name: ACL Injury, cruciate ligament injury - anterior; Knee injury - anterior cruciate ligament.The knee is similar to a hinge joint, located where the end of the femur (thigh bone) meets the top of the tibia (shin bone). Four main ligaments connect these two bones:Anterior Cruciate Ligament: Lies in the middle of the knee. It prevents the tibia from sliding out in front of the femur, and provides rotational stability to the knee.
  • PCL (posterior cruciate ligament): Works with the anterior Cruciate Ligament. It prevents the tibia from sliding backwards under the femur.
  • MCL (medial collateral ligament): Runs along the inner part (side) of the knee and prevents the knee from bending inward.
  • LCL (lateral collateral ligament): Runs along the outer part (side) of the knee and prevents the knee from bending outward.
Injuries to the ACL are quite common on the slopes. The anterior Cruciate Ligament provides our joint with stability for all of our rotational sports. This stability is more than just a "trust" issue of the knee. The ACL protects the meniscus (cushion cartilage) caused by shear and twisting; the meniscus protects our joints from developing arthritis.An Anterior Cruciate Ligament tear is cause for concern because the ACL is necessary for twisting, turning and pivoting activities (like skiing).The most common cause of swelling in one's knee (when one is less than 40 years old) is a tear of the Anterior Cruciate Ligament. This is true in almost 75 percent of people. In fact, sudden onset swelling in a young athlete is a torn ACL until proven otherwise. Other injuries to be concerned about in this age group include a meniscus tear, a patella (kneecap) dislocation, or damage to the cartilage within the knee.You should follow-up with a physician as soon as possible to be evaluated for X-rays and an MRI scans.One should avoid twisting, turning, or pivoting activities after the injury to avoid further damage to other important structures within the knee. About 75 percent of people who tear their ACL report hearing or feeling a pop. This pop is felt to be due to a bone bruise, which occurs when the joint partially dislocates and the anterior Cruciate Ligament stretches and tears.Anterior Cruciate LigamentSymptoms:A "popping" sound at the time of injury.
  • Knee swelling within 6 hours of injury.
  • Pain, especially when you try to put weight on the injured leg.
  • Those who have only a mild injury may notice that the knee feels unstable or seems to "give way" when using it.
Diagnosis:Often the diagnosis can be made on the basis of the physical exam alone, but to confirm the diagnosis and severity of the disease following tests may needed, they may include:X-rays: X-rays may be needed to rule out a bone fracture. However, X-rays can't visualize soft tissues such as ligaments and tendons.
  • Magnetic resonance imaging (MRI): An MRI can show the extent of an anterior Cruciate Ligament injury and whether other knee ligaments or joint cartilage also are injured.
  • Ultrasound: Ultrasound may be used to check for injuries in the ligaments, tendons and muscles of the knee.
  • Arthroscopy: During arthroscopy, your doctor inserts a narrow, fiber-optic viewing scope and other instruments into your knee through very small incisions. This allows your doctor to directly see the damage and, in many cases, perform repairs at the same time.
Treatment:For mild anterior Cruciate Ligament injury should be treated with:Elevating the joint (above the level of the heart).
  • Ice.
  • Pain relievers such as nonsteroidal anti-inflammatory drugs.
  • Some people may need crutches to walk until the swelling and pain have improved.
  • Your doctor may suggest physical therapy to help you regain joint motion and leg strength.
For severe Anterior Cruciate Ligament  your doctor may recommend surgery to rebuild the ACL. If you are one of the active individuals that will soon have your ACL replaced, there are some things you should know. Your ACL will be replaced with either some of your own tissue, called an autograft or a cadaver graft — also known as an allograft. After surgery, there usually is a fair amount of pain, but your surgeon will keep encouraging you to “work on range of motion, get the swelling down, and eliminate the risk of scar tissue forming.” Strengthening exercises will follow.Regardless of the type of graft that is used during ACL reconstruction, the knee must undergo “remodeling,” which is a fancy way of saying that the ligament must get weaker before it gets stronger. Your body must grow new blood vessels into the new ACL. These blood vessels take away the old graft fibers, leaving a weakened scaffold. Next, new “ACL cells” get deposited on the scaffold, making a better or stronger ACL graft.Rehabilitation:Following an Anterior Cruciate Ligament reconstruction, wait until normal range of motion is achieved, and the graft and surrounding tissues are strong enough, before returning to sports. Once these have been achieved, and a patient is more than six- to nine-months post surgery, functional testing will help determine if the person is ready to safely return to activities.The ideal functional test may include:Test the strength of the muscles about the knee.
  • Test the athlete's endurance.
  • Test agility, trust and the ability to “accept a load.”
  • Be safe. Failing the test should not put the knee at risk.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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