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Knee ACL

The anterior cruciate ligament (ACL) is one of a pair of ligaments in the center of the knee joint that form a cross, and this is where the name “cruciate” comes from. There is both an anterior cruciate ligament (ACL) and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize the knee from front-to-back during normal and athletic activities. The ligaments of the knee make sure that the weight that is transmitted through the knee joint is centered within the joint minimizing the amount of wear and tear on the cartilage inside the knee.


The weight-bearing surfaces of our knees are covered with a layer of cartilage (called as”articular cartilage”). There are also two shock absorbers in your knee on either side of the joint between the cartilage surfaces of the femur and the tibia. These two structures are called the medial meniscus and the lateral meniscus. The menisci are horseshoe-shaped shock absorbers that help to both center the knee joint during activity and to minimize the amount of stress on the articular cartilage. The combination of the menisci and the surface cartilage in your knee produces a nearly frictionless gliding surface.

What happens when the ACL is torn?


The ACL is the primary restraint to anterior displacement of the tibia on the femur. This means that when the ACL is injured, the shinbone can slide forward on the thighbone, causing the knee to “give away/buckle and the patient complains of Instability.


Some people who rupture their ACL can recall the exact moment at which they felt it pop. This usually happens when changing direction quickly in pivoting or cutting sports like soccer, landing from a jump in sports such as basketball, or falling while skiing. Other than sports the common causes of ACL injury is fall of two wheelers in road traffic accident, dashboard injury, sudden twisting to knee by putting foot on uneven ground, pot hole or even falling from stairs.


The four “classic” symptoms that people may feel when they tear their ACL are:


  • They hear a “pop” from inside the knee
  • They feel the knee give away at the time of injury
  • They develop a swollen knee immediately or within a few hours
  • The pain is bad enough that the player is unable to continue to play that day & others find difficulty to walk around even for their daily activities.


ACL injuries and children


ACL injuries do occur in children. If the child tears his or her ACL while playing sports or in an accident. The bones and joints of children are very different from the bones and joints of adults because children’s bones are still growing. This can make an ACL injury a bit more complicated for the children. The surgeon would want to find the best way to make sure that your child has a good knee that functions normally and does not hurt. This can be difficult because children are very active and it is hard to get them to slow down and avoid certain activities that may damage their knees. At the same time, ACL surgery for children is more difficult than it is in adults because there is the risk that the normal development of the bones can be changed by the surgery. There are some situations in which ACL injuries in children can cause enough looseness in the knee that participation in certain sports carries a very high risk of damaging the rest of the knee if the ACL is not fixed. These sports involve running, jumping, and changing direction quickly, like soccer, basketball, baseball, or skiing. In this situation, the child should either stop participating in these sports, or should get his/her ACL fixed. However, if the child does not play these sports, or if surgeon believes that the child’s knee does not have a significant amount of looseness after the ACL has been torn, then the child may not need the surgery.


Currently, there are no solid recommendations for which surgical techniques are best for which age groups. Children who are close to maturity and generally more than about fourteen years old can have their ACL’s replaced safely with standard techniques. Children who are much younger may need to either wait until they are older, or if their knee is unstable enough they may need to have a different type of reconstruction that avoids drilling holes through the growth plate.


On field treatment of ACL/ knee injury


An ACL injury should be treated with a splint, ice, elevation of the joint, and pain relievers such as nonsteroidal anti-inflammatory drugs. The patient should not continue to play until evaluation and treatment has taken place. Some people may need crutches to walk until the swelling and pain has improved. Physical therapy may help regain joint motion and leg strength.




In the case of a serious knee injury, do not attempt to move the joint. A splint(long knee brace)should be used to keep the knee straight until evaluation by trained medical personnel has been performed.


Do not return to play until proper evaluation and treatment has taken place.




Use proper techniques when playing sports or exercising.


Although the issue is controversial, the use of knee braces during aggressive athletic activity, such as football, has not been shown to decrease the incidence of knee injuries and may give the player a false sense of security.


Diagnosing a torn ACL


To diagnose a torn ACL, doctor at A+ Center first wants to know as much as possible about how the injury has occurred. Be prepared to describe:

  • How did the injury happen and whether you heard or felt a pop.
  • Whether there was swelling immediately after the injury.
  • If you were unable to continue being physically active.
  • All of these are signs and symptoms of a possible ACL tear.


Knee examination


Doctor at A+ Center examines your knee to determine if the ACL is torn. Commonly used exams are the Lachman’s test and the pivot shift test.


If the movement in your knee is restricted by swelling or by contraction of the muscles in the back of your upper leg, doctor may not be able to detect a torn ACL with these tests.


Imaging studies


ACL tears don’t show up on X-rays, although certain types of shin fractures associated with ACL tears may be visible. In diagnosing a torn ACL, some studies show that magnetic resonance imaging (MRI) has the same accuracy as a careful history and physical exam. Depending on the nature of the injury and other exam findings, however, an MRI is sometimes helpful in identifying damage to other structures in the knee treatment.




You and doctor at A+ Center may choose nonsurgical rehabilitation if:


  • Your knee is stable during typical daily activities.
  • Your knee cartilage hasn’t been damaged.
  • You have no desire to paticipate in high risk activities involving jumping ,cutting & pivoting.


Nonsurgical rehabilitation may also be appropriate for a child or an adolescent with a torn ACL. If your child has no damage to the knee other than the ACL and can avoid high-risk activities, the doctor may recommend postponing surgery until your child’s bones have finished growing, although with current techniques, ACL reconstruction is generally possible without damaging the growth plate in growing children.


Physical therapy: what to expect


The goal of physical therapy is to strengthen the muscles around your knee to make up for the absence of an intact ACL. Training focuses on the:

  • Muscles in the back of the thigh (hamstrings)
  • Muscles in the front of the thigh (quadriceps)
  • Calf
  • Hip
  • Ankle

Some exercises can be done at home. Others require the use of weight machines, exercise bicycles or treadmills, which may require visits to A+ Orthopedic & Sports Med Center. In the early stages of rehab, you work on re-establishing full range of motion in your knee. Then you progress to knee, hip and ankle-strengthening exercises combined with training to improve your stability and balance. Finally, you work on training specific to your sport or work activities, including exercises to help you prevent further injury, such as learning how to land properly from a jump.