What Is The Anterior Cruciate Ligament?

The anterior cruciate ligament (ACL) is one of the most important of four strong ligaments connecting the bones of the knee joint. It is often injured. Ligaments are strong, dense structures made of connective tissue that stabilize a joint. They connect bone to bone across the joint.

The function of the ACL is to provide stability to the knee and minimize stress across the knee joint :

It restrains excessive forward movement of the lower leg bone (the tibia) in relation to the thigh bone (the femur). It limits rotational movements of the knee...

What Causes An ACL Tear?

Movements of the knee that place a great strain on the ACL can cause damage to the ligament. Hyperextension of the knee, that is, if the knee is straightened more than 10 degrees beyond its normal fully straightened position, is a very common cause of an ACL tear. This position of the knee forces the lower leg excessively forward in relation to the upper leg. Pivoting injuries of the knee with excessive inward turning of the lower leg can also damage the ACL....

Non-Athletic-Related Injuries
Non-sport related injuries to the ACL result from similar contact and non-contact stresses on the ligament. Examples vary from being struck on the outer side of the knee to landing on the knee forcing it into an overstraightened position with the knee turned inward....

Diagnosing An ACL Tear

The diagnosis of an ACL tear is based on: A ] Physical Examination The physician will take a thorough history addressing how the injury occurred and ascertaining when the pain may have first appeared. Questions regarding any earlier knee injuries are important as often ligaments and cartilage structures may have been previously strained. Any previous episodes of knee instability or the knee giving way is important information. B ] Radiographic Evaluation Acute knee injuries generally warrant x-ray films. They are carefully evaluated for any possible tearing away of bone where the ligaments attach. Also, the x-ray will show any loose bone fragments or other fractures if they are present. C ] MRI Magnetic resonance imaging is a noninvasive test that produces an excellent image of all parts of the knee. In this test, the individual lies in a hollow cylinder while powerful magnets create signals from inside the knee. These signals are then converted into a computer image that clearly shows any damage to the structures inside the joint. D ] KT 1000 An instrument called the KT 1000 is a device that can give information about the integrity of the ACL. It allows the or therapist to measure the amount of forward motion of the lower leg in relation to the upper leg. It is used frequently. Both knees are usually tested and then compared. This device also accurately measures the amount of backward movement of the knee joint....

What Can Be Done For An ACL Tear?

The initial goals of treatment immediately after injury are to reduce pain and swelling and regain range of motion and strength. Even if the surgery is likely, achieving as much knee motion and strength as possible can greatly reduce complications after surgery... Immediately after the injury The physician may request very gradual weight-bearing exercise immediately after the initial ACL injury. Braces used early after the injury are called rehabilitation kneebraces and are off-the-shelf designs used for conservative treatment of the ligament tear....

Post-Injury Exercises

As the swelling in and around the joint decreases and weight-bearing progresses, mild strengthening exercises are started. Quadriceps sets are one example of strengthening exercises at this stage. With the knee placed at approximately 10 degrees from being straight, along with a small towel roll directly behind the knee, the individual pushes downward into the towel roll for a count of six to 10 seconds. This is repeated 10 times. It should be done several times throughout the day... Bracing Bracing for the anterior cruciate ligament comes in two forms :

Rehabilitation Brace Functional Brace...

Functional or sport braces are available both off-the-shelf and as custom-fit. Physicians prescribe this type of brace to treat the unstable knee in people when surgery is not recommended, as well as to protect the knee in those who have had surgery....

Do I Have To Have Surgery ?

Treatment decisions for ACL tears are always individualized - tailored to each individual. The decision whether to offer surgery is based on the person's age, activity level, how unstable the knee is, and whether other structures in the knee have been injured... Reconstruction Surgery For ACL Tears If it has been decided that you are a candidate for surgery it is important to be both mentally and physically prepared. This includes understanding the injury, the surgery, and the rehabilitation goals....

How Is The ACL Repaired?

There are a number of different techniques available to repair a torn ACL Each surgeon has his preference for each particular situation. In fact we don't talk about ACL "repair" but rather about ACL "reconstruction." This is because a torn ACL cannot simply be repaired by sewing it together again. This was the method tried in the early days of repairing ACL tears, but it was shown to be ineffective. Thus, newer methods were developed which involve reconstructing the ACL ligament, including substituting a new ligament for the damaged one. Using tendons from other parts of the body as a substitute for the ACL was found to be the most effective way of reconstructing the torn ACL. Currently, the two most popular methods in use are using part of the patella tendon or using a hamstring muscle tendon... There are several available operative procedures : A ] Patellar tendon graft procedure Since it was popularized in the mid-1980s, the patellar tendon graft has been the "gold standard" choice for ACL reconstruction. This type of ACL replacement uses the middle third of the person's own patella tendon and is referred to as a bone-tendon-bone (BTB) graft....

B ] Hamstring graft procedure

Hamstring reconstruction is an alternative to the bone-patellar-bone graft fixation and is growing in popularity. In this procedure, rather than using the patellar tendon, the surgeon uses the patient's own hamstring tendon, either the semitendinosus or gracilis tendons from the same leg.... C ] Allograft procedure Another option is the use of tissue from a cadaver (a deceased person) called an allograft. Patellar tendon, hamstring tendon, or achilles tendon allografts can be used as tissues inserted and fixed with the same techniques that are used for autografts (grafts using the individual's own tissue)... Synthetic grafts Synthetic grafts (i.e., grafts made from other materials) were commonly used in the 1970s but were generally unsuccessful. There are currently no synthetic ligaments in the U.S. approved by the FDA for primary ACL reconstruction....

What Can I Expect After My ACL Reconstruction?

For most individuals with a torn ACL, reconstruction will restore stability to the knee. Reconstructed knees are reliable and stable.