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SPORTS INJURIES - Anterior Cruciate Ligament (ACL) Reconstruction Animation

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ACL - Causes and Symptoms

Anterior Cruciate Ligament (ACL) Injuries – Causes

Anterior cruciate ligament (ACL) injuries are caused when the knee is straightened beyond its normal limits (hyperextended), twisted, or bent side to side.

Typical situations that can lead to ACL injuries include:

Changing direction quickly or cutting around an obstacle or another player with one foot solidly planted on the ground. (This can happen in sports that put high demand on the ACL, such as basketball, football, soccer, skiing, and gymnastics.)

Landing after a jump with a sudden slowing down, especially if the leg is straight or slightly bent (such as in basketball).

Falling off a ladder, stepping off a curb, jumping from a moderate or extreme height, stepping into a hole, or missing a step when walking down a staircase. Injuries like these tend to be caused by stopping suddenly, with the leg straight or slightly bent.

Inactive people and some older adults who have weak leg muscles may injure their knees during normal daily activities. But they usually injure bones, not ligaments.

When contact causes an ACL injury, it can be from playing a sport, from a sudden and severe accident, or from less obvious contact injuries.

Symptoms

Symptoms of a severe and sudden (acute) anterior cruciate ligament (ACL) injury include:

●  Feeling or hearing a "pop" in the knee at the time of injury.

●  Sudden instability in the knee. (The knee feels wobbly, buckles, or gives
    out.) This may happen after a jump or change in direction or after a direct
    blow to the side of the knee.

●  Pain on the outside and back of the knee.

●  Knee swelling within the first few hours of the injury. This may be a sign of
    bleeding inside the joint. Swelling that occurs suddenly is usually a sign of a
    serious knee injury.

●  Limited knee movement because of swelling and/or pain.

After an acute injury, you will almost always have to stop the activity you are doing, but you may be able to walk.

Other health problems can cause symptoms like those of an ACL injury. They include a bone break or injuries to the knee cushions (menisci) or to other ligaments in the knee.

Chronic ACL deficiency

The main symptom of chronic (long-lasting and recurrent) ACL deficiency is an unstable knee joint. The knee buckles or gives out, sometimes with pain and swelling. This happens more often over time. But not everyone with an ACL injury develops a chronic ACL deficiency.

What Happens

If you have a sudden (acute) anterior cruciate ligament (ACL) injury, you typically know when it happens. You may feel or hear a pop, and the knee may give out, causing you to fall. The knee swells and often is too painful or unstable for you to continue any activity.

An ACL injury can cause small or medium tears of the ligament, a complete tear of the ligament (rupture), a separation of the ligament from the upper or lower leg bone (avulsion), or a separation of the ligament and part of the bone from the rest of the bone (avulsion fracture). When any of these occur, the lower leg bone moves abnormally forward on the upper bone, with a sense of the knee giving out or buckling.

How an anterior cruciate ligament (ACL) injury is treated and how it heals depends on:

●  The condition of the ACL before the injury. This includes prior injuries,
    partial tears, ACL deficiency, and changes due to age.

●  The general condition and health of the rest of your knee before this injury.

●  The amount of damage or injury to the ACL. Injuries are usually grouped
    into grade I, II, or III sprains (tears) according to the amount of damage.

●  Other injuries to the knee joint, such as to the cartilage camera.gif or
    menisci camera.gif, or to bones in the knee.

●  Your age, how active you are, and how committed you are to treatment and
    rehabilitation (rehab).

●  The time of diagnosis. If the ACL diagnosis is not made soon after the injury,
    the knee may be further damaged with use.

An ACL injury may develop into long-lasting and recurrent (chronic) ACL deficiency that leads to an unstable knee—the knee buckles or gives out, sometimes with pain and swelling. This can occur if you had an ACL injury in the past and didn't know it or if your ACL has not been treated or has been treated unsuccessfully. ACL deficiency can cause damage to the joint, including osteoarthritis. But not everyone with an ACL injury gets ACL deficiency.

People with minor ACL injuries usually begin treatment with a physical rehab program. Rehab exercises build strength and flexibility in the muscles on the front of the thigh (quadriceps) and strengthen and tighten the muscles in the back of the thigh (hamstrings). Most people return to their normal activities after a few weeks of rehab.

More serious ACL injuries may need several months of rehab or surgery followed by several months of rehab to regain your knee strength, knee stability, and range of motion.

Not all ACL injuries require surgery. But whether you have surgery or not, you need to start strengthening your knee and regaining motion soon after you injure it. This prepares you for your rehab program if you choose not to have surgery. It also helps prepare the knee for surgery if you choose to have it.

What Increases Your Risk

Things that increase your risk of anterior cruciate ligament (ACL) injuries include:

●  Playing sports that involve sudden changes in direction or cutting around
    other players or obstacles, such as skiing, football, soccer, basketball,
    baseball, and tennis.

