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What is the Anterior Cruciate Ligament (ACL)?
The Anterior Cruciate Ligament (ACL) is a ligament which is located within the knee joint, attaching at the top of the tibia (shin bone) and bottom of the femur (thigh bone). The role of the ACL is to provide stability to the knee joint during dynamic, multi-directional movements such as twisting and pivoting. Like all ligaments, the ACL is made up of thick, fibrous tissue which is supposed to have a small amount of give, but once the slack of the ligament is taken up it should not stretch any further, or tear. Different people will have different levels of laxity in their ligaments due to genetic factors.
How is the ACL Typically Injured?
The ACL is often injured in sudden movements, such as stopping, pivoting, twisting, landing or changing the direction of the body. More specifically, the ACL is often at higher risk of injury under non-contact, planted foot, knee extended (straightened) and dynamic inwards rotation of the knee (knee valgus). The final factor that is typically involved in common ACL tears is a lack of control of the centre of mass (COM) of the body in relation to your leg.
Who is Most Likely to Sustain a Torn ACL?
- Those most likely to sustain a torn ACL, typically fall into the categories below:
- Multi-directional sports (more commonly team sports)
- Females (anywhere from 2-8x more likely than males, depending on the sport)
- Young athletes (19-25yrs for males, 14-18yrs for females)
- Those who have experienced an ACL tear previously (more likely to tear the ACL in the opposite knee)
What are the Treatment Options for a Torn ACL?
Treatment options are often separated into two different categories, surgical and non-surgical. There is no set method to determine a one-size-fits-all decision as to whether an individual requires surgical or non-surgical management. More commonly, each individual will require a physical assessment from multiple health-care professionals, including general practitioner, physiotherapist and an orthopaedic surgeon. At this point, personal factors will be considered alongside the outcome of physical assessment, which will then guide the individual towards a recommended management plan of either surgical or non-surgical management.
What Does ACL Rehab Look Like?
ACL rehab is a long-term process, which is currently estimated to be between 6-9 months for elite level athletes, and 9-12+ months for recreational athletes. The journey is much less guided by time, but more so guided by physical progress in movement control, muscular endurance and strength, impact and load tolerance and much more. Each individual will have their own requirements to meet, depending on their goals, but ACL rehab has undergone high levels of research as the injury became more prevalent. This has led to some rehab protocols being formed by high level surgeons, doctors, physiotherapists and sports physicians as a form of best practice. These are commonly followed to ensure that the correct standards are being met before meeting certain milestones (running, jumping, change of direction, return to training, return to playing etc.)
Author: Jacob Calvert, Physiotherapist