ACL Tears

What are ACL tears? Generally, ACL tears are a common injury for athletes and can have a major effect on one’s athletic ability. By definition, ACL tears are when the anterior cruciate ligament in the knee tears. A torn anterior cruciate ligament in the knee. The ACL or the anterior cruciate ligament is a tissue that connects the thigh bone to the shinbone, at the knee. Types of ACL Tears:

1. Grade 1: Mild damage to the ligament but the knee joint is still stable

2. Grade 2: The ACL is stretched and loose, this is a partial tear and is rare
   

3. Grade 3: Complete ligament tear when the ACL is split into two pieces and the knee is unstable

Causes: A prominent cause of ACL tears is sports or exercise-related activities. Certain sports or activities can put lots of stress on the knee, and thus cause a tear. Examples include Suddenly slowing down and changing direction, pivoting with your foot firmly planted, landing awkwardly from a jump, stopping suddenly, or receiving a direct blow to the knee or having a collision. That said, many ACL tears occur in light of sports such as football, basketball, soccer, gymnastics, and skiing. Diagnosis & Tests: In order to diagnose an ACL tear, a doctor will first begin with a physical exam. During a physical exam, doctors look for signs of swelling or tenderness of the knee as they compare the injured knee to your other knee. A doctor will also position the knee differently to test the range of motion and function of the joint. Usually, all that is needed to confirm an ACL tear is a physical exam, however, more tests are required to determine the extent of the tear. The first test is an x-ray, which doesn’t show ligaments, however will rule out a bone fracture. Next is an MRI, which creates images of both hard and soft tissues, including the ligaments. That said, in an MRI the ACL tear severity can be shown as well as damage to different knee tissues such as the cartilage. Lastly, an ultrasound uses sound waves to display internal structures. Ultrasounds can be used to diagnose injuries in the knee’s ligaments, tendons, and muscles. Overall, the diagnosis of an ACL tear begins with a physical exam and is followed by tests such as X-rays, MRIs, and ultrasounds to diagnose the severity. Symptoms:

• A loud pop or a "popping" sensation in the knee

• Severe pain and inability to continue activity

• Rapid swelling

• Loss of range of motion

• A feeling of instability with weight-bearing

Risk Factors: Despite what might be one’s first thought, many groups of people are at greater risk of ACL tears in comparison to others. The first risk factor is being female, as a result of differences in anatomy, muscle strength, and hormones. In addition, athletes are at much higher risk of torn ACLs as they are constantly putting stress on the knee during their activities. Another risk factor includes poor conditioning, which weakens the knee and makes it more vulnerable to a tear. Those who exercise as well are at greater risk of ACL tears if they exercise incorrectly in faulty movement patterns, including moving one's knees inward while squatting. Another risk factor is wearing shoes that don’t fit properly, putting extensive stress on the knees. In addition, using poorly maintained sports equipment makes it easier for an ACL to tear, as it can easily get in the way of the knee's flexibility. For example, ski bindings that aren’t adjusted properly, as one wrong move can damage the knee if it goes the wrong way. Lastly, playing on artificial turf is a risk factor for ACL tears. A majority of these risk factors aren’t biological, yet are still extremely important to recognize when determining the likelihood of an ACL tear. Treatment: Immediately following an ACL tear, it is significant to follow your injury with R.I.C.E, which stands for rest, ice, compression, and elevation. It is important to prioritize rest and limit any pressure or weight to the injured knee. In addition, icing the knee at least every two hours for twenty minutes at a time. As for compression, an elastic bandage or compression wrap should be used. Lastly, for elevation, ensure your knee is being propped up as you lay down. Following this immediate treatment begins with rehabilitation in which treatment begins with a few weeks of rehabilitative therapy. A brace will be used in addition to crutches and a physical therapist will provide sample strengthening exercises. Rehabilitation reduces pain and swelling as well as is helpful towards the knee's range of motion and the strength of muscles. Rehabilitation is popular amongst people who are inactive or play sports with less stress to the knee. Following rehabilitation is typically surgery depending on the severity of the tear. Surgery is typically recommended for athletes, if more than one ligament is injured, and if the tear is resulting in buckling of the knee during everyday activities. During the surgery, the damaged ligament is removed and replaced with a graft that is made of a segment of a tendon. For example, a piece of tendon could be taken from your hamstring to be used as a graft. Surgery follows with more rehabilitative therapy and in theory with rigorous rehabilitation will result in success. Recovery time varies, however the longer the recovery time the more likely it is to avoid re-injury and gain full function back to the knee. For athletes particularly, testing strength, stability, and movement are significant before returning to one's sport. It can take over a year for athletes to fully recover from an ACL tear and play their sport again, proving the seriousness one must take in proper treatment of an ACL tear. Prevention: Certain training and exercise can be used to the advantage of lowering the risk of an ACL tear. Professionals who can provide instruction and information for feedback include sports medicine physicians, physical therapists, or athletic trainers. Certain exercises that help to reduce the risk of an ACL tear include core strengthening exercises, hamstring strengthening exercises to balance leg muscle strength, focusing on proper technique and knee position, in addition to improving technique during cutting movements. Strengthening these muscles and focusing on technique prevents the inward movement of the knee, which then goes on to prevent an ACL tear. Additionally, wearing the proper footwear and padding for your sport is significant to preventing injury. For skiers, it is important to ensure your ski bindings are adjusted correctly by a trained professional. Sources: https://www.mayoclinic.org/diseases-conditions/acl-injury/symptoms-causes/syc-20350738 https://www.hss.edu/condition-list_torn-acl.asp https://www.chop.edu/conditions-diseases/anterior-cruciate-ligament-acl-injuries