Anterior Cruciate Ligament Tears

The Anterior Cruciate Ligament or ACL is the ligament present in the knee’s center connecting the thighbone (femur) to the shinbone (tibia). It also acts as the main stabilizing ligament. The main function of ACL is to prevent Hyperextension, a position in which the body parts and the joints are extended to high angles.
ACL tear is a common knee joint injury caused by an abrupt change in direction resulting in the overstretching of the ACL. Athletes playing high impact sports like Football, Cricket, Hockey etc., are prone to this injury.

The other causes of ACL tears are:

• Sudden change in direction
• Sudden slowing down or stopping while running
• Incorrect landing during a jump
• Trauma to the knee from a collision or tackle
• Vehicle accidents                                                                                                                                

The patients usually experience some of the following symptoms:

• Loud popping sound
• Knees giving out from under you
• Swelling
• Tender knee
• Problem while walking

In some cases, an untreated torn ACL can cause degeneration of the knee leading to arthritis.

Treatment

Non-Surgical Treatment

ACL tears usually need surgical intervention but in some cases, non-surgical treatment methods can prove effective, in the case of the elderly and very less active patients. If the stability of the knee is intact, the doctor might recommend the following:

• Bracing of the knee to provide stability and walking on crutches to prevent giving weight to the leg.
• Physical Therapy is recommended to strengthen the knee and restore its functionality.

Surgical Treatment

The ACL tear is usually treated by performing the ACL Reconstruction Surgery, where the ACL is reconstructed by replacing the damaged ligament using the tissues around your knee joint, helping to restore the knee’s function after an injury. This replacement tissue is called the Graft.
The graft is usually a segment of a tendon, which is a tissue similar to the ligament that connects muscle to the bone. The different sources for a graft are:

• Bone Patellar Tendon
• Hamstring Tendon

The Hamstring Tendon is the more preferred graft source for the reconstruction surgery, since they reduce the risk of re-injury due to the following properties:

• High Load to Failure strength
• Stiffness of this graft

The Procedure

The graft placement and positioning is the key factor for proper functioning of the knee and restoration of the physiologic kinematics of the knee joint in ACL reconstruction. The ACL reconstruction surgery can be performed by -

• Key-Hole or Arthroscopic Surgery

The knee arthroscopy is a more preferred surgery option due to its faster operating and recovery times and lesser complications when compared to the open surgery. The surgeon will make small incisions to insert the tiny arthroscope to guide the small instruments to perform the surgery.
After the surgery, patient will have a rehabilitative therapy. A successful ACL reconstruction surgery along with this rigorous rehabilitation can help restore the knee’s stability and function and the patient can get back to their regular activities.
In some knee arthroscopies, the surgeon might use Bio-Absorbable implants which will dissolve into the body tissues. Some of the advantages that these implants provide are:

• No distortion in CT or MRI scan images unlike metal screws
• Avoids another surgery to remove the implants