ACL injury

ACL knee injury is typical in sports that involve sudden changes of direction, for example football,and soccer. The majority are non-contact injuries that occur during sudden twisting motion (for example, once the feet are planted one of the ways and the knees are turned one other way) orwhen landing from the jump. An anterior cruciate ligament injury may be the over-stretching ortearing from the anterior cruciate ligament(ACL) in the knee. An acl tear might be partial or complete.

The knee is comparable to a hinge joint, located in which the end of the thigh bone (femur) meets the top shin bone (tibia). Four main ligaments connect both of these bones:
 Medial collateral ligament (MCL) - runs across the inner part (side) from the knee and prevents the knee from bending inward.
 Lateral collateral ligament (LCL) - runs across the outer part (side) from the knee and prevents the knee from bending outward.
 Anterior cruciate ligament (ACL) - is based on the middle of the knee. It prevents the tibia from sliding in front of the femur, and offers rotational stability towards the knee.
 Posterior cruciate ligament (PCL) - works together with the ACL. It prevents the tibia from sliding backwards underneath the femur.
The ACL and PCL cross one another inside the knee, forming an "X." For this reason they are called the "cruciate" (cross-like) ligaments. The role from the Anterior Cruciate Ligament is to prevent forward movement from the Tibia from beneath the femur. The Posterior Cruciate Ligament prevents movement from the Tibia in a backwards direction.
ACL knee injuries often occur along with other injuries. The classic example happens when the ACL is torn simultaneously as both the MCL and medial meniscus (among the shock-absorbing cartilages in the knee). This kind of injury often happens in football players and skiers. Women may have an ACL tear than men. The reason for this is not completely understood, however it may be due to variations in anatomy and muscle function. Adults usually tear their ACL in the center of the ligament or pull the ligament from the femur bone. These injuries don't heal by themselves. Children may pull off their ACL having a piece of bone still attached. These injuries may heal by themselves, or they may require a surgical procedure to fix the bone. Many people are able to live and performance normally with a torn ACL. However, many people complain that their knee is unstable and could "give out" with physical activity. Unrepaired ACL tears could also lead to early arthritis within the affected knee.


Causes for ACL Knee Injury
Creating any quick stop, coupled with a direction change while running, pivoting, landing from the jump, or overextending the knee joint (called hyperextended knee), may also cause injury to the ACL.
ACL tears are closely related to contact or non-contact injuries. A blow aside of the knee, which could occur during a football tackle, may lead to an ACL tear. Basketball, football, soccer, and skiing are typical causes of ACL tears.
The signs of ACL tear
 A "popping" sound during the time of injury
 Knee swelling within 6 hours of damage
Pain, especially when you attempt to put weight around the injured leg
A sense of initial instability, might be masked later by extensive swelling
Tenderness in the medial side from the joint which may indicate cartilage injury
Restricted movement, especially a failure to fully straighten the lower limb Possible widespread mild tenderness

 Diagnosis for ACL tear

The pivot-shift test, anterior drawer make sure the Lachman test are utilized during the clinical study of suspected ACL injury. The ACL may also be visualized using a magnetic resonance imaging scan.
Pivot Shift Test- Person depends on one side of the body. Knee is extended and internally rotated. Doctor applies stress to lateral side from the knee, while the knee has been flexed. A positive test indicates an accident felt at 30 degrees flexion.
Anterior drawer test- The individual is positioned lying supine using the hip flexed to 45° and also the knee to 90°. The examiner positions themselves to take a seat on the examination table while watching involved knee and grasping the tibia just beneath the joint type of the knee. The thumbs are put along the joint line on each side of the patellar tendon. The index fingers are utilized to palpate the hamstring tendons to make sure that they are relaxed. The tibia will be drawn forward anteriorly. A heightened amount of anterior tibial translation in contrast to the opposite limb or insufficient a firm end-point indicates whether sprain of the anteromedial bundle from the ACL or a complete tear from the ACL. This test ought to be performed along with other ACL-specific tests to help get yourself a proper diagnosis.
Lachman test- The knee is flexed at 30 degrees. Examiner pulls around the tibia to assess the quantity of anterior motion of the tibia as compared to the femur. An ACL-deficient knee will demonstrate increased forward translation from the tibia at the conclusion of the movement.
Though clinical examination in experienced hands is extremely accurate, the diagnosis is generally confirmed by MRI, that has greatly lessened the requirement for diagnostic arthroscopy.
ACL Knee Injury Conservative Management Goals

• Decrease inflammation, swelling and
• Restore normal ROM (especially knee extension).
• Restore voluntary muscle activation.
•  Provide patient education for post-op rehabilitation.
• To lower PAIN SWELLING AND INFLAMMATION-
•  Cryotherapy +elevation using the knee in full extension.
•  TENS/IFT .
•  Elastic crepe or knee sleeve.
•  Brace while walking.
• To revive NORMAL ROM -
•  Ankle pumps.
•  Heel slides- knee flexion upto tolerance and knee extension to 0°.
•  SLR- 3 way SLR(flexion, abduction, adduction).
• RESTORE NORMAL MUSCLE STRENGTH-
• Quadriceps setting.
•  Hamstring setting ( 3 times a lot more than quads setting).
•  Elecrical muscle stimulation to quadriceps during voluntary muscle stimulation.
• Progress to - Mini squat.
•  Lunges.
•  Static cycling.
•  Step down and up.

Exercises for ACL Injury.


Heel slide: Sit on the floor with legs outstretched. Slowly bend the knee of you injured leg while sliding your heel/foot across the floor toward you. Slide back into the starting position and repeat 10 times.


Isometric Contraction of the Quadriceps: Sit on the floor with your injured leg straight and your other leg bent. Contract the quadricep of the injured knee without moving the leg. (Press down against the floor). Hold for 10 seconds. Relax. Repeat 10 times.
Prone knee flexion: Lie on your stomach with your legs straight. Bend your knee and bring your heel toward your buttocks. Hold 5 seconds. Relax. Repeat 10 times.
Add the following exercises once knee swelling decreases and you can stand evenly on both legs without favoring the injured knee.


Passive knee extension: Sit in a chair and place your heel on another chair of equal height. Relax your leg and allow your knee to straighten. Rest in this position 1-2 minutes several times a day to stretch out the hamstrings.


Heel raise: While standing, place your hand on a chair/counter for balance. Raise up onto your toes and hold it for 5 seconds. Slowly lower your heel to the floor and repeat 10 times.


Half squat: Stand holding a sturdy table with both hands. With feet shoulder’s width apart, slowly bend your knees and squat, lowering your hips into a half squat. Hold 10 seconds and then slowly return to a standing postion. Repeat 10 times.


Knee extension: Loop one end of Theraband around a table leg and the other around the ankle of your injured leg and face the table. Bend your knee about 45 degrees agaist the resistance of the tubing and return.


One Legged Standing: As tolerated, try to stand unassisted on the injured leg for 10 seconds. Work up to this exercise over several weeks.