Physio for ACL injury treatment
The ACL is the anterior cruciate ligament of the knee. It forms one-half of the cruciate ligaments and is responsible for stopping the tibia from sliding forward under the knee. An ACL injury has several types. It can be a strain where there’s an injury to the ligament but it is still intact or a full rupture of the ligament. There is a third type which is post-operative ACL, which usually refers to an ACL reconstruction where tissue from elsewhere in the body is used to help rebuild the ACL.
How does an ACL injury happen?
Most often, the injury happens quickly when changing direction or landing in sport. They can often be due to the weight supporting leg being in knee valgus (knee pointing inwards) and hip internal rotation while the tibia is externally rotated (see here) while being loaded when changing direction or landing. Other common causes are a side impact or other external force, such as a shove.
ACL Injury Grading
ACL injuries have 3 grades
- The ligament is stretched but not torn
- A little pain or swelling
- No feeling of being unstable
- No laxity under testing
- Partial tear
- Moderate swelling and loss of function
- Will feel unstable and may give way
- Some movement and pain under physio testing
- Full tear
- Some tenderness but often pain is actually markedly low
- May find a range of swelling from maximal to minimal
- No control of certain knee movements
- Lots of movement under physio testing
- Some bleeding in the joint
Does a torn ACL need surgery?
The answer is not always, for example, many elite sportspeople have returned to full play with no ACL (see here).
They can achieve this through a lengthy rehabilitation process. The purpose of which is to retrain the lower limb to have the strength and muscular control to replace the job of the ACL.
Whether this achievable is largely dependent on the scale of the injury and if other structures have been involved. For example, a lax medial collateral ligament (MCL) is often found after an ACL rupture and a sufficiently lax MCL maybe mean that it is impossible to control the knee fully in certain positions.
Your physio will advise you on your options for your best recovery and return to sport.
Do I need an MRI (magnetic resonance imaging) scan?
An MRI scan is useful to confirm an ACL strain. It provides information on the grade of the injury and will show if other structures have been injured (see below).
What does the Rehab process involve?
The rehab process can be a lengthy and intensive process whether conservatively managed (no surgery) or post ACL reconstruction. It consists of:
- An initial phase of recovery from injury or surgery with appropriate mobility and low-grade strength exercises.
- A strength and neuromuscular control phase. This phase increases the leg’s capacity to accept a load.
- A functional phase, which comprises of training complex movement, such as running, jumping, landing and change of direction.
- A graded re-introduction to the sport.
What else could be injured?
As mentioned before Medial collateral ligaments can also be injured as well as Cartilage (meniscus) tears and sometimes the Posterior Cruciate Ligament (PCL)
An often overlooked injury to the Postero-Lateral Corner can sometimes also have occurred. It is important that you physio identify if your PLC is intact, as failure to address this can cause complications later.
If you have recently had an ACL injury you will have many questions. We are always happy to chat with you so please contact us by email or telephone if you have any queries and we can guide you on your next steps in your programme.
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