ACL TEAR TREATMENT EXPLAINED IN DETAIL

TREATMENT for ACL TEAR

ACL LIGAMENT (anterior cruciate ligament)

• It is 1 of the 4 ligaments in the knee that provides stabilization .
• ACL arises from the front of the medial femoral condyle and passes through the middle of the knee to attach between the bony outcroppings that are located between the tibia plateaus. 
• It prevents the thighbone from sliding backward on the tibia. 

ACL (anterior cruciate ligament)

What is a torn ACL?

A torn anterior cruciate ligament (ACL) is a 2nd or 3rd degree sprain of the ACL.

Common Causes of ACL TEAR

• Most ACL TEAR occur due to injury, usually in a sport.
• ACL injuries are more common during sports that involve a lot of twisting and turning like basketball, football, soccer, and gymnastics, skiing.

Mechanism behind Tearing of the ACL.

• The ligament tears when the foot is firmly planted and the knee locks and twists or pivots at the same time.
• Even a blow to the knee from the side can cause ACL TEAR.

3 Grades of ACL Injury  :-

• Grade 1 injury: The ACL can still keep the knee stable, but the ligament is overstretched.
• Grade 2 injury: Partial tear occurs in this stage, It involves the ACL stretching to the point that it becomes loose.
• Grade 3 injury: Complete tear of the ligament, ACL tears in 2 and no longer controlls the kneecap.

Diagnosis of ACL Tear

• ACL tears can be diagnosed by a physical exam .
• X-rays or MRI are done to see damage to bone, cartilage or menisci.

Physical examination for ACL TEAR

Lachman's test

• The knee is examined for swelling, bruising, and deformity. 
• Presence of knee joint fluid (effusion) is examined. 
• A variety of maneuvers are used to confirm ACL Tear. These include the Lachman test, the pivot-shift test, and the anterior drawer test. 
• The Lachman test is best for assessing ACL tears. 

Knee imaging for ACL

• In patients with an ACL tear, the X-rays are often normal.
• Magnetic resonance imaging (MRI) is now the test of choice to image for ligament injury. 

Treatment Approach for ACL Tear

• Approaches to treatment vary, depending on the severity of the injury and the age and fitness of the person.
• Both Non Surgical and Surgical Treatments are available according to the activity level of Patient.

The standard activity levels are as follows:

• Level I: jumping, pivoting, and hard cutting
• Level II: heavy manual work or side-to-side sports
• Level III: light manual work and noncutting sports like running and bicycling
• Level IV: sedentary lifestyle without sports

Surgical approach is for those who wish to return to Level I and II activities and nonsurgical approach is considered for patients who have level III and IV lifestyles.

Non Surgical Treatment of ACL TEAR

• Small ACL sprains or tears just require a brace and physical rehabilitation. 
• Crutches should be used to keep weight off the knee till recovery
• After an ACL injury, RICE APPROACH should be taken i.e. Rest, Ice, Compress, Elevate
• Patient should take Medications to deal with pain :-Over the counter Pain killers

Physical Therapy for ACL recovery

• Physical Therapy strengthens the muscles around your knee and helps to regain full range of motion.
• Common excersices are Quad sets, straight-leg raises, and heel slides .
• Advanced exercises to be done only after symptoms (pain) decrease and patient is again able to bear weight. Advanced Exercises include side-lying leg lifts, glute sets, bridges, mini-squats, heel raises, and prone hamstring curls. Few of these Exercises have been demonstrated  in the video by one of the best physiotherapist.

Surgical Treatment for ACL TEAR

• At first Non-surgical treatments are considered but if the tear is complete and the knee is unstable, or the knee doesn't heal with non-surgical treatment, surgery is necessary. 
• Surgery is recommended to athletes because the ACL is needed in order to safely perform the sharp movements that are required in sports. 
• Torn ACL cannot heal on its own because there is no blood supply to it.
• Because of its blood supply and other technical factors, the torn ACL ends are not usually sewn together and instead, a graft is used to replace the ACL. 
• In an ACL reconstruction surgery, the damaged ligament is removed and replaced with a segment of tendon tissue similar to a ligament that connects muscle to bone. 
• This video depicts the 3D animation of ACL RECONSTRUCTION SURGERY.

• 3 major types of ACL reconstructive surgery are given below.
• 1. Patella tendon-bond auto graft - the central 1/3 of the patella tendon is removed along with a piece of bone at the attachment sites at the kneecap and tibia. 
• 2. Hamstring auto graft - 2 tendons from the hamstring muscles are taken and wrapped together to form the new ACL. 
• 3. Quadriceps tendon grafts - These grafts are excellent for revision surgery, pediatric ACL tears and PCL tears.
• Or else, Allograft (taken from a cadaver) is used.
• After surgery you'll resume another course of rehabilitative therapy.

Recovery Time after  ACL Reconstructive Surgery

• It's important to ensure that strength, stability and movement patterns are optimized before you return to an activity with a risk for ACL injury.
• Generally, it takes as long as a year or more before athletes can safely return to play. 
• The first 3 weeks concentrate on gradually increasing knee range of motion in a controlled way. 
• The new ligament needs time to heal and care is taken not to rip the graft. 
• By week 6, the knee should have full range of motion and a stationary bicycle or stair-climber can be used to maintain range of motion and begin strengthening exercises of the surrounding muscles.
• The next 4-6 months are used to restore knee function to what it was before the injury. 

How to Prevent ACL INJURY 

• The risk of injury can potentially be decreased by maintaining muscle strength and flexibility. 
• Warming up, stretching, and cooling down are ways of protecting joints and muscles.
• Wear braces as a precautionary measure in mild Knee pain.

Knee Braces for Support

• Strengthening exercises and agility drills help to prevent injury.
• It is important to avoid landing on a fully extended and locked leg.

Zlatan's ACL INJURY

Even Football star Zlatan Ibrahimovic went through an ACL Injury and he took about six and half months for a comeback.
Zlatan said ‘If people knew the real injury, they would be in shock that I was still playing’. See his recovery story in this video .

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