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Knee Injuries
More Information
| Diagnose | Repair |
Ligaments are tough, nonstretchable fibers that hold your bones together. A tear to the anterior cruciate ligament (ACL) of your knee joint is among the most common sport-related injuries. The ACL connects the thighbone (the femur) to the shinbone (the tibia) and acts to prevent your thighbone from moving too far forward over the knee joint. This ligament also helps stabilize the shinbone from rotating out of the knee joint.
The ACL can tear when it’s stretched beyond its normal range. This typically happens by sudden twisting movements, slowing down from running, or landing from a jump. Injury to the ACL can result from a direct blow to the knee, or from non-contact injuries such as making a sudden stop or landing on an extended leg. At the time of injury, you may hear an audible popping sound, and the knee will give way. Shortly after the injury, the knee will become swollen and walking will be very difficult. The swelling and pain will subside after the first few days.
A different injury to the knee to be aware of is a Meniscus Tear. A meniscal tear can also occur simultaneously with injury to other ligaments of the knee (in particular, the anterior cruciate ligament which helps to connect the upper and lower leg bones).
Following the acute injury you should use a knee immobilizer and crutches until you regain good muscular control of the leg. Extended use of the knee immobilizer should be limited to avoid quadriceps atrophy. You are encouraged to bear as much weight on the leg as is comfortable.
Crushed ice or an Aircast knee Cryocuff along with nonsteroidal anti-inflammatory medications such as Advil, Nuprin, Motrin, Ibuprofen, Aleve (2 tablets twice a day) are used to help control pain and swelling. The nonsteroidal anti-inflammatory medications are continued for 7 - 10 days following the acute injury.
In most cases, your ProSports physician will be able to diagnose and ACL injury with direct examination. In the likelihood that there may be additional injury to the joint, or if the swelling makes diagnosis difficult, your physician may conduct an MRI or arthroscope the fully evaluate the injury to the knee.
Because the ACL is not capable of healing itself (ligaments, unlike muscles, do not have their own blood supply), it can only be reconstructed (that is, replaced) surgically — it cannot simply be repaired. Less active people may choose to treat a torn ligament nonsurgically with a rehabilitation program focusing on muscle strengthening and lifestyle changes. Surgical reconstruction, however, may help many people recover full function after an ACL tear. Your doctor can discuss these different options with you and help choose what is right for you.
The decision whether or not to surgically repair the ACL depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee, and the "laxity," or looseness, of the joint.
For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.
After ACL reconstruction, performing rehabilitative exercises may gradually return full flexibility and stability to your knee. Building strength in your thigh and calf muscles to support the reconstructed knee is a primary goal of rehabilitation. You may also need to use a knee brace for a short time, and it is important not to return to full activity too soon to prevent reinjury.
ACL rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.
If you have undergone surgery for an ACL tear, the ACL protocol contains instructions and exercises to help you recover.
Knee Arthroscopy Specialists
