At King’s our expert orthopaedic surgeons have access to the most advanced diagnostic technology in Dubai, to help ensure you receive the best treatment possible for your Anterior Cruciate Ligament (ACL) injury.
What is an ACL Injury?
An ACL injury occurs when there is a tear or sprain of the anterior cruciate ligament (ACL). As one of the major ligaments of the knee, the ACL can be prone to injury, particularly during sports where there are sudden stops, changes in direction and jumping involved. Activities such as football, basketball, softball and skiing are some of the most likely to cause an injury to the ACL.
Common signs and symptoms
Severe pain which stops you from continuing your activity and hearing a loud “pop” or experiencing a popping sensation in the knee is a common sign of an ACL injury. Most people will also suffer symptoms such as:
- Rapid swelling of the knee
- A reduced range of motion
- Difficulty with weight bearing and a feeling of instability
Common causes of ACL injury
The ACL ligament is a strong band of tissue which connects the thighbone (femur) to your shinbone (tibia). It plays a key part in stabilizing the knee, and this is why you may experience a feeling of your knee giving way when you have an ACL injury.
Sudden and varied movements are the main causes of ACL injuries, with most injuries being sustained during sports. Activities that can put a lot of stress on the ACL include:
- Stopping or slowing suddenly
- Pivoting heavily on your foot
- Jumping and landing awkwardly
- Receiving a direct impact to the knee such as a football tackle
Your risk factors for developing an injury may be higher if you:
- Wear badly fitting or inappropriate sports shoes
- Participate in sports such as soccer, softball, football, skiing, basketball
- Are female – it is thought that differences in strength, anatomy and hormones may put women at an increased risk of an ACL injury
- Have poor conditioning or a lack of strength in the knee
- Use defective sports equipment
- Play on artificial grass
In some cases, an ACL injury may be considered mild, with the ligament being stretched but still intact. In more serious cases, the ligament will be partially or completely torn.
Diagnosing an ACL injury
To reach a diagnosis, your doctor will examine your knee to see how badly the ACL has been stretched or torn. To establish this, they may send you for one or more imaging tests (scans):
- X-ray – to detect fractures
- Ultrasound scan – to help your doctor to see the condition of your soft tissues
- Magnetic Resonance Imaging (MRI) scan – to look at soft tissue damage in more detail, particularly to tendons, cartilage, muscles and ligaments
Once you doctor has established the extent of your injury, they will decide on an appropriate treatment plan for you.
Treating an ACL Injury
Whether you require non-surgical or surgical treatment will depend on the extent of the damage to your ACL, your symptoms and whether any surrounding tissues have also been affected.
An ACL injury is commonly classified by grade, and we treat all three grades of injury at King’s
- Grade 1 – Mild damage. The ACL has been mildly stretched but still provides adequate support to the knee joint. Surgery is unlikely.
- Grade 2 – Partially torn. In this case the ACL is both stretched and partially torn. The knee joint is moderately unstable. Surgery may be required.
- Grade 3 – Complete tear. The ACL is completely torn in half and provides no stability to the knee joint. Surgery would be recommended depending on age, profession and hobbies, and other factors.
It is important to practice first aid immediately after an ACL injury occurs. In the first instance and later on at home, you should follow the R.I.C.E (rest, ice, compression, elevation) approach to help reduce pain and swelling:
If you are a candidate for non-surgical treatment, you may be referred for physiotherapy and rehabilitation. You may need to continue the therapy for several weeks. It is important that you follow the exercises as advised in order to increase your chances of recovering well. You may also need to wear a hinged knee brace.
ACL Surgery at King’s
A surgical reconstruction of the ACL involves replacing the torn ligament with a substitute graft made of tendon. There are different types of grafts which can be performed either using a tendon from your own body (where the graft is known as an autograft) or by using a tendon from a donor body (known as an allograft). Common options for the graft include use of the following tendons:
- Patellar (kneecap) tendon
- Hamstring tendon
- Quadriceps tendon
- Achilles tendon (when using a donor tendon)
You may need to undergo physiotherapy prior to surgery and wear a brace for a period to allow the ligament time to heal.
After surgery, you will feel some pain and your doctor will prescribe short term painkillers to help with the management of this.
Recovering after surgery
In the first 10 to 14 days after surgery, your doctor may recommend that you wear a brace or use crutches when weight bearing.
You will also be given physiotherapy, and this is crucial to the success of the surgery. The main aim of rehabilitation following an ACL reconstruction is to reduce knee swelling, maintain mobility of the kneecap, regain full range of motion of the knee and strengthen the surrounding muscles.
To aid your recovery, it is important that you follow the advice and exercises dictated by your doctor and physiotherapist.
Your doctor will advise you when you can return to sports activities.