Anterior Cruciate Ligament (ACL Injury)

When you suffer from an Achilles tendon injury, such as tendinitis, an Achilles tendon rupture, Haglund's Syndrome or retrocalcaneal bursitis, your knees may experience unbalanced loads as you favour your sore ankle. This can cause excess strain on one of your knees, over working your ACL (anterior cruciate ligament) and causing it to experience tears.

The anterior cruciate ligament (ACL) is the key ligament which bonds together the upper and lower parts of the leg at the knee, stabilizing the knee and limiting the rotation and forward/backward motions.

In the United States, it is estimated that ACL injuries happen to 1 in every 3000 people and usually occur when the foot is planted firmly and the knee pivots, twists or overextends suddenly. ACL injuries account for more than two-thirds of all knee injuries in skiers and are fairly common in other sports such as volleyball, basketball, and racket sports.

A ruptured ACL is typically diagnosed by a doctor - an MRI exam is advisable, as this can also identify whether the meniscus (cartilage in the knee that provides cushioning) is damaged as well. Some ACL tears caused by a blow to the knee are accompanied by meniscus and MCL tears. When this occurs, it is referred to as the "unhappy triad". If your meniscus is damaged, you should definitely avoid exercises that could aggravate this condition.

To prevent ACL injury it is important to have strong quadriceps and hamstrings muscles. Women experience ACL tears 7-8 times more frequently than men due to hormonal and anatomical differences. Women tend to have stronger quadricep muscles at the front of the thigh compared to their hamstrings at the back of the thigh. This creates an imbalance that can increase the stress on the ACL when landing a jump.

Once the ACL has been damaged, an individual's risk of developing knee osteoarthritis (degeneration of the joint cartilage) later in life is 9 times higher.

If the anterior cruciate ligament is torn, surgery may be recommended by your doctor, however, there are occasions when surgery is not necessary, or not worth the potential for further damage. This is because the ACL is not always crucial for people that do not exercise heavily. As with all recommendations for surgery, it is usually advised to get a second opinion.

Symptoms

Minor ACL tears may go unnoticed at first but will appear a few hours later with pain and swelling. Even with a slight tear, your knee may feel unstable and may 'give way' with sudden movements.

More serious ACL tears or ruptures are accompanied by severe pain and often a popping sound. Swelling in the knee usually gets worse for several hours following an ACL tear, with the most rapid swelling occuring within the first 4 hours. The knee may feel as though something has snapped and walking or bending the knee is usually impossible.

Diagnosis

To diagnose an ACL tear, the doctor will move the knee in several positions and examine the knee strength and stability. Common exams used to diagnose an ACL injury include:

• Palpation and observation is often the first step in diagnosing. The joint will be examined for swelling, bruising and deformities. Next the doctor pressing lightly on the knee to check for the degree of tenderness, swelling and warmth. Some tenderness usually indicates a mild, or grade 1, ligament sprain and acute pain indicates a more serious injury such as a tear.
• The doctor will also assess the range of motion at the knee. You will be asked to bend and straighten your knee and then the doctor will bend it for you to check for limitations due to pain and swelling.
• An arthroscopy may also be used to allow the doctor an internal look at the ligament. A tiny camera is inserted into the knee and the doctor can use a small surgical instrument to gently tug at the ACL to determine the extent of the damage. An arthroscopy can be performed on an outpatient basis.
• After a physical exam has been completed, an x-ray may be required to rule out the possibility of a bone fracture.
• A magnetic resonance imaging (MRI) scan may also be done to determine the extent of the ACL injury and to discover whether the menisci or any other ligaments have been damaged.

If ACL reconstructive surgery is necessary, remember that proper post-surgery rehabilitation is very important, perhaps even more important than the surgery itself. Activities should set out to promote healing, increase flexibility in the knee and strengthen surrounding muscles. Your physical therapist will probably set up a "passive range of motion" program, and put you in a hinged knee brace for a month or two to prevent hyperextension or hyperflexion in the knee. An important point for ACL patients to remember after surgery is that every effort must be made to increase range of motion and flexibility at the knee.

ACL Treatments - What You Can Do!

Treatment differs from case to case depending on the degree of instability in the knee and the patient's activity level. Treating an ACL injury with rest, Cold Compression, Ultrasound Therapy, and Blood Flow Stimulation Therapy will speed healing and improve the function of the knee so you can return to your normal activities. Once the ACL has improved and activities can be resumed, you will first want to build muscle strength around the knee under the guidance of a physical therapist.

Using these therapies after surgery will control pain and swelling, reduce tissue damage, speed healing and treat the scar tissue resulting from the healing process. You will have a healthier knee with a greater range of motion than if your recontructed ACL was left untreated.

Cold Compression Therapy

Using cold compression immediately following an ACL tear reduces pain and swelling and reduces the tissue damage that occurs with soft tissue injuries like ligament tears.

