Anterior cruciate ligament tear is an injury commonly seen in athletes. It can be a serious injury to the ligament, interrupting the continuity of its fibers. This tear can occur, either in the middle of the ligament, or detached from the thigh or tibia.
The anterior cruciate ligament is a strong ligament that provides great stability to the knee, while also absorbing shock, preventing and stabilizing movements such as excessive knee flexion, excessive knee extension (hyperextension) and anterior displacement of the tibia relative to the thigh. .
When a rotational injury occurs to the knee (eg pivot movements, car accidents), then the deforming forces produced at the time