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Sports Knee Injuries

ACL Ruptures

ACL-Ruptures

What is an ACL?

The anterior cruciate ligament (ACL) connects two bones in your knees, namely the femur and tibia bones. This gives the knee its rotational stability while controlling its back-and-forth movement. It allows you to do exercises that require your knees to twist and turn. Without the ACL, your knee will feel unstable when doing activities such as basketball, football and tennis.
ACL

How does the ACL rupture?

The ACL is a strong and robust structure in the knee. However, it can still rupture in severe twisting injuries of the knee. An example is when a basketball player lands awkwardly and twists his or her knee. Footballers are also prone to this when the studs of their boots get stuck in the ground and they twist their body while running. This twisting injury of the knee while the foot is planted to the ground is enough to rupture the ACL.

Several studies have also shown that female athletes are at higher risk of ACL ruptures than their male counterparts due to differences in physical conditioning, muscular strength, effects of estrogen and ligament laxity as well as anatomical differences in the pelvis and leg alignments.

How do I know if I ruptured my ACL?

Patients often have severe pain and swelling in the knee when they rupture their ACL. Some even reported a ‘pop’ or snapping sound before they hit the ground. After the initial period of pain and swelling, patients may experience stiffness or instability of their knee when performing certain activities. These include coming down the stairs, getting out of cars and playing sports that require twisting and turning (basketball, football, etc.)

Patients may not achieve stability while jogging in a straight line or cycling as there is minimal twisting movement in the knee when performing these exercises. Oher symptoms include discomfort while walking, loss of range of motion and pain along the knee joint.
Knee-pain-2
Your doctor will first take a thorough history from you about your injury, how you were immediately after the incident and any symptoms that you experienced several weeks or months after the fall. A clinical examination of the knee is then performed to assess knee swelling, general range of movement as well as stability of the knee.

An X-ray of the knee will be done to exclude any fractures while an MRI would be the modality of choice to assess an ACL rupture. Some patients have other injuries such as meniscal tears or ligament sprains in addition to the ACL rupture from the fall. An MRI scan of the knee will be able to detect these injuries in one step.

What treatments do I need after I rupture my ACL?

The initial aim of treatment is to reduce the pain and swelling in the knee. Anti-inflammatory medication, knee compression, and ice packs are just some of the ways to achieve this.

A knee brace can be used to protect your knee from instability. To further protect you from falling, crutches may be provided to help you walk. Physiotherapy after an ACL rupture aims to restore the normal range of motion of the knee, normal gait while walking and develop muscle strength of the quads and hamstring muscles. The torn or ruptured ACL will not heal itself. This is because the blood supply to the ACL had been disrupted during the injury.

Whether you decide to have surgery or not, rehabilitation plays a vital role in helping you return to your daily activities. Your surgeon and physiotherapist will customize a rehabilitation program for you to facilitate an accelerated recovery.

Can your ACL be repaired?

The ACL cannot be repaired if it is completely ruptured. Previous attempts at repairs by surgeons in the past were associated with severe knee pain and stiffness. Before any surgery is performed, your surgeon will ensure that the swelling in your knee has improved significantly, have full range of motion and you should be able to walk normally on a flat surface.

The ACL must be reconstructed to restore the stability of your knee. This is done through arthroscopic or key-hole techniques to facilitate an early return to function, and your torn ACL is replaced with a tissue graft. There are several options to obtain this tissue graft, including your own hamstrings, your patella, and its surrounding tendons as well a cadaveric graft (allograft).

There are advantages and disadvantages to all options, and it is recommended to discuss with your surgeon on the option that suits you best.

How is the ACL surgery performed?

The duration of the ACL surgery can take anywhere from 60 to 90 minutes. Younger patients typically undergo this surgery under a general anaesthetic.
 
There are two arthroscopic (less than 1cm) scars over the knee joint itself, and another scar over the tibia where the tissue graft is harvested from, and the graft is then advanced into the knee.

ACL Rehabilitation

6-week-Treatment
A knee brace after surgery is crucial and is applied to provide support and stability. Physiotherapy after surgery helps to reduce knee swelling and maintaining the strength of the quads muscle of your thigh. Both open and closed kinetic chain exercises are performed to achieve full extension of your knee and about 70 degrees of flexion.

3 weeks post-surgery

Walking is normally  improved within 3 to 4 weeks after the surgery, with most patients only using one crutch to improve the control of your quads and hamstring muscles.

5 weeks post-surgery

Patients will be slowly weaned off the knee brace as their walking and muscle strength and control gradually improves at this stage.

3 months post-surgery

Exercises such as running, jumping, and cycling may be resumed at about 3 months after the surgery. These exercises will be varied in terms of duration, intensity, speed, and complexity of tasks.

4-5 months post-surgery

The goal of rehabilitation at this stage is to maximize endurance and strength of the muscle around the knee.

Strenuous twisting motion of the knee such as a return to football or basketball is not recommended before 12 months, as your new ACL graft merely acts as a scaffold while your body adds new tissue to it and strengthens it again. There are have been numerous examples of both social and professional athletes who returned to a high level of exercise and sports too early and re-ruptured their new ACL graft.

Our Location

  • 3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 228510
  • +65 6733 4565
  • +65 9766 4565
  • Mon-Fri 8:30am - 5:30pm
    Sat 8:30am - 12:30pm
    Sun/Ph Closed

Contact Form

Our Location

  • 3 Mount Elizabeth, #08-05 Mount Elizabeth Medical Centre, Singapore 228510
  • +65 6733 4565
  • +65 9766 4565
  • Mon-Fri 8:30am - 5:30pm
    Sat 8:30am - 12:30pm
    Sun/Ph Closed

Contact Form