●  Making accidental movements that may twist your knee. Examples include
    falling off a ladder, jumping from an extreme height, stepping into a hole, or
    missing a step on a staircase.

●  Losing muscle tone in legs (from aging or inactivity).

●  Having unbalanced leg muscle strength, such as if the muscles in the front
    of your thigh (quadriceps) are stronger than the muscles at the back of your
    thigh (hamstrings).

●  Previous ACL injuries, especially if your knee sometimes gives out or
    buckles (chronic ACL deficiency).

When To Call a Doctor

if you have an injury to your knee and:

●  You have severe pain in your knee.

●  Your knee appears to be deformed.

●  You have signs of damage to the nerves or blood vessels. Signs include
    numbness, tingling, a "pins-and-needles" sensation below the injury, an
    inability to move your leg below the injury, pale or bluish skin, or your leg
    feels cold.

●  You have severe swelling in your knee right after the injury.

Call your doctor today if:

●  Your knee begins to swell within 2 hours of the injury.

●  You hear or feel a pop in your knee during an injury.

●  Your knee won't bear weight.

●  You are unable to straighten your leg completely.

●  Your knee is unstable, buckles, or gives out.

●  Your knee "locks" in one position.

●  You have had an anterior cruciate ligament (ACL) injury in the past, and you
    have reinjured your knee.

Before your appointment, don't put weight on the injured knee. Use crutches if you need to. Apply ice and wrap your knee in an elastic bandage or neoprene (synthetic rubber) sleeve. Rest and elevate the knee. Take a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil) or naproxen (Aleve), to reduce swelling. For more information on first aid steps, see Home Treatment.

Watchful waiting

Watchful waiting is a period of time during which you and your doctor observe your symptoms or condition without using medical treatment. Watchful waiting is not appropriate if knee pain is severe; if your knee is deformed, swells, or has limited movement immediately after an injury; or if you are unable to bear any weight because of either pain or instability.

Serious knee injuries need to be checked for possible broken bones as well as ligament or cartilage camera.gif damage. Whenever immediate swelling follows an injury, there also may be torn blood vessels or damaged nerves in the knee. Your doctor will check your knee to make sure the blood supply to your leg is normal and the nerves are intact.

If you have occasional pain in your knee or your knee sometimes gives way or buckles, have your doctor check it. If you have damaged your ACL, it is important to get treatment so that your knee is appropriately managed. This may reduce the chance that you will get osteoarthritis in your knee.

Who to see

Knee problems can be diagnosed by:

●  Emergency medicine specialists (for acute knee injury).

●  Family medicine doctors familiar with knee injuries.

●  Orthopedic surgeons.

●  Sports medicine specialists.

If surgery is considered, you may be referred to an orthopedic surgeon (possibly a sports medicine specialist) who is experienced in knee surgery.

Exams and Tests

An anterior cruciate ligament (ACL) injury is diagnosed through a medical history and a physical exam. A doctor who specializes in knee injuries (for example, an orthopedic surgeon or sports medicine specialist) will usually be able to accurately diagnose an ACL injury after:

●  Taking your medical history. You will be asked how you injured your knee,
    about your symptoms at the time of injury, whether you have had any other
    knee injuries, and general questions about your health.

●  Checking your knees for stability, strength, range of movement, swelling,
    and tenderness. Tests for stability include a Lachman test and a pivot shift
    test. The Lachman test compares the degree of looseness (laxity) in your
    knees.

●  Looking at an X-ray, which is usually done for any knee injury if there is
    pain, swelling, or you cannot put your weight on the leg. Although an ACL
    injury cannot be directly diagnosed by an X-ray, an X-ray can show whether
    a bone is broken, any bone fragments are in the knee, the ACL is torn from
    the bone (avulsion), or blood is present in the knee (effusion).

If you see your doctor soon after your injury, the pain and the degree of swelling and muscle tenseness may make it difficult for your doctor to accurately diagnose the condition.

More imaging tests

Other tests that may help your doctor see how badly the knee is injured include:

●  An MRI. It can identify an ACL tear or other problems, such as meniscus
    tears or other ligament injuries.

●  A CT scan. It can be done to see any small breaks in the bones.

Looking at fluid in the knee

If your knee looks red, feels warm to the touch, or is very swollen, a knee joint aspiration (arthrocentesis) may be done. This involves removing fluid from the knee joint with a needle. It is done to:

●  Help relieve pain and pressure. This may make the physical exam easier
    and make you more comfortable.

●  Check joint fluid for possible infection or inflammation.

●  Look for blood, which may mean there is a tear.

●  Look for drops of fat, which may mean there is a broken bone.

Local anesthetic may be injected to reduce pain and make the knee easier to examine.

Other tests

Arthrometric testing: In this test, your doctor uses a tool to measure the looseness of your knee. This test is especially useful in people whose pain or size makes a physical exam difficult. An arthrometer has two sensor pads and a pressure handle that allows your doctor to put force on the knee.

ArthroscopyArthroscopy: This can be used to diagnose an ACL injury and as a method of surgery. It involves inserting tools through one or more small incisions in the knee, which allows your doctor to examine the structures inside the knee joint, including the ACL.

Before arthroscopy, you and your doctor will decide what will be done if certain conditions are found. For example, you may decide in advance that if a complete tear of the ACL is found, it will be reconstructed during the arthroscopy. Or if a more severe condition is found, you and your doctor may agree to discuss the condition rather than proceeding with surgery at that time.

Source: http://www.webmd.com/

ACL - Topic Overview

Topic Overview

An anterior cruciate ligament, or ACL, injury is a tear in one of the knee ligaments that joins the upper leg bone with the lower leg bone camera.gif. The ACL keeps the knee stable.

Injuries range from mild, such as a small tear, to severe, such as when the ligament tears completely or when the ligament and part of the bone separate from the rest of the bone.

Without treatment, the injured ACL is less able to control knee movement, and the bones are more likely to rub against each other. This is called chronic ACL deficiency. The abnormal bone movement can also damage the tissue (cartilage camera.gif) that covers the ends of the bones and can trap and tear the pads (menisci camera.gif) that cushion the knee joints. This damage can lead to osteoarthritis.

Sometimes other knee ligaments or parts of the knee are also injured. This includes cartilage such as the menisci, or bones in the knee joint, which can be broken.

Your ACL can be injured if your knee joint is bent backward, twisted, or bent side to side. The chance of injury is higher if more than one of these movements occurs at the same time. Contact (being hit by another person or object) also can cause an ACL injury.

An ACL injury often occurs during sports. The injury can happen when your foot is firmly planted on the ground and a sudden force hits your knee while your leg is straight or slightly bent. This can happen when you are changing direction rapidly, slowing down when running, or landing from a jump. This type of injury is common in soccer, skiing, football, and other sports with lots of stop-and-go movements, jumping, or weaving. Falling off a ladder or missing a step on a staircase are other likely causes. Like any other body part, the ACL becomes weaker with age. So a tear happens more easily in people older than age 40.

Symptoms of an acute ACL injury include:

●  Feeling or hearing a pop in the knee at the time of injury.

●  Pain on the outside and back of the knee.

●  The knee swelling within the first few hours of the injury. This may be a sign of
     bleeding inside the knee joint. Swelling that occurs suddenly is usually a sign of
     a serious knee injury.

●  Limited knee movement because of pain or swelling or both.

●  The knee feeling unstable, buckling, or giving out.

After an acute injury, you will probably have to stop whatever you are doing because of the pain, but you may be able to walk.

The main symptom of chronic ACL deficiency is the knee buckling or giving out, sometimes with pain and swelling. This can happen when an ACL injury is not treated.

Your doctor can tell whether you have an ACL injury by asking questions about your past health and examining your knee. The doctor may ask: How did you injure your knee? Have you had any other knee injuries? Your doctor will check for stability, movement, and tenderness in both the injured and uninjured knee.

You may need X-rays, which can show damage to the knee bones. Or you may need other imaging tests, such as an MRI. An MRI can show damage to ligaments, tendons, muscles, and knee cartilage. Arthroscopy may also be done. During arthroscopy, your doctor inserts surgical tools through one or more small cuts (incisions) in the knee to look at the inside of the knee.

Start first aid right away. These first-aid tips will reduce swelling and pain. Use the RICE method. The letters stand for Rest the knee, put Ice on it, use an elastic bandage to give gentle Compression to the knee, and Elevate the leg by propping it up above the level of your heart. And at first it's also important to move your leg as little as possible. Take over-the-counter pain medicine.

You may need to walk with crutches and use a knee immobilizer to keep your knee still for the first few days after the injury.

Your knee will need to be checked by your doctor. It's important to get treatment. If you don't, the injury may become a long-lasting problem.

There are two ways to treat the injury:

●  Exercises and training, also called rehab. It takes several months of rehab for
     your knee to get better.

●  Surgery. You and your doctor can decide if rehab is enough or if surgery is right
     for you.

   
If you have surgery, you will also have several months of rehab afterward.

Your treatment will depend on how much of the ACL is torn, whether other parts of the knee are injured, how active you are, your age, your overall health, and how long ago the injury occurred.

There are three main treatment goals:

●  Make the knee stable if it is unsteady, or at least make it stable enough to do
     your daily activities.

●  Make your knee strong enough to do all the activities you used to do.

●  Reduce the chance that your knee will be damaged more.

The best way to prevent ACL injuries is to stretch and strengthen the leg muscles, especially the front and back muscles of the thigh (quadriceps and hamstrings).

Here are other things you can do that may help prevent ACL injuries:

●  Avoid wearing shoes with cleats in contact sports.

●  Avoid wearing high-heeled shoes.

●  Avoid sports that involve lots of twisting and contact.

Source: http://www.webmd.com/