ACL (Anterior Cruciate Ligament)


ACL injuries occur commonly in multi-directional sports such as Netball, Soccer, Football and Rugby. The ACL is an intra-articular (inside the joint) ligament complex that assists with stability of the knee. Injuries to this ligament can cause a feeling of instability in the knee.


Females are at a higher risk of injury, however, in Australia we see high numbers in both female and male athletes (Beck 2017). 


Diagnosis of an ACL injury is normally based on the mechanism of injury and symptoms, clinical assessment, and clarification of imaging is required in most cases. Skiing and snowboarding are also common injury mechanisms that we see and rehabilitate in PROmotion.


ACL injuries in isolation are rare, with many also having injuries to different structures of the knee such as menisci, collateral ligaments, and bony bruising or more significant joint trauma.

Causes

The main mechanism of injury with an ACL injury is a pivot movement (ie changing direction quickly) or a single leg landing. This is why this injury occurs commonly in multi-directional sports. The injury can occur following contact (e.g a tackle or bump) or non-contact (e.g landing). These injuries are generally traumatic, and have high levels of symptoms initially. However, every case can be different in terms of symptom onset (Brukner & Khan, 2017)

Signs & Symptoms

  • Initial injury will likely align with one of the mechanisms above. There may be an audible ‘pop’ in many cases

  • Immediate pain, and significant swelling in the joint

  • Difficulty moving the knee freely, and a feeling of instability or giving way

Differential Diagnosis

  • Collateral ligament (Medial or Lateral) or Posterior collateral ligament injury

  • Chondral (joint) injury

  • Medial or Lateral Meniscal Injury

  • Patella Dislocation

  • Tibial plateau fracture

*many of these injuries can occur in conjunction with an ACL injury

PROmotion Assessment and Outcomes Measures

  • At PROmotion, ACL’s assessments and rehabilitation are one of our ‘PRO’ Services. We perform expert assessments, work with the multi-disciplinary team and guide the injured person from injury back to return to performance.

  • Initial Assessment: thorough subjective assessment, clinical assessment, and management planning.

  • Referral if required to your GP, expert Sports Medicine Physicians, and Orthopaedic Specialists.

  • We also perform periodic assessments, which utilises strength-testing equipment, biomechanical assessments using video software, and high level athletic performance testing. We take measurements of psychological readiness for returning to play and subjective scoring on knee function so we know exactly how you feel about your knee.

These assessments are utilised by Orthopaedic Surgeons, Sports Medicine Physicians and other Rehab Providers to assist in clinical decision-making and rehabilitation planning.

ACL functional testing and monitoring has been recommended to reduce risk of repeat injury post ACL reconstruction (Grindem et al. 2016).

How to Manage

  • ACL Reconstruction: some cases of ACL injuries require surgical reconstruction. An Orthopaedic Specialist performs this surgery. Rehabilitation requires commitment and dedication. Timelines for return to play and completion of rehab vary for everyone, however, many people return to sport between 9-15 months.

  • After the initial post surgical period, you’ll find that your rehabilitation is more like a high level strength and conditioning program that you enjoy. Our Physiotherapist and Exercise Physiology team will be with you every step of the way.

  • Conservative ACL Management: There is a growing body of evidence to show that people can make a good recovery from ACL injuries without surgical intervention. Considerations around goals for returning to sport, type of sport, age, underlying tissue health, and other social factors such as work and family are taken in to account during this decision making process.

It is important that this is an informed decision, and your Physiotherapist can give you an insight in to the pros and cons of each pathway for you. Seeking additional opinions from an Orthopaedic Specialist or Sports Medicine Physician may also be an option before you make your decision.


In PROmotion we are passionate about improving outcomes following anterior cruciate ligament injuries, and will be delighted to discuss this further with you.

References

  1. Beck, N. A., Lawrence, J. T. R., Nordin, J. D., DeFor, T. A., & Tompkins, M. (2017). ACL Tears in School-Aged Children and Adolescents Over 20 Years. Pediatrics, 139(3). doi:10.1542/peds.2016-1877

  2. Grindem, H., Snyder-Mackler, L., Moksnes, H., Engebretsen, L., & Risberg, M. A. (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. Br J Sports Med, 50(13), 804-808. doi:10.1136/bjsports-2016-096031

  3. Brukner, P., & Khan, K. (2017). Brukner & Khan's clinical sports medicine. Volume 1 : injuries (5th edition.. ed.): Sydney, New South Wales : McGraw-Hill Education Australia.