Dr Rahul Aggarwal
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ACL

WHAT IS ANTERIOR CRUCIATE LIGAMENT (ACL)

The anterior cruciate ligament (ACL) is one of a pair of cruciate ligaments in the human knee, and runs diagonally in the middle of the knee, attaching proximally to lateral femur condyle and distally to anterior tibia.

FUNCTION OF ACL

  • It provides stability to the joint by preventing the tibia from sliding out in front of the femur.

SYMPTOMS OF ACL TEAR

  • Knee swelling and pain.
  • Instability at knee- complaint of a feeling of ‘give way’ while walking, climbing up and down stairs.

DIAGNOSIS

  • Clinical examination:
  1. Lachman’s Test:
  2. Anterior Drawer test
  3. Pivot shift test
  • Radiological
  1. Xray knee AP & Lateral view
  2. MRI of affected knee - Investigation of choice

TREATMENT

  • Nonsurgical Treatment
  1. In patients with partial tears and no knee instability in low-demand person.
  2. Children with open tibial, femoral epiphysis and stable knee.

Advice:

  1. NSAIDs, ice, rest to reduce swelling and pain.
  2. Progressive range of motion exercises
  3. Progressive strength training
  4. Re-evaluation at 3, 6 and 12 months. If repeated episode of “give-way” are reported, increase in laxity seen, then delayed ACL reconstruction is considered.
  • Surgical Treatment
  1. Arthroscopic primary ACL repair:
  • Can be useful in only selective patients.
  • Patients presenting early after injury
  • Femoral side avulsion tear of ACL
  • Good ACL tissue length and quality

       2. Arthroscopic ACL reconstruction

  • Treatment of Choice
  • The ruptured ligament is replaced by a tissue graft, which can be obtained from several sources.
  1. Autografts -employing bone or tissue harvested from the patient's body.
  2. Allografts -using bone or tissue from another body, either a cadaver or a live donor.

REHABILITATION:

  1. Immediate post op: limb elevation, appropriate analgesics, a brace and cold therapy device.
  2. Patient is usually discharged on Day 2.
  3. Regular dressing of wound advised. Stitches are removed on Day 12-15.
  4. Physiotherapy
    1. Range of motion exercises started on Day 2.
    2. Muscle strength training (Open-chain) started and progress according to patient’s compliance.
    3. Patient is advised non-weight bearing mobilization on walker support upto 6 weeks.