ACL TEAR

An ACL tear refers to an injury to the anterior cruciate ligament (ACL), which is one of the major ligaments in the knee. This injury is quite common, especially among athletes involved in sports that require sudden stops, changes in direction, or jumping. 

• Grade 1 ACL Tear: This is considered a mild injury where the ligament is stretched but not torn completely. The ACL is still able to help stabilize the knee joint, though it may be slightly damaged.
• Grade 2 ACL Tear: This is a moderate injury where the ACL is partially torn. The ligament is significantly stretched and may cause some instability in the knee joint.
• Grade 3 ACL Tear: This is a severe injury where the ACL is completely torn into two pieces. The knee joint is unstable and may buckle or give way during weight-bearing activities.

Cause/Mechanism: 

ACL tears often occur during sports or activities that involve twisting, sudden stops, pivoting motions, or a direct blow to the knee.

Symptoms:

Sudden and intense pain in the knee.

Swelling within a few hours of the injury.

Difficulty or inability to continue the activity.

Feeling of instability or "giving way" in the knee.

Muscles involved:

1. Quadriceps: This is a group of four muscles located on the front of the thigh (rectus femoris, vastus lateralis, vastus medialis, and vastus intermedius). These muscles are responsible for extending the knee joint.

2. Hamstrings: These are a group of three muscles located on the back of the thigh (biceps femoris, semitendinosus, and semimembranosus). They help flex bend the knee joint and also provide stability to the knee.
3. Gastrocnemius and Soleus: These are the calf muscles that act on the ankle joint but also contribute to knee joint stability indirectly.
4. Tensor Fasciae Latae (TFL): This is a muscle of the thigh that helps stabilize the knee joint and is involved in hip abduction and internal rotation.
5. Adductors: These muscles (adductor magnus, adductor longus, adductor brevis, gracilis, and pectineus) are located on the inside of the thigh and contribute to stabilizing the hip and knee joints.
6. Gluteus Muscles: The gluteus medius and minimus, which are muscles of the hip, also play a role in stabilizing the knee joint, particularly during weight-bearing activities and movements such as walking, running, and jumping.
7. Iliotibial (IT) Band: While not a muscle, the IT band is a thick band of connective tissue that runs along the outside of the thigh. It plays a role in stabilizing the knee joint, especially during activities involving lateral movement and knee flexion.

Diagnosis:

Physical examination 

• Observation: Inspect the knee for signs of swelling, bruising, or deformity.
• Palpation: Gentle palpation of the knee joint to assess for tenderness, warmth, and any abnormal bumps or depressions.
• Range of Motion (ROM): Testing the knee's range of motion, both actively (by the patient) and passively (by the examiner), to assess any limitations or pain during movement.
• Ligament Testing: 

Lachman Test: This test evaluates anterior instability of the knee, which is a hallmark sign of ACL tears. The examiner stabilizes the thigh with one hand while gently pulling the lower leg forward with the other.

Anterior Drawer Test: Similar to the Lachman test, this test involves pulling the lower leg forward to assess anterior translation of the tibia relative to the femur.
 

Pivot Shift Test: This test assesses rotational instability of the knee joint, which can be indicative of ACL injuries. It involves flexing the knee, applying a valgus (inward) stress, and then extending the knee while applying a rotational force.

Lateral Pivot Shift Test: A variant of the pivot shift test specifically designed to assess lateral instability of the knee joint.

• Strength Testing: Evaluating the strength of the quadriceps, hamstrings, and other muscles around the knee joint, as weakness can contribute to instability.
• Functional Testing: Assessing functional activities such as walking, running, jumping, and squatting to evaluate how well the knee joint supports weight-bearing and dynamic movements.

Imaging tests 

MRI (Magnetic Resonance Imaging) is typically used to confirm the diagnosis and assess the extent of the injury.

Treatment:

Conservative 

Some minor tears can heal with rest, physical therapy, and a knee brace. However, complete tears often require surgery.

Operative

ACL reconstruction surgery is common for athletes and active individuals. It involves replacing the torn ACL with a graft (often from the patient's own hamstring or patellar tendon) to restore stability to the knee.

 

Recovery:

Recovery time varies but generally involves a period of rest, followed by physical therapy to regain strength, range of motion, and stability in the knee.

Full recovery to pre-injury levels of activity can take several months, and it's crucial to follow the rehabilitation program prescribed by the doctor and physiotherapist.

 

Prevention:

ACL tears can sometimes be prevented by strengthening the muscles around the knee (especially the hamstrings and quadriceps) and improving balance and agility.

Using proper techniques during sports activities and wearing appropriate footwear can also reduce the risk of injury.
 

Again, we at Benphysio do provide this service in all our outlets in Oval Damansara, Bangsar, Puchong, KL Ampang, Cheras and Giza KD. We specialized in hands-on physiotherapy to treat the problem. Feel free to call us to make an appointment to get your problem diagnosed by our physiotherapists and fixed via hands on physiotherapy. We are available at Oval Damansara, Bangsar, Puchong, KL Ampang, Cheras and Giza KD.

 

Created by: Haikal (KL)

 

References:

1. Musahl, V., & Karlsson, J. (2019). Anterior cruciate ligament tear. New England Journal of Medicine, 380(24), 2341-2348.
2. Chambat, P. (2013). ACL tear. Orthopaedics & Traumatology: Surgery & Research, 99(1), S43-S52.