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.
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