Overview
ACL or Anterior Cruciate Ligament is one of the 4 main ligaments in the knee joint. Ligaments are rubbery ropes that connect and hold the 2 bones together. ACL along with its fellow ligament PCL in the center of the knee joint protects and stabilizes the knee against translational forces (front to back) and also against rotational forces (twisting).
Why & how does it happen?
ACL tear are one of commonest injury to the knee joint. It typically happens when the knee is twisted suddenly while the foot is still planted on the ground. When the twisting forces overwhelm what the ACL can manage to resist, the ACL tear occurs. Majority of the ACL injuries occur due to non-contact in the sense without a direct injury to the knee.
Who gets this injury?
We see this typically in sporting population such as footballers, basketball players, cricketers, badminton and so on. Fall from the two wheelers, bikes and cycles are another common reason for this injury. Typical age group is 20 to 45 years.
Symptoms
Natural History (Progression of disease in the absence of treatment)
The ACL tear will gradually become pain-free over a period of few weeks. However, as ACL cannot heal naturally, the instability and pain on sudden change of direction of twisting movements of the leg persists indefinitely. That can over a period of time lead to further soft tissue injuries (meniscus and cartilage) in the joint and arthritis at the earlier age than anticipated.
Natural History (Progression of disease in the absence of treatment)
The Achilles tendon tear leads to loss of power to propel the body weight over the forefoot. The tear does not heal naturally. Although pain resolves over a period of few months, clumsiness with walking over the steep surfaces and climbing the stairs up and down perseveres for long term.
When to seek medical help?
Initial assessment, an x-ray and pain relieving medicines is what is needed as an immediate remedy. Further assessment by an expert Arthroscopy Surgeon and MRI scan are necessary to analyze the extent of injury.
What happens to ACL if no treatment is undertaken?
ACL does not heal by itself as it has poor blood supply and the joint fluid in the knee does not allow it to heal. In spite of ACL injury, one can walk, cycle, swim, do certain gym activities and even run on a treadmill once the pain has improved after few weeks. However, activities such as running criss-cross, going up and down the stairs, on the ground/court games or even something as simple as running behind a bus in a tangent way can lead to pain or feeling that something is going to give away.
Secondly as the knee will keep on skidding, it increases wear and tear in the joint leading to osteoarthritis at an earlier age than expected.
What happens when I visit the Consultant?
You will be asked about the nature of injury, symptoms further to that so far. Consultant will examine you and discuss the treatment modalities.
What are the treatment options?
A partial ACL tear may still be treatable with PRP Injections, however, a complete treatment often needs an ACL repair / reconstruction surgery.