The anterior cruciate ligament (ACL) is important for maintaining stability of the knee joint, particularly with movements involving weaving, pivoting or kicking. If the ACL ruptures, the knee can become unstable. Damage to ligaments is graded I to III; grade III being the most severe and indicating a complete ligament rupture. The surgical treatment for this type of injury is an ACL reconstruction/repair (ACLR). For self-help exercises for treating ACL repairs, you can go to our Instagram page via a link at the end of this article – “How to Treat ACL Repairs”. Make sure you follow us on Instagram for more great health and fitness tips and advice.
Now, it is important to note that not every person that damages their ACL requires surgery, and those that choose the conservative management route can still return to high level sport without deficits, if a complete rehabilitation program is followed.
In regards to surgical management, the goal of reconstructive surgery is to restore stability and to maintain full mobility of the knee joint. The most common type of ACLR is using a tissue graft from the subjects hamstrings, specifically the semitendinosus muscle, to create a new ACL.
Post-operative care involves working closely with your physiotherapist and following a rehabilitation program. The aim will be to focus on regaining your muscle strength, particularly of your quadriceps (front of thigh), hamstrings (back of thigh) and hip muscles, as well as normalising your movement patterns for hopping, running, jumping and landing. Following the advice from your physiotherapist and completing your rehabilitation plan will significantly minimise the risk of re-injury.
Essential Anatomy
To better understand ACLR, it is important to understand some basic human anatomy.
The knee has four main ligaments. Two located inside the knee joint, anterior and posterior cruciate ligaments, and the others located on the outside of the joint, the medial and lateral collateral ligaments. The ACL is a band of dense connective tissue which runs from the back of the femur (thigh bone) to the front aspect of the tibia (shin bone). The ACL is a key structure in the knee joint as it resists the shin bone sliding forward or rotational loads of the knee.
The knee is supported by the quadriceps and hamstring muscle groups, as well as the calf muscles. The hamstring group is made up of biceps femoris, semitendinosus and semimembranosus muscles. It is of these muscles that a graft is taken to build a new ACL during reconstructive surgery.
What causes ACL Injuries?
An ACL injury usually occurs during a twisting movement, sudden stopping, or incorrect landing from a jump. These movements are most commonly seen in sports such as netball, basketball, football and soccer. ACL injuries usually occur when the foot is in contact with the ground and the knee is suddenly forced backwards, or if the knee is slightly bent and collapses inwards.
Physiotherapy Treatment
Post-operative care of an ACLR is very important. The major goals are to:
- Gain good functional stability
- Repair muscle strength
- Reach the best possible functional goal
- Decrease the risk for re-injury
In addition, any problems with flexibility, control and strength of the hip, knee and ankle will be addressed during your rehabilitation.
Mobility
Common flexibility issues include:
- Tight musculature of the hamstring muscle group (back of thigh)
- Tight musculature of the quadriceps muscle group (front of thigh)
- Tight musculature of the hip/buttock region (ie. gluteal muscles)
- Tight calf muscles
- Stiff knee joint
- Possibility stiff ankle and hip joints
To address these, we use manual therapy and soft tissue massage, as well as teaching our clients to stretch and perform self-treatment with tools, such as foam rollers.
Control
Control refers to the ability for an individual to monitor and adjust their body position and posture through a variety of different settings. When it comes to ACLR, control of the hip, knee and ankle joints is very important. Your physiotherapist will assess your control to determine if this a contributing factor to the problem.
In many cases, control exercises have a beneficial therapeutic effect as they introduce the body to a safe and pain-free ranges of motion that the person may not have been aware of.
Strength
Strength is very important when it comes to the rehabilitation of ACLR. Strong and resilient tissues promote optimal function and are less likely to become tight or weak. Therefore, it less likely these structures will send the brain pain signals when under pressure from increased loaded activities.
Summary
In summary, if you have had a recent ACL reconstruction remember:
- It is important to follow the advice of your physiotherapist during your rehabilitation to get the best possible outcomes after surgery
- Flexibility, control and strength deficits need to be identified and addressed during your rehabilitation
- Strictly following your rehabilitation program will minimise the risk of re-injury and get you back to to sporting and physical activity
If you have had a recent ACL Repair, book in with your physiotherapist for a thorough assessment using this link – FREE INITIAL ASSESSMENT. Once the cause has been identified the road to recovery can begin.
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