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Many athletes fear the common ACL injury
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Dr. Timothy Sweo examines a patient's knee. |
Walk into any orthopedics clinic and most likely you'll see someone there with an injury to the anterior cruciate ligament (ACL) in the knee.
Torn ACLs most often are related to high impact sports or when the knee is forced to make sharp changes in movement and during abrupt stops from high speed, explained Dr. Timothy Sweo, an orthopedic surgeon with Sports, Orthopedic and Spine in Jackson. ACL tears also can happen in older people after a slip or fall and are seen mostly in people over 40 due to wear and tear of the ligaments.
The ACL is one of four major knee ligaments. It is critical to knee stability because it prevents excessive motion of the knee joint.
People who injure their ACL often complain of symptoms of their knee giving-out from under them. Injuries of the ACL range from mild, such as small tears, to severe when the ligament is completely torn. An ACL injury can be a debilitating injury to the knee; it is seen most often in athletes.
ACL injuries can occur when an athlete rapidly decelerates and then takes a sharp or sudden change in direction (cutting). ACL failure has been linked to heavy or stiff-legged landing, as well as twisting or turning the knee while landing.
"About 80 percent of sports-related ACL tears are 'non-contact' injuries," said Dr. Sweo. "This means that the injury occurs without the contact of another player, such as a tackle in football. Most often ACL tears occur when pivoting or landing from a jump. The knee gives out from under you when the ACL is torn."
Women playing sports like soccer, basketball, tennis and volleyball are significantly more prone to ACL injuries than men. The discrepancy has been attributed to differences between the sexes in anatomy, general muscular strength, reaction time of muscle contraction and coordination and training techniques. Several women's college sports programs have reduced ACL tears through a training program that teaches athletes how to minimize the stress they place on their ACL.
You can tell if your ACL may be torn if you heard a popping sound as the injury occurred, swelling occurred after a couple of hours, you have severe pain when bending your knee and your knee buckles or locks during movement or gives way while standing still with weight on the affected knee.
"Pain – also a major symptom in an ACL injury – can range from moderate to severe," Dr. Sweo said.
"On examination, your doctor can look for signs of instability of the knee. Special tests place stress on the ACL and can detect a torn ligament. An MRI also may be used to determine if the ligament is torn."
ACL tears do not necessarily require surgery if the ACL is not completely torn, Dr. Sweo said. Many patients start to feel better within a few weeks of the injury. The knee may feel normal again, but problems with instability may persist.
"Some people are able to live and function normally with a torn ACL," said Dr. Sweo. "However, some continue to complain of instability, worrying that their knee may "give out" with physical activity. Unrepaired ACL tears may also lead to early arthritis in the affected knee."
ACL reconstruction is the usual surgery for an ACL tear. "A repair of the ligament is rarely a possibility, and thus the ligament is reconstructed using another tendon or ligament to substitute for the torn ligament," said Dr. Sweo.
"The ACL lies in the middle of the knee; it prevents the tibia from sliding out in front of the femur and provides rotational stability to the knee. Adults usually tear their ACL in the middle of the ligament or pull the ligament off the femur bone. These injuries do not heal by themselves."