Anterior Cruciate Ligament

Anterior Cruciate Ligament Injury
Injury of the anterior cruciate ligament (ACL) is common among athletes who play sports such as football, basketball and soccer. The ACL is located in the knee joint, which consists of the femur (thigh bone), tibia (shin bone) and the patella (kneecap).

The ACL is connected to the femur and tibia, which are bones located inside the joint. Other ligaments exist and are located on the outside of the joint. The exception is the posterior cruciate ligament (PCL), which is also located inside the joint. The ACL and PCL form an “X” with the ACL crossing in front of the PCL. These ligaments stabilize the knee joint to prevent excessive forward and backward motion.

ACL Sprain
Athletes can sustain a grade one, two or three sprain to the ACL. A grade one anterior cruciate ligament sprain—the least severe—results in mild stretching of the ligament. Grade one sprains are characterized by pain and some swelling in the knee joint.

A grade two sprain results in a greater degree of instability in the knee joint and is often referred to as a tear of the ligament. Finally, a grade three sprain is a complete tear of the ACL. The joint is now unstable. The most common injuries to the ACL are complete tears.

ACL Injuries
Injury to the ACL can result from several different movements, such as a rapid change of direction, sudden stop, decreasing speed of running, incorrect landing and direct contact or collision. Differences in training methods among male and female athletes may be a key factor in the increased incident of female injury compared to males.

In addition, other theories suggest lack in muscular strength, neuromuscular control, body alignment, laxity of ligaments and estrogen’s influence. As Atlanta’s premiere Sports Medicine program, Gwinnett Medical Center–Duluth specializes in helping ALL athletes safely and quickly recover from ACL injuries like sprains and tears.

ACL Tear Symptoms
When an anterior cruciate ligament tear occurs, athletes often say they hear a “pop” or that their knee “gave out.” Swelling and pain are immediate and may increase over the first 24 hours. As mentioned, a complete tear of the ACL will leave the knee joint unstable and the athlete will not feel comfortable returning to his or her sport.

Further injury to the surrounding tissue can result if the athlete returns to play prior to examination or treatment of the injury. Other symptoms include loss of full range of motion, tenderness along the joint line and discomfort walking.

Non-Surgical Treatment for ACL Tear
Depending on the age and activity level of the patient, surgery may not be necessary. However, if the patient desires to return to his or her sport, surgery will be the best option. Non-surgical options include bracing and physical therapy.

Wearing a brace given by an orthopedic physician will protect the injured knee from instability; however, this does not replace an ACL. Crutches may be necessary initially to provide a greater degree of protection. Physical therapy to strengthen the supportive muscles around the joint will begin as soon as swelling around the joint decreases.

Surgical Treatment of ACL Tears
Most ACLs cannot be repaired using the original ligament. Instead, the ligament must be reconstructed using grafts from the patellar tendon, quadriceps tendon, hamstring tendon or even from a cadaver. There are advantages and disadvantages for each method, which you should discuss with your specialist.

ACL Rehabilitation
Physical therapy is essential to returning an athlete to his or her sport, as well as to increasing their ability to complete activities of daily living. Physical therapy will focus on increasing range of motion and strength to the joint and surrounding muscles of the joint.

For a free physician referral, please call 678-312-5000.