Anterior Cruciate Ligament Injury
DefinitionAn anterior cruciate ligament (ACL) injury is a tear in the ACL ligament. The ACL is located in the middle of the knee joint. It connects the lower leg bone to the thigh bone. It stabilizes the knee and prevents the lower leg bone from sliding too far forward at the knee.
|Anterior Cruciate Ligament Injury|
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CausesACL injury occurs when your knee gets twisted or during a hard landing from a jump. It can also happen with:
- Sudden stops or changes in direction
- Sidestepping or pivoting
- Direct contact
Risk FactorsACL injuries are more common in women. Other factors that increase your chance of ACL injury include:
- Weak knee structure
- Muscle strength imbalance between the quadriceps and hamstrings
- Playing sports that require sudden changes of direction and deceleration
- Use of incorrect technique for cutting, planting, pivoting, or jumping
- Previous injury or reconstructive ACL surgery
SymptomsSymptoms may include:
- A popping sound at the time of the injury
- Pain and swelling in the knee
- Loss of full range of motion
- Weakness or instability in the knee
- Difficulty walking
DiagnosisYou will be asked about your symptoms and how you injured your knee. A physical exam will be done.Your knee will need to be viewed. This can be done with:
- Grade 1—Mild ligament damage.
- Grade 2—Partial tearing of the ligament.
- Grade 3—Complete tearing of the ligament.
TreatmentTalk with your doctor about the best treatment plan for you. Recovery time ranges depending on the grade of your injury. Treatment steps may include:
Acute CareRestYour ligament will need time to heal. Avoid activities that place extra stress on the knee:
- Do not do activities that cause pain. This includes running, jumping, and weight lifting using the legs.
- Do not play sports until your doctor has said it is safe to do so.
- Over-the-counter medication, such as ibuprofen or acetaminophen
- Topical pain medication—creams or patches that are applied to the skin
- Prescription pain relievers
Recovery StepsPhysical TherapyYou may be referred to a physical therapist. Your therapist will provide you with exercises to help promote recovery.HeatUse heat only when you are returning to physical activity. Heat may then be used before stretching or getting ready to play sports to help loosen the ligament.StretchingWhen the acute pain is gone, start gentle stretching as advised. Stay within pain limits. Hold each stretch for about 10 seconds and repeat 6 times. Stretch several times a day.StrengtheningBegin strengthening exercises for your ligaments as advised.
SurgerySurgery may be needed to fully restore function of the knee. The decision to have surgery should be made after discussion with your doctor about your athletic needs, age, and related factors.
PreventionTo reduce your chance of injuring the ACL, take these steps:
- Plyometrics , a form of jumping exercises, can be used to train and strengthen the leg muscles for jumping and landing.
- When jumping and landing or turning and pivoting, your hips and knees should be bent, not straight.
- Strengthen both the quadriceps and the hamstrings.
- Maintain proper technique when exercising or playing sports.
American Orthopaedic Society for Sports Medicine
OrthoInfo—American Academy of Orthopaedic Surgeons
Canadian Orthopaedic Association
Canadian Orthopaedic Foundation
Anterior cruciate ligament (ACL) injury. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated February 5, 2015. Accessed March 3, 2015.
Anterior cruciate ligament injuries. American Academy of Orthopaedic Surgeons Ortho Info website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00549. Updated March 2014. Accessed March 3, 2015.
Anterior cruciate ligament injuries: treatment and rehabilitation. Encyclopedia of Sports Medicine and Science website. Available at: http://sportsci.org/encyc/aclinj/aclinj.html. Updated April 18, 1998. Accessed March 3, 2015.
ACL Injury: Does It Require Surgery? American Academy of Orthopaedic Surgeons website. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=A00297. Updated September 2009. Accessed March 3, 2015.
Griffin LY, Agel J, et al. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. 2000;8:141-150.
Knee sprains and meniscal injuries. Merck Manual for Health Care Professionals. Available at: http://www.merckmanuals.com/professional/injuries%5Fpoisoning/fractures%5Fdislocations%5Fand%5Fsprains/knee%5Fsprains%5Fand%5Fmeniscal%5Finjuries.html. Updated December 2014. Accessed March 3, 2015.
Ligament injuries to the knee. John Hopkins Medicine website. Available at. http://www.hopkinsmedicine.org/healthlibrary/conditions/adult/orthopaedic%5Fdisorders/ligament%5Finjuries%5Fto%5Fthe%5Fknee%5F85,P00926. Accessed March 3, 2015.
7/6/2009 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Prodromos CC, Han Y, et al. A meta-analysis of the incidence of anterior cruciate ligament tears as a function of gender, sport, and a knee injury-reduction regimen. Arthroscopy. 2007;23:1320-1325.
5/12/2014 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Anterior cruciate ligament injuries: Diagnosis, treatment, and prevention. Pediatrics. 2014 Apr [Epub ahead of print].
- Reviewer: Teresa Briedwell, PT, DPT
- Review Date: 03/2015
- Update Date: 05/12/2014
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