Lewis Gale Physicians November 01, 2017

Planning ahead may reduce a painful injury.

As Mother Nature blankets the mountains with the cold white stuff, hundreds of thousands of ski enthusiasts head out to the slopes. For most skiers, a day of fun is followed by a relaxing evening by the fire or a night about town. Unfortunately, injury cuts the day short for some and ruins the evening and ski season entirely for others. One of the most common injuries is a tear of the anterior cruciate ligament (ACL).

Of course, the ACL is prone to injury in other sports, as well. Basketball, in particular, lends itself to ACL injuries that occur when landing from a jump, cutting, pivoting, or with sudden deceleration. ACL tears often occur when a player forcefully plants his or her foot during a high-speed, high-impact stop and change of direction, or during a routine jump-stop that players may do dozens of times in a game.

In one NCAA tournament game, University of Connecticut’s former standout Shea Ralph recalls, "Kesha gave me a lead pass, but it was going out of bounds. I tried to stop on my right leg and reach out of bounds to get the ball, spin, and get a lay-up. When I planted my foot, my leg below my knee just stopped, but the rest of my body kept going. I felt my knee shift. [The pain] was continuous and sharp. Kind of like somebody stabbed me in the leg and was moving the knife around."

Anatomy and Function of the ACL

Ligaments are strong connective tissues that connect one bone to another. The ACL is one of two important ligaments in the center of the knee that connect the thigh bone (femur) to the shin bone (tibia). Along with the posterior cruciate ligament (PCL), the ACL helps provide stability for knee by preventing the thigh bone from sliding forward and backward on the shin bone.

Symptoms

Damage to the ACL can range from a minor injury (grade 1 sprain) to a full rupture (grade 3 sprain). Symptoms will vary depending on the injury, but may include:

  • Pain
  • A popping noise when injury occurs
  • Swelling in the knee that occurs within 24 hours
  • Loss of full range of motion
  • Instability—a wobbly feeling that will make it difficult to stand or walk

These symptoms are often good indicators of an ACL injury, but a doctor or trainer will examine the knee at the time of injury to assess the stability of the ligament. Your doctor will also order an x-ray of the knee to rule out a fracture of the bone. An MRI is usually ordered to confirm the diagnosis and evaluate other structures that may have been injured at the same time.

Treatment

If you are diagnosed with a torn ACL, your treatment will depend on your age, activity requirements, and the extent of your injury. Here are the most common treatments:

Conservative

  • Rest and stay off the knee as much as possible for the first few days.
  • Keep the knee iced and elevated.
  • Anti-inflammatory medications, like ibuprofen, will help with pain.
  • Physical therapy is important in reducing pain and improving strength and motion of the knee
  • Wearing a knee brace to stabilize the knee joint.

For patients who are younger and more active, surgery is usually recommended to stabilize the knee joint and prevent the long-term problems associated with having an unstable knee.

Surgical

ACL surgery is an elective procedure. This means that surgery is not always necessary and may depend on your lifestyle and age. Surgery may be recommended if you have:

  • A complete tear of the ACL
  • A high degree of joint instability
  • Injury to the knee that affects more than one ligament
  • A need to return to sports or other activities that require pivoting, turning, or sharp movements
  • No improvement with conservative treatment

Surgical treatment involves reconstructing the ligament because a direct repair of the ligament is ineffective. A graft, usually from a tendon or ligament around the knee, is used to replace the ACL. This procedure is effective because it uses a patient’s own tissue and allows the knee to regain its normal range of motion. There is a low risk of infection or graft rupture. The reconstruction usually lasts a lifetime, but repeat tears can occur.

Rehabilitation

Physical therapy programs will help to strengthen the knee during conservative treatments and after surgery. These programs will help you:

  • Regain range of motion
  • Strengthen the muscles around the knee
  • Improve balance
  • Protect the ligament from further damage
  • Provide physical training to get you back to sports or work

An ACL brace may be prescribed after the surgery to help protect the healing ligament.

Potential Complications

Complications after ACL surgery are rare, but all procedures have some risk. Before surgery you doctor will review potential complications that may include:

  • Infection
  • Excess bleeding
  • Blood clots
  • Reaction to anesthesia
  • The operation does not provide the desired improvement in function
  • Numbness or stiffness around the knee
  • Kneecap pain after surgery

Before your procedure, your doctor will discuss ways to reduce your risk of complications such as:

  • Stop smoking
  • Reduce or eliminate alcohol intake
  • Manage chronic diseases such as diabetes or obesity

Prevention

Treatment for ACL injuries is effective, but considering the pain, inconvenience, surgery, and lengthy recovery, your best bet is to prevent the injury in the first place. The best way to prevent an injury to the ACL is to strengthen the muscles surrounding the knee, specifically the hamstrings and quadriceps. These two sets of muscles are crucial to regaining balance and control. Strengthening the hamstrings and quadriceps may help prevent twisting and hyperextension of the knee that may contribute to ACL injuries.

Strength training is one important way to help prevent injury. Others include:

  • Staying in control when involved in sports like skiing and basketball.
  • Bending your hips and knees to soften the blow when landing from a jump.
  • Warming up before exercising.

Protecting the ACL

Ralph has made some adjustments to try to prevent another ACL injury while playing basketball, like distributing her weight more evenly on both feet when jump-stopping. Because of her body type, she has taken even more precautions. "I worked on turning my feet outward and being conscious of it," she explains. "I also worked on keeping my knees faced out, how to jump and land, how to collapse if I fall, how to position my leg if people are about to fall on it."

Methods that help prevent ACL injury include:

  • Plyometrics, a type of jumping exercise, used to train and strengthen the leg muscles
  • Warm-up exercises
  • Strength training for your quadriceps and hamstrings
  • Stretching exercises for your legs

Talk to your coach or trainer. If you believe that you may have an ACL injury, Dr. Robyn Hakanson can review your symptoms, diagnose, and prescribe a treatment plan. To schedule an appointment, call the office at (540) 772-3530 or click the button to schedule an appointment online.

Book An Appointment Online with Dr. Robyn Hakanson