Anterior Cruciate Ligament (ACL)
The Anterior Cruciate Ligament (ACL) is a crucial component of your knee joint, playing a vital role in stabilising your knee during sports as well as routine physical activities. It is one of the many ligaments (rope-like structures) that connect the femur (thigh bone) to the tibia (shin bone). The role of this ligament is to ensure that your knee moves in a controlled and stable manner, especially during activities that involve sudden stops or changes in direction. These include day-to-day activities like going downstairs, walking on uneven roads, taking sudden turns, jumping, dancing, or playing any sports activity that places twisting forces on your knee.
An ACL injury is a common knee injury. It often occurs in athletes and individuals who engage in high-impact sports. However, it also occurs in non-sports persons in varied scenarios, some of which include fall from a bike or scooty, uneven landing on the ground while jumping, twisting injury while dancing at a marriage party, missing a step while going downstairs, slipping while walking on a bumpy road, etc. An ACL injury can range from a mild sprain to a complete tear.
Symptoms of an ACL injury may include a popping noise at the time of the injury, along with acute onset pain and swelling in the knee.
Once the acute stage settles, the swelling may subside and the patient may regain normal pain-free walking, but there is a feeling of instability in activities that are dependent on an intact ACL, particularly those that put a twisting force on the knee.
Such instability can result in frequent falls and inability to pursue activities like sports and dance. An unstable knee is also prone to additional injuries to the structures inside the knee like the meniscus and the cartilage. Additionally, over time, an unstable knee can get damaged completely with the development of osteoarthritis at a very early age (called post-traumatic osteoarthritis).
For those who have a near-complete tear or have an active lifestyle, ACL reconstruction surgery is recommended. In case of incomplete or partial ACL tears, the prognosis depends on the extent of ACL fibres injured, the activity demands of the patient, and the post-injury rehabilitation. Many patients are able to lead active life after a proper rehabiliitation following a partial ACL injury. Some newer modalities are also being tried in such cases, like PRP injection, to promote healing. However, in some patients, even after a good rehabilitation, the partially injured ligament may not regain required strengh and function and the patients may require an ACL augmentation. Your arthroscopic surgeon would be able to guide you regarding the best treatment option in your particular case.
The surgery aims to restore knee stability and function, allowing a good percentage of patients to return to their previous level of activity. A comprehensive rehabilitation program after the surgery is crucial. Rehabilitation focuses on reducing swelling, improving knee movement, and gradually increasing strength, stability and agility, using a well planned protocol which is further tailored for each individual patient. This process can take several months, depending on the individual’s progress and perseverance.
ACL reconstruction is a procedure where the torn ligament is replaced with a graft, usually taken from the patient’s own body (autograft). The surgery is done using arthroscopy (key hole surgery). It is one of the most comon procedures performed by any arthroscopic surgeon. However, like any other surgery, there may be many unexpected findings in the joint requiring additional procedures, or there may be complications during or after surgery, and an experienced arthroscopic surgeon would be in the best position to prevent as well as handle such unexpected situations.
Prevention strategies for ACL injuries include proper training and exercise to strengthen leg muscles, especially the quadriceps and hamstrings, practicing techniques for jumping and landing properly, and incorporating balance and agility exercises into regular training routines.
In summary, while ACL injuries can be daunting, proper treatment, including surgery and rehabilitation when necessary, can lead to a successful recovery, and a significant proportion of patients are able to resume their sports activities at their pre-injury levels.
