Should you worry about an ACL in­jury?

An in­jured an­te­rior cru­ci­ate lig­a­ment (ACL) isn’t easy but it’s also not an end to your ac­tiv­i­ties. Dr Sidik Che Kob, a con­sul­tant or­thopaedic and arthro­scopic sport sur­geon from Co­lum­bia Asia Hos­pi­tal, Klang, talks about its preven­tion and treat­ment.

Shape (Malaysia) - - HEALTH HIGHLIGHT -

What is ACL?

The an­te­rior cru­ci­ate lig­a­ment con­nects the fe­mur (thigh­bone) and tibia (shin bone). It runs di­ag­o­nally at the mid­dle of the knee, and func­tions to stop the tibia from slid­ing out in front of the fe­mur. It is a key sta­bi­lizer to your knee, es­pe­cially dur­ing sport in piv­ot­ing ac­tiv­i­ties.

Who is prone to it?

Fe­male ath­letes are known to have a higher risk of an ACL tear. Biome­chan­i­cal stud­ies sug­gest that women’s wider pelvis, makes the thigh­bone an­gle down­ward more sharply than men’s, cre­at­ing a knock knee ten­dency in women. Hor­mones have also been named as cul­prits since es­tro­gen af­fects the lax­ity or loose­ness of the joints. Greater joint lax­ity means greater stress on the lig­a­ments.

How to pre­vent an ACL in­jury?

If you’re an ac­tive per­son, you can con­sider sev­eral ex­er­cises or phys­io­ther­apy. You could take part in train­ing drills that re­quire balance, power and agility. Adding ply­o­met­ric ex­er­cises like jump­ing, and balance drills help im­prove neu­ro­mus­cu­lar con­di­tion­ing and mus­cu­lar re­ac­tions to re­duce the risk of in­jury. It’s also im­por­tant to warm up, stretch and cool down when you’re en­gag­ing in an ex­er­cise or sport. Also, con­sider grad­u­ally in­creas­ing the in­ten­sity and du­ra­tion of train­ing, and al­low ad­e­quate re­cov­ery time be­tween ex­er­cise or train­ing ses­sions. Wear­ing the right pro­tec­tive equip­ment in­clud­ing footwear helps to sta­bi­lize your legs. For ath­letes, many team physi­cians now rou­tinely rec­om­mend an ACL con­di­tion­ing pro­gramme for fe­male play­ers. Plan­ning at least four weeks of en­durance train­ing be­fore sport­ing sea­sons also pre­pares the body for the chal­lenge.

Treat­ment for an in­jured ACL?

The best way to avoid an ACL re­con­struc­tive surgery is to un­der­take a com­pre­hen­sive ACL-de­fi­cient knee re­ha­bil­i­ta­tion pro­gramme that in­volves leg strength­en­ing, pro­pri­o­cep­tion and high-level balance re­train­ing, sport-spe­cific agility and func­tional en­hance­ment. Your phys­io­ther­a­pist is an ex­pert in the pre­scrip­tion of ACL tear ex­er­cises. If your knee in­sta­bil­ity symp­toms per­sist dur­ing sport ac­tiv­i­ties de­spite ad­e­quate phys­io­ther­apy, you may con­sider an early ACL re­con­struc­tion surgery. This pro­vides the best chance of hav­ing nearly nor­mal knee func­tion af­ter an ACL tear with limited dam­age to the knee car­ti­lage layer. Cur­rent arthro­scopic ACL re­con­struc­tive surgery has about a 90%-95% suc­cess rate. The surgery aims to achieve a sta­ble knee with­out pain, and the abil­ity to re­turn to stren­u­ous ac­tiv­i­ties. Dur­ing the pro­ce­dure, a lighted tele­scopic lens called an arthro­scope, is in­serted di­rectly into the knee joint to con­firm that the ACL is torn and to look for other in­juries. If there is dam­age to other parts of the knee (like in the car­ti­lage bumper), your sur­geon will treat that at the same time. Most ACL re­con­struc­tions are done by us­ing a graft or ‘donor’ ten­don from your body. A new ACL will then grow along the graft. Most com­monly, two of the ham­string ten­dons from the back of the thigh are used as a graft. The ham­string ten­dons are har­vested or re­moved from a small cut around the knee. Other graft op­tions in­clude the patel­lar ten­don or an al­lo­graft - a ten­don do­nated by an­other per­son.

Dr Sidik Che Kob

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