Anterior Cruciate Ligament (ACL) Injury

The anterior cruciate ligament originates at the medial wall of the lateral femoral condyle and inserts into the middle of the intercondylar area.

Together with the Posterior cruciate ligament constitute a significant structure for the stabilization and kinematics of the knee joint.

They provide firstly stability during flexion/extension of the knee but as well during rotatory movements. They basically avoid excessive shift of the tibia over the femur during the knee motion.

The ACL is considered as the primary passive restraint to anterior translation of the tibia with respect to the femur.

ACL injury is between the most common injuries in the knee, the likelihood is greater in who plays sports involving pivoting and therefore rotational forces.

Anterior Cruciate Ligament (ACL) Injury is divided in 3 grades depending on the severity:

• Grade 1: mild damage to the ligament, tear of less than one-third of the fibres,  laxity less than 5 mm.  The joint is still quite stable.
• Grade 2: The ACL ligament suffered a partial tear of one-third to two-thirds of fibers present in the ligament with a knee laxity of 5–10 mm.

The joint has some grade of instability.

• Grade 3: is a complete tear of the ACL ligament, tear of more than two-thirds of the fibers with a knee laxity of 10–15 mm, the joint is unstable.

Anterior Cruciate Ligament (ACL) Injury can be caused by:

• Direct contact: direct blow to the knee

• Non-contact: sudden changes in the direction of movement, rapid stopping, jumping and landing abnormally.

Treatment after ACL Injury:

The treatment of ACL injuries can be managed non-operatively or operatively.

Depending upon different factors such as their severity, pre-injury fitness status, baseline level of physical activity, functional demands, age, occupation and other associated injuries.

We can easily understand that a young professional athlete will have different physical demands compared with a sedentary person aged 70.

These factors should be discussed between the patient with a consultant orthopaedic and a Physiotherapist in order to draw the best suitable solution for the individual.

References:

Evans J, and Nielson J.I.(2019),Anterior Cruciate Ligament (ACL) Knee Injuries.

Grindem H. et al(2018), Anterior Cruciate Ligament Injury—Who Succeeds Without Reconstructive Surgery? The Delaware-Oslo ACL Cohort Study.

doi: 10.1177/2325967118774255

Marieswaran M. et al(2018),A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

doi: 10.1155/2018/4657824