What is an ACL?
What is an ACL for?

The Anterior cruciate ligament (ACL) is one of the key ligaments that act to stabilize the knee joint. The ACL connects your thighbone (femur) to the shin (tibia). Together with the posterior cruciate ligament (PCL), the ACL forms a cross-shaped band that prevents excessive forwards or backward movement of the shinbone relative to the thigh, as well as provides the knee with rotational stability.

The ACL is the most commonly injured ligament in the knee and often affects younger, active individuals who participate in sports. Injuries to the ACL are usually caused by non-contact rotational forces such as sudden changes in direction, rapid stopping, jumping, and landing abnormally. In some cases, a direct force to the side of the knee can also cause ACL injuries. Soccer players, skiers, basketball players, and football players are among the most common athletes affected by ACL injuries because these sports involve pivoting, rapid deceleration, and quick directional changes. Any trauma or movement that causes the lower leg to rotate or slide forward relative to the femur is capable of tearing an ACL.

What is the difference between an ACL strain, tear and rupture?

ACL injuries can be categorized into three groups based on their severity. Grade 1 ACL tears are the least severe and are characterized by stretching the ligament. Grade 2 tears are very small and may be associated with a moderate amount of knee instability. Grade 3 ACL injuries occur when the fibers of the ligament are completely ruptured resulting in the ligament completely tearing into two parts. The majority of ACL injuries are complete ruptures while only 10-15% are partial tears. 

What are the chances of an ACL tear?
ACL Risk Factors:

Females are more likely to suffer from ACL tears compared to males. The reason for this may be due to differences in the anatomical alignment of the lower limbs, weaker hamstrings relative to quadriceps strength, and hormonal factors. Younger individuals may also be at an increased risk for ACL injuries. ACL reconstruction in people below the age of 20 has increased drastically in recent years which might be due to the increased number of youth and adolescents participating in competitive sports. 

What are the signs of an ACL tear?
Symptoms of an ACL tear include:

• Initial sharp pain

• Hearing a pop at the time of injury

• Swelling

• Bruising around the knee

• Pain and tenderness along the front of the knee

• A feeling of the knee “giving out”

• Decreased range of motion

• Difficulty weight-bearing and walking 

Some symptoms such as pain, swelling, and tenderness, will occur immediately after the injury. Other signs, such as bruising, will appear and worsen in the days following the injury. 

How do you treat an ACL tear?

So you think you may have sustained an ACL tear? What’s next?

Firstly, stop any sporting activities. Rest and apply ice to the injury to reduce pain and inflammation. Swelling can be managed by placing a compression bandage around the knee. Elevating the knee by keeping it supported above hip height may also help to reduce swelling. Over-the-counter anti-inflammatory medication can be taken if needed to help with pain and swelling over the first few days. 

The next step would be to book an appointment with a physiotherapist. ACL tears are a serious injury. The physiotherapists at Elios Health can help assess the severity of the injury and guide you through important decisions about your injury, treatment options, and rehabilitation process.

Our physiotherapists will also assess your knee for other injuries that may accompany your ACL tear such as meniscus tears, or damage to the other ligaments. Depending on the severity of the injury, surgical treatment options of the ligament may be considered. The practitioners at Elios health will help guide you through this decision based on their clinical evaluation of your knee, your activity level, medical history, and goals. The bottom line is, the decision between conservative and operative treatment is different for everyone, and greatly depends on personal goals and values.  

Regardless of which treatment route you opt for, Elios Health will be there to support you through your rehabilitation so that you can return to the sports and activities that you love. Visit our Vancouver clinic on Main Street at the King Edward intersection.

Original Post by Rachel Rubin-Sarganis
Photo by Sebastian Stains