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Understanding ACL Injuries: Road to Recovery and Return to Sport

Updated: Oct 15, 2023

Have you ever experienced a sudden jolt of pain in your knee,or heard a “pop” in your knee while playing sports or engaging in physical activities and felt like something “gave way”?

If you think that it might be something more sinister than a muscle strain, you might have torn your Anterior Cruciate Ligament (ACL). Though it's just a small ligament in your knee, it plays a big role in providing stability and preventing your knee from moving in ways it shouldn't. When it's injured, the knee's stability is compromised, leading to pain, swelling, and limited mobility. In this article, we will explore the anatomy of the knee, the mechanism of ACL injury, and the next course of action for recovery.


To understand ACL injuries, it's essential to know the knee's anatomy. The knee joint is a complex structure comprising bones, ligaments, tendons, and cartilage. The femur (thigh bone) and tibia (shin bone) meet to form the joint, with the patella (kneecap) gliding on the front of the femur. Ligaments hold the bones together, and the ACL plays a crucial role in stabilising the joint.


How does an ACL injury occur?

ACL injuries typically occur during sports activities that involve sudden changes in direction, deceleration, or landing from a jump. Some common scenarios leading to ACL injuries include:

  • Sudden stops and change in direction: Abruptly changing direction or pivoting while running or playing sports can strain or tear the ACL.

  • Hyperextension: Overextending the knee joint, especially during jumping or landing, can lead to ACL damage.

  • Non-contact injuries: Sometimes, an ACL injury can occur without any direct contact with another player. It can happen due to awkward landings or sudden twists.


What types of ACL injuries are there?

ACL tears can be partial or complete, depending on the extent of ligament damage. Partial tears involve a partial rupture of the ACL fibres, whereas complete tears involve a complete tear across the ligament. Complete tears usually require more extensive treatment and a longer recovery period.


What can I do to manage an ACL injury?

There are ways to manage an ACL injury:

  • Conservative Management

  • Operative Management


Conservative Management

In the realm of ACL injuries, research has yielded fascinating insights into the effectiveness of conservative management versus ACL reconstruction. Studies, such as the one conducted by Cuzzolin et. al (2021), have shown that ACL reconstruction does not offer any advantage in preventing knee osteoarthritis when compared to conservative management. Although this may come as a surprise, it's crucial to note that even with conservative management, wear and tear persists due to abnormal knee kinematics resulting from the ACL deficiency.


The key lies in understanding that every individual copes with an ACL injury in their own unique way, as emphasized by the study conducted by Musahl et. al (2020):

  • Copers: Ability to return to their pre-injury levels while maintaining subjective stability.

  • Adapters: Adapters modify their level of activity to mitigate subjective instability by reducing their intensity or choosing alternative activities.

  • Non-Copers: Unable to return to pre-injury levels due to subjective instability with episodes of giving way


Operative Management

ACL reconstruction can be done using various graft options, such as an autograft or allograft.


With an autograft, your surgeon will use tendons from your own body, such as the quadriceps tendon, patellar tendon, or hamstring tendon, to replace your torn ACL. On the other hand, an allograft uses tissue from a donor to replace the damaged ligament. While both options have their pros and cons, the specifics will be discussed more in-depth in a future article.





How long will recovery of an ACL injury take?

The duration of recovery from an ACL injury is not a one-size-fits-all approach. It varies based on various factors, including the severity of the injury, the type of management chosen, and the patient's overall health and commitment to rehabilitation. Generally, returning to daily activities may take several weeks, while getting back to sports can take several months.


Can I return to sport after an ACL injury?

Returning to sports after an ACL injury and surgery should be a gradual process. Rather than focusing solely on the timeline, it's essential to achieve specific milestones that demonstrate the knee's stability and strength. These milestones may include the ability to walk without a limp, perform single-leg squats, and participate in sports-specific drills without pain or instability.


The decision to return to full sports participation should be a joint effort involving the patient, physiotherapist, and your orthopaedic doctor.


Why You Should Start With Prehabilitation Before Surgery

Prehabilitation, or "prehab," involves engaging in targeted exercise and physical therapy before undergoing ACL reconstruction surgery. Prehab aims to strengthen the surrounding muscles, improve knee range of motion, and reduce swelling, all of which can lead to better surgical outcomes and a smoother postoperative recovery. Engaging in prehab can also help individuals who plan to defer their surgery by providing additional knee stability and function.


An ACL injury can be a challenging setback, but with proper management and treatment, individuals can make a successful recovery and return to their desired level of activity. Whether opting for conservative or operative management, the road to recovery requires patience, dedication to rehabilitation, and collaboration with healthcare professionals. Remember that each injury and person is unique, so it's crucial to follow the personalized guidance of medical experts for the best outcomes in ACL injury recovery.


Having trouble with your ACL and need a second opinion or guidance in your rehabilitation journey? Drop us an email at hello@thrivehealthcare.com.sg today!


Written by:

Diyanah Yusoff

Physiotherapist, Thrive Healthcare


References:

  • Anterior Cruciate Ligament Reconstruction versus Nonoperative Treatment: Better Function and Less Secondary Meniscectomies But No Difference in Knee Osteoarthritis—A Meta-Analysis (Cuzzolin et. al, 2021)

  • “ACL surgery: when to do it?” (Musahl et. al, 2020)

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