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ACL tear

The anterior cruciate ligament (known by the acronym ACL) is one of the four most important ligaments in the knee. This ligament can break partially or totally due to a forced rotation from direct or indirect trauma causing mechanical stresses during sports.

Age group

All age groups are susceptible to ACL injuries especially those who play sports or perform strenuous jobs.

Anatomy of the cruciate ligament

The ACL is a bundle of fibrous tissue that guarantees the stability of the knee rotation and the tibia’s anterior translation movements on the femur. The tibia with the posterior cruciate ligament crosses at the centre of the joint, giving stability during the entire range of motion. This is especially true during torsion or pivot movements of the knee.

Symptoms

If the ACL is injured, one of the most noticeable symptoms (in addition to acute pain) is the sensation of knee failure. At the moment of the trauma, some patients report hearing a popping noise. Within hours of the trauma, there will be pain, swelling, and movement difficulty.

When should you call a doctor?

You should call a doctor immediately after an injury/a trauma.

Diagnostic tools

The extent of the injury to the ACL is evaluated during the orthopaedic visit with tests such as the Lachmann test, the Jerk Test and the Anterior Drawer test. Additional radiological examination of the knee might also be required to verify the presence of bone fractures and an MRI to assess the extent and type of anterior cruciate injury and identify any meniscal and ligament injuries.

What to do in the meantime

Rest the knee, use crutches to walk with only a light load applied to the affected knee, apply ice (not in direct contact with the skin), take painkillers, and possibly stabilize the joint with a knee brace if the feeling of instability is not tolerable.

How to prevent ligament injury

Since these injuries can be the result of direct or indirect trauma, it is not possible to prevent the injury completely, but you can minimize the risk by improving ligament health with physical activity aimed at strengthening the knee muscles.

Conservative therapies

Conservative therapy is only recommended in a few cases, particularly when the patient is an elder or lives a sedentary lifestyle. In these cases, a period of rest associated with anti-inflammatory drugs and the application of ice is suggested together with a physiotherapy program to recover the range of motion and functionality of the knee. Surgery is always recommended in young patients, especially those with high functional demands or involved in sports activities characterized by knee twisting movements (e.g., football, basketball, volleyball, rugby, skiing, etc.). Anterior cruciate reconstruction or repair operation reduces the risk of knee instability or injuring the menisci and cartilage, thus reducing the risk of developing knee arthrosis in the future.

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