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Anterior Cruciate Ligament Centre Our clinic has excelled in developing pathways for ACL diagnosis, managment - surgical pathways, working closley with top ACL surgeons in Belfast and Dublin to facilitate speedy diagnosis and return to play - full function.
How would you know it was damaged?: An Anterior Cruciate Ligament (ACL) tear is a fairly common knee injury in sports that involve changing direction and turning. The ACL lies deep within the knee joint, connecting the thigh bone with the shin bone. The function of the ACL is to prevent excessive forward movement of the shin in relation to the thigh and also to prevent excessive rotation at the knee joint. The ACL plays a major role in maintaining knee joint stability.
An ACL injury can occur in several different ways, most notably by landing from a jump onto a bent knee then twisting, or landing on a knee that is over-extended. In collision sports, direct contact to the knee from opponents can cause an ACL injury. Because of the amount of force that is required to damage the ACL it is not uncommon for other structures within the knee such as the meniscus or medial ligament to also be damaged.
During the acute stage of the injury (the first 48-72 hours) exact diagnosis is very difficult due to the gross swelling around the joint. The initial goals of physiotherapy treatment are to reduce knee pain and knee swelling. Ice packs can be applied for periods of twenty minutes every couple of hours (never apply ice directly to the skin as it can cause an ice burn) to relieve pain and reduce bleeding within the tissue. The Aircast Knee Cryo/Cuff is the most effective method of providing ice therapy and can be used for the home treatment of knee injuries and knee pain. It can provide continuous ice cold water and compression for 6 hours to significantly reduce knee pain and knee swelling.
Once the initial treatment for the swollen knee has taken effect, the clinical diagnosis may be possible. This may be achieved by the medical personnel performing stress tests on the knee ligaments - the degree of laxity within the joint will allow the clinician to estimate the degree of damage. If there is any doubt, or to confirm the clinical tests, the patient is sent for further investigations. Most commonly an MRI scan is used to ascertain the level of knee injury.
The treatment of the ACL injury is dependent upon the amount of damage and the subsequent functional impairment, the age of the patient and the level of sporting activity. If the diagnostic investigations reveal only a partial tear of some of the fibres of the ACL, and there is minimal instability, then a conservative approach with a physiotherapist is usually indicated. This option is also more likely for more sedentary individuals. In the case of individuals who are involved in a high level of sport where a degree of instability is functionally unacceptable, then ACL reconstruction knee surgery is the surest way to restore normal function.
ACL reconstruction knee surgery has evolved beyond recognition since the first ACL repair in 1963. Development has continued since then and the latest surgical technique uses a strip of the patella tendon from the patient's knee, or a section of the lower hamstring [semi tendonosis] as a graft to replace the ACL.
In addition to advances in the surgical procedure, there have been advances in post-operative rehabilitation that have seen a return to sports activity, in most cases, in seven to nine months.
Paul McCormac with Enda Gormley during his ACL rehab Feb 1993 - went on to win the 1993 ALSTAR & All Ireland.
Download our ACL programme at our patient centre. Look out for our programme videos on youtube coming soon 2008.
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