Whether it was a loved one, yourself, or your 1st round fantasy football draft pick [I'm not naming any names SEQUON BARKLEY ;) ]... the odds are high that you have definitely encountered or been impacted in some way by an ACL tear. With More than 100.000 occurrences annually, the Anterior Cruciate Ligament (ACL) Tear is one of the most common knee injuries we see in Physical Therapy. This blog is all about the ACL... what it is, how it is injured, and what you need to know about recovery. At PTSP we treat ACL tears at all different stages and with varying severities, so this is our jam.
So Let's get to it!
Anatomy:
The ACL is one of the 4 main ligaments of the knee and the most common of the 4 to be injured. It is a rope-like structure located in the center of the knee spanning from the lateral condyle of the femur to the intercondyloid eminence of the tibia. With this orientation it is able to resist anterior tibial shear and provide rotational stability to the knee. The ACL is tensioned the most when the knee is at 30 and 90 degrees of flexion.
Mechanism of Injury:
ACL tears can be sustained on contact but most of the injuries are sustained during non contact mechanisms like sudden changes of directions or jump landings. In non-contact situations, the knee rotates inward, an additional strain is placed on the ACL, and it tears. Many people report hearing a pop or feel a "popping" sensation, the knee may swell, feel unstable, and become too painful to bear weight. In addition, 50% of injuries to the ACL occur alongside injuries to the articular cartilage, meniscus, or other ligaments.
Injuries to ligaments like the ACL are considered sprains and can be classified according to severity.
Grade I: The ligament damage is mild. The ligament has been stretched but still maintains the ability to help keep the knee joint stable.
Grade II: the ligament is partially torn, it has been stretched to a point where it becomes loose, and the knee stability is compromised.
Grade III: The ligament is fully torn. Either it has torn in half or has been torn away from the bone. The knee is unstable.
Treatment:
Many factors go into deciding a treatment plan which include: the grade of the ACL injury, the athlete's future goals, and activity levels. The adult athlete that is no longer competitive may be successful with a course of physical therapy and a lifelong commitment to strength training for injury prevention. Competitive athletes with their sights set on returning to their sport are likely to undergo a surgical reconstruction. With the ACL located so deep into the knee joint, conservative treatments have in the past shown to have poor outcomes. The ACL has difficulty forming a fibrous clot due to the low blood supply available and therefore cannot easily repair itself. During the ACL reconstruction procedure, the torn or ruptured ACL is completely removed and replaced with a piece of tendon or ligament tissue from the patient (autograft) or a donor (allograft).
*Those who do not undergo a reconstruction may be at higher risk to develop knee osteoarthritis in the future due to the shear forces the knee will experience.
Rehabilitation:
Regardless of the grade of your tear, if your treatment is conservative or surgical repair... you will absolutely need physical therapy after an ACL injury.
If you are proceeding with conservative treatment, you can expect your physical therapist to evaluate you for determination of your phase. Although all ACL's do the same thing, each athlete is an individual, therefore their recovery programming will be individualized. What does stay consistent throughout recovery is that you must meet the goals in each phase to progress to the next. Most importantly, COMPLETE YOUR REHAB!!! Rehab is not done once you have begun running, take the time to prepare to return to sport safely and prevent re-injury.
Phases of Recovery
Pre-op: Injury Recovery & Readiness for surgery
Goals:
-eliminate swelling
-regain full range of motion
-regain 90% of strength in the quads and hamstring compared with the other side
*if we achieve these 3 things post surgery the patient is likely to have a better surgical outcome
Phase 1: Recovery from surgery
Goals:
-full knee extension
-reduce swelling to mild
- get the quad firing
*work to gain full extension first, flexion will progress slowly with time.
Phase 2: Strength & Neuromuscular control
Goals:
-regain single leg balance
-regain most of your muscle strength
-single leg squat with good control of alignment
Phase 3: Running, agility & landings
Goals:
-attain excellent hopping performance
-complete agility program and modified game play
-regain full strength and balance
Phase 4: Return to sport
-very individualized to the athlete, incorporate regular drills they would perform when not injured
-get the athlete confident and mentally ready. successful repetition and game simulation.
-continue strength and stability of the knee
-can start to join into sport transition from restricted to unrestricted
*current research suggests a minimum of 9 months of rehab and meeting these 3 criteria:
successful return to sport testing
the athlete is confident, comfortable, and eager to return to sport per ACL-RSI and IKDC
the athlete commits to an ACL injury prevention program while in sport. Used in pre-training or pre-game warmup.
Phase 5: prevention of re-injury
-continued commitment to plyometric, balance and strength exercises
-proper pre-game and pre-training warmups
-ACL injury prevention programs give great direction
It takes a skilled team and commitment to the recovery from an ACL injury. If you have any questions or need assistance with your recovery, your Physical Therapy San Pedro team is here to guide you! Reach out, we would be so happy to help get you back on your feet doing what you love.
If you are interested in working with us we work with clients on site and virtually through Telehealth. Click here if you are interested in booking a a session or getting more information! https://www.physicaltherapysanpedro.com/sports
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Much Love <3 ,
The PTSP Docs
Dr. Daisuke, Dr. Brown, Dr. Bay, & Dr. Sandoval
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