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    Orthosports Medical Center  P.O. Box 71055, Jumeirah Beach Road, Jumeirah 1, Dubai, U.A.E.  25°14'14.0"N 55°16'03.6"E ,    +971 04 345 0601     Get in touch
Anterior Cruciate Ligament (ACL) Strain/Rupture

This is one of the most common knee injuries involving the knee. You may have heard of professional athletes suffering from this injury/condition.
The anterior cruciate ligament is the ligament in the knee joint that is attached diagonally forming an “X” figure with the posterior cruciate ligament. These ligaments are responsible for controlling the knee’s back and forth motion. These also provide rotational stability of the knee. These also prevent sliding of tibia anteriorly in front of the femur.

knee1Chief Complaint

Most of the patients diagnosed with this problem often have chief complaints of pain in the knee with “feeling the knee is unstable” or “I cannot trust my knee when walking especially on an uneven surface.” The knee may have limited range of motion and oftentimes are swollen. They also may have heard a “pop” directly related to trauma/injury.

Physical Examination

Our orthopedic specialists here at Orthosports Medical Center would need to do a series of tests to better address each symptom. The specialist would need to do physical examination, and patient would be asked to change into comfortable and non-constricting shorts to expose the knee for better examination.

  • Drawer Test – A positive drawer test may mean laxity of the ligaments and may indicate a tear of the ligaments.
  • Lachman Test – A positive Lachman test would mean an injury to the ligaments.
  • Pivot-shift Test – Unlike the other two, this test is to determine instability.

Diagnostic Study

  • An x-ray could be done to visualize the bones to determine whether the injury is associated with it.
  • A definitive diagnostic study relating to a diagnosis of anterior or posterior cruciate ligament injury is Magnetic Resonance Imaging (MRI) of the knee. With this, soft tissues are visualized clearly.

knee2
*MRI study of the knee showing a normal appearance of ACL on the LEFT and a rupture on the RIGHT.*

Diagnosis

These strains may be classified depending on the severity or extent of the injury which may fall under the following categories:

  • Grade 1 – Mild damage in the ligament. Stretched. Still with knee stability.
  • Grade 2 – Loosening of the ligament after being stretched. Still with knee stability.
  • Grade 3 – More likely a complete tear of the ligament making the knee unstable.

Treatment

Treatment may vary depending on the extent of the injury, and the patient’s need for invasive treatment. There may be 2 types of approaches, which are:

Non-Surgical

Although the only treatment for this kind of injury is done surgically, some patients may opt not to do it invasively, depending on their needs. Age relatedness and activities in which they need to be able to participate are a big part in the decision making.

Athletes, for example, needs to have the surgery done because they need to get back to their sports activities. On the other hand, older people or not so active people may prefer not to have it corrected as they are not demanding their knees too much.

If they opt not to have it corrected, they may use conservative treatments which may include the following:

  • Bracing with hinges maintain the alignment of the knee. With this, patient will feel confident with their knee “not giving way.”
  • Doing physiotherapy to strengthen the muscles that are supporting the knee.

Surgical

As most ACL tears cannot be stitched back together, it oftentimes is reconstructed. That is, taking grafts from other tendons and attaching it as to where the ligament is supposed to be.

There are many options as to which tendon may be used.

  • Hamstring tendon – located at the back of the thigh.
  • Quadriceps tendon – located in the front, kneecap to the thigh.
  • Patellar tendon – located in the front, kneecap to the leg
  • Allograft – cadaveric graft may be used as well

You may discuss with our orthopedic specialists as to which tendon is most likely a good donor for the graft.

Suspecting of maybe having this knee condition? We can evaluate you for that. Click here to book an appointment with our Orthopedic Specialists.