Sports Injuries
What is an ACL injury?
Most athletes and active runners experience ACL injury. This article lays down direct facts about this injury and the necessary treatment.
24 April 2020
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Common mechanisms of ACL injury include:
Non-contact (70%):
- pivoting during acceleration or deceleration
- forceful twisting of the knee with the foot immobilised
Contact (30%):
- ACL is usually torn in severe valgus stress e.g. opponent crashing into the patient’s knee from the outside to the inside
Experiencing an ACL injury
The ACL is the most important and commonly injured ligament, accounting for almost half of knee injuries worldwide. There are almost 400,000 ACL reconstructions in the USA alone.
Well-known sportsmen with ACL injuries include Zlatan Ibrahimovic of Manchester United, Tom Brady of the New England Patriots (National Football League) and Alex Morgan of the U.S.A. World Cup Winning Women’s team.
Due to the nature of the injury, cases are naturally higher for people who participate in soccer, badminton, skiing and basketball.
Symptoms
The ACL is usually torn by a significant knee injury leading to knee pain and swelling. The swelling of the involved knee joint develops almost immediately. The patient may also hear a ‘pop’ sound or sensation. Also, the patient may experience instability of the knee.
Known symptoms:
- Immediate swelling
- Deep knee pain
- ‘pop’ sound or sensation
- Knee instability
Investigating an ACL injury
There are two ways to confirm an ACL injury. One is X-ray, and another is going through a magnetic resonance imaging (MRI) of the knee.
X-rays of the knee are a standard procedure for patients with an ACL injury.
Patients would undergo an MRI to confirm clinical diagnosis of an ACL rupture and evaluate for other injuries such as meniscus tear, cartilage injury and other ligament injury. MRI is safe, radiation-free, and has a very high detection rate.
Treatment for an ACL injury
Patients with ACL injury should undergo a course of physiotherapy and rehabilitation for strengthening.
Most patients who want to return to sports would usually need ACL reconstruction. ACL reconstruction is performed by knee arthroscopy techniques (keyhole surgery). A graft would be needed to reconstruct the ACL. Available options for reconstruction are Autograft (patient’s tendon) or allograft (donor's tendon).
If there are associated injuries such as meniscus tear or cartilage injuries, the assigned surgeon will also treat the injuries in the same keyhole approach. The surgery will be performed under general or regional anaesthesia. The surgery will take about one hour.
Patients will stay in the ward overnight and be discharged the next day. They may have to use crutches depending on the injuries and surgery. After surgery, patients will need physiotherapy for about 9 to 12 months to return to competitive sports. The assigned surgeon will regularly review the condition after surgery to make sure recovery is on track.