ACL Injury Treatment
The Anterior Cruciate Ligament (ACL) is one of the major ligaments in your knee. It connects the tibia and the femur and is the main ligament responsible for controlling the stability of the knee joint during landing and pivoting actions.
An ACL injury often occurs as a sports injury as a result of a non-contact event in which an individual changes direction at speed while playing a multi-directional sport, such as AFL. This is associated with a sprain to the knee and ligament.
Many people hear a “pop” in the knee with this injury and the knee may swell immediately, feel unstable and the knee pain may be too severe to bear weight. However, on occasions, people can continue to function with an ACL injury but often do not have the confidence in turning and landing. Often this injury can be diagnosed clinically, but some cases may require an MRI to confirm. ACL injuries occur most commonly in young and active individuals and can have negative long-term impact both physically (ability to engage in multi-directional sports) and psychologically (distress due to the lack of ability to play sport), but ACL injury treatment is possible.
- How common is it?
- ACL injury risk factors
- Myths & facts about ACL injuries
- Approaching ACL injury
- Assessing ACL injury
- Treating ACL injury
How common is it?
Australia has the highest reported rates of ACL injury in the world. Research reports that over the last 15 years, the annual incidence of ACL injuries has increased by 74% among Australians under the age of 25. ACL injury most commonly occurs during sports that involve sudden stops or changes in direction, jumping and landing such as soccer, basketball, football, AFL, rugby union, rugby league, Netball and downhill skiing. It occurs in both males and females.
Risk factors for ACL injury
Females are at greater risk of ACL injury due to their anatomy of the pelvis, lower limbs and lower levels of muscle strength compared to males. Participating in certain sports can increase the risks based on high degrees of change of direction, cutting, turning and landing. Poor fitness, lower limb weakness and poor coordination increase the risk for an ACL injury. Poor footwear and poor playing surfaces are also factors that can increase risk. ACL injury is most common between the ages of 15 and 45, mostly related to people who engage in active weight-bearing sports. Having a history of an ACL injury increases the risk of re-injury and of new injury significantly. Other risk factors include obesity and deconditioning of lower limb muscles, in particular the hip muscles.
Myths about ACL injury
✖ Surgery is always necessary for ACL injury treatment
✖ I should rest my knee for 4-6 weeks after surgery before I start my rehab
✖ I need to wait at least 12 months before I can return to sport after ACL surgery
✖ I need to have surgery if I want to return to sports
✖ Surgery provides a quicker return to sport
✖ ACL injury surgery reduces the risk of arthritis in the future
✖ I do not need to complete a rehabilitation program after my ACL repair – If I just give it a year, I should be okay
✖ Exercise and loading a knee with an ACL injury is harmful for my joint
Facts about ACL injury
✔ Surgery is only one option for the treatment of an ACL injury. You need to discuss the options with your medical team. Many people can cope with an injured ACL and return to good function and sport without ACL injury treatment, but this is discussed on an individual basis.
✔ Resting your knee for too long will reduce your muscle strength and put more pressure on the knee joint. The sooner you get your knee moving the better, in most cases.
✔ Many ACL ruptures don’t require surgery if they are rehabilitated well.
✔ If you have an ACL tear, your confidence in your knee is the best predictor of outcome.
✔ Many patients and athletes can return to sports practice without surgery. In fact, evidence indicates that a non-surgical approach, including targeted rehabilitation exercises, may be a better approach to the treatment of an ACL injury.
✔ Many athletes have returned to sport faster after rehabilitation and without surgery. Returning to sport is based on your strength, agility, function (and type of graft if you’ve had surgery) and confidence with sport specific activities.
✔ Surgery does not reduce the risk of arthritis in the future. After having an ACL injury, the likelihood of having an arthritic-looking knee is high for all. However, that does not necessarily mean that everyone will develop knee pain and disability.
Approaching ACL injury
There is growing evidence that exercise programs that focus on lower limb strength, agility and coordination can reduce ACL injuries. Prevention is always better than cure. Physiotherapists at Body Logic Physiotherapy can develop sports specific prevention programs for you.
Non-surgical approach to ACL treatment
Recent research has found similar outcomes with respect to pain, symptoms, function, return to sport levels, and quality of life in people who haven’t had surgery compared to those who have. There is good evidence to suggest that many people with an ACL injury can return to sport and function at a high level without the need for surgery. Rehabilitation must target strength and functional performance, linked to a gradual increase in training load, and be guided by a return to sport timeframe. More research continues to emerge showing a good strength and conditioning program combined with proprioception, agility, landing, cutting and change of direction training can help reduce the need for surgery. This doesn’t apply to all cases but is always worth discussing with one of our physiotherapists. Often non-surgical management means you aren’t out of sport for as long and can remain safe when you return.
Non-surgical treatment of ACL injuries is not inferior to early surgery for improving symptoms, function, quality of life, sports participation, and the likelihood of developing knee osteoarthritis is no different between either approach. Current guidelines for non-surgical management of ACL injuries suggest a time frame between 3 to 6 months from commencing rehabilitation to return to play, although this can vary on an individual basis.
Surgical approach to ACL treatment
There are many types of surgery that are used to reconstruct the ACL injury with the 2 most common involving a patella tendon graft (PTG) or semitendinosus graft (STG) which is using the knee tendon or hamstring tendon respectively.
The time frames for return to sport vary depending on the surgeon and each case, but generally the surgeons prefer to use a time frame between 10-12 months. Physiotherapy after surgery is extremely important and needs to be guided to achieve the best outcome possible.
Body Logic Physiotherapy have well-structured rehabilitation programs that use similar principles as the West Coast Eagles Football Club in the rehabilitation of Nic Naitanui and Mark Lecras from their previous ACL injuries.
Assessment of ACL injury
There is strong evidence that physiotherapy interventions can be effective for ACL injuries with or without surgery. Physiotherapists at Body Logic Physiotherapy can:
- Help diagnose your knee injury.
- Advise you on what the best treatment would be for your knee following an ACL tear.
- Communicate with your Surgeon (if surgery is required), and work out the best time frames for you to get back to sport.
- Develop an exercise program that is specific to YOU.
- Perform a return to sport screening test to make sure you are safe and confident before getting back to competition.
- Be available to answer important questions you have about your knee and your rehab plan.
We will first undertake a comprehensive history in order to understand the mechanism of injury, your history of injuries, and how this injury impacts on all aspects of your life so we can help you get back to doing what you enjoy. We will also ask you about your sleep, activity levels, lifestyle and goals, so we can help you get healthy and back to doing the things that are important to you. We will also screen you to ensure the pain isn’t caused by other health problems.
Following this we will conduct a comprehensive examination. This will usually involve a clinical examination to determine the level of stability of your knee, the strength and endurance of your leg muscles, and your overall fitness if this is indicated. The examination and treatment will be tailored to each person’s needs and goals.
Treatment of ACL injury
Based on all the information from the examination, we will explain to you in simple language the factors that may have contributed to your injury, and the factors that may implicate on your recovery. The best treatments options available to you will be discussed, and a shared decision about the best option will be made.
At Body Logic Physiotherapy we aim to coach people to get back in charge of their body and their health. In this short video, you can see the journey of your ACL rehabilitation and injury treatment with one of our Specialist Physiotherapists, Chris Perkin. For more information, please get in touch with our friendly team.
‘ACL Injury Prevention Is Better Than A Cure’ – Preventing ACL injuries is better than curing them. Find out more: https://www.mickhughes.physio/single-post/2016/05/11/ACL-Injury-Prevention-Is-Better-Than-Cure
Chris Perkins gives insight into an ACL rehabilitation program: https://youtu.be/2-jFRcr8VPs