Anterior Cruciate
Ligament Rupture (ACL)

The ACL is one of two ligaments inside the knee that cross over each other, with the other being the posterior cruciate ligament (PCL). This is why they have been named as the cruciate ligaments. Their function is to help to control and stabilise the knee during motion, as well as providing feedback to the nervous system. Unlike the ball and socket joints (such as the hip), the knee has very little inherent bony stability and so it relies on its surrounding structures for this.

Commonly the ACL is injured during sporting activity and particularly when there is rotation around a flexed knee. Often this is in a non-contact situation, rather than a tackle. Sometimes the injury mechanism can appear relatively innocuous, and the diagnosis can be overlooked, although growing awareness and the increased use of MRI scanning has reduced the length of time to diagnosis. The ligament can be injured along with the other ligaments of the knee, the articular cartilage, the menisci, tendons and can be associated with fractures.

If your knee is injured and it ‘blows up’ very quickly, then a ruptured ACL has to be considered as a possible diagnosis. Usually, patients are very aware themselves that they have suffered a serious injury, and it is essential to seek medical assessment. Its useful to have initial X-rays, primarily to look for a fracture, but there can be tell tale signs that an ACL injury is likely. Your examination may be revealing at this stage, but often this can be easier when there has been some time for the initial ‘swelling’ to reduce. It is blood in the joint (haemarthrosis) that causes it to swell up. An MRI scan is usually organised, or a CT scan as well, if there is a fracture to consider.

Initial treatment consists of RICE (rest, ice, compression, elevation) and usually crutches. In addition, it is important to work on maintaining muscular function and to start to regain the range of motion of the joint. Early consultation with a physiotherapist is ideal in helping to achieve these goals, and to optimise the knee joint prior to surgery (pre-habilitation). Another term rather than RICE, is POLICE. This stands for protection, optimal loading, ice, compression and elevation and the idea is to emphasise that rehabilitation should start as early as possible.

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