The Knee Freezie Wrap^® allows you to treat yourself in an effective and convenient way following an ACL tear, if re-injury occurs (which is common due to the instability of the knee), or following surgery if it is required.

Cold Compression Therapy works by interrupting and slowing nerve and cell function in the damaged area. This is important because once blood vessels are damaged, they can no longer carry oxygenated blood to the damaged ACL and cells begin to break-down.

The deep cold provided by the Knee Freezie Wrap^® slows cell function thereby reducing cellular break-down. Furthermore, because the cold wraps serve to numb the nerves, the wraps also reduce pain! The Knee Freezie Wrap^® uses a deep cold gel pack with a medical-grade neoprene compression cover to keep the ice off the skin preventing cryoburn and to keep the cold in the area that you need it.

Ultrasound Therapy

Ultrasound Therapy increases tissue elasticity while promoting the flow of blood (filled with vital oxygen and nutrients) to your injured ACL. This cleans the injured area by getting rid of damaged tissue and reducing the inflammation surrounding the ACL to open up the blood vessels and begin healing.

During the healing process, scar tissue builds on the ligament and can attach the ACL to the PCL or other surrounding tissue in the joint, limiting the flexibility in your knee. Fortunately, you can treat your ACL with therapeutic ultrasound to soften scar tissue and improve your range of motion.

Not only does ultrasound aid in the duration of healing, but it helps to prevent long term complications. Pain, scar tissue, lack of mobility and arthritis are some of the more common long term complications of an ACL injury. By treating your ligament with ultrasound, scar tissue is softened reducing the risk of chronic problems in the future.

For those who suffer from long term complications of existing knee injuries, ultrasound can help. Ultrasound therapy can break up scar tissue in the affected area.

Ultrasound can also be used to administer therapeutic medicines into the body. This is a process known as phonophoresis. Ultrasound with phonophoresis is rapidly becoming more popular than ultrasound therapy alone.

Phonophoresis can be received using a MendMeShop^® Ultrasound Therapy System. The treatment is safe, easy, painless, and generally requires between 5 - 10 minutes.

Ultrasound is based on a form of deep tissue therapy, which is generated through high frequency sound waves (that we can not hear). These waves send vibrations deep into your body and slightly increase the temperature of your soft tissue cells. The waves are delivered through a hand held transducer and conductive gel that are used together in a slow, circular motion on your skin over the injured area.

Once the inflammation and swelling of an ACL tear has been alleviated, nourishing and strengthening the ligament tissue is recommended. Using Blood Flow Stimulation Therapy will speed your recovery and heal your ligament more completely preparing it for leg strengthening exercises. Talk to your doctor or physical therapist to find out which exercises are appropriate for your situation.

Blood Flow Stimulation Therapy

After the inflammation and swelling is gone you can begin to treat your ACL tear with Blood Flow Stimulation Therapy, or BFST^®. BFST^® increases the amount of blood that flows naturally to your knee to nourish cartilage, muscles, tendons, and ligaments to speed healing.

By treating yourself with Blood Flow Stimulation Therapy you can increase your body's blood supply to the knee and your body's natural healing power. In addition, the fresh blood flow whisks away dead cells and toxins that have built up from the injury leaving the area clean and able to heal faster. Our Knee Inferno Wrap^® provides effective, non-invasive, non-addictive pain relief and healing with no side effects.

During your recovery, you will probably have to modify and/or eliminate any activities that cause pain or discomfort in your knee until your pain and inflammation settle. Taking the time to care for your knee properly will have your knee back to normal faster and allow you to get back to the activities you enjoy.

With these 3 easy therapies you will notice incredible improvement in your knee. The more diligent you are with your treatment and rehabilitation, the faster you will see successful results!

Surgery and Recovery

If an injured ligament does not strengthen appropriately or you continue to experience the knee giving way, arthroscopic surgery and ligament reconstruction may be necessary.

If ACL reconstructive surgery is necessary, remember that proper post-surgery rehabilitation is very important, perhaps even more important than the surgery itself.

An important point for ACL patients to remember is that after surgery, every effort must be made to increase range of motion and flexibility at the knee. Weakness in the knee can usually be eliminated by extra strengthening exercises, but increased stiffness can sometimes be permanent if not scar tissue is not treated.

Not only will ultrasound reduce the pain and inflammation in your knee, but will help increase the range of motion in your joint, reduce post operative scar tissue and increase flexibility in the surrounding muscles, tendons and ligaments. Ask your physical therapist about ultrasound and if it's right for your reconstructed ACL! As with all medical devices, make sure your physician is aware of any treatment plan you decide to take.

If your knee is unstable or weak, wearing a brace during exercise and activity can reduce the risk of reinjury to the ligament while your knee is regaining strength.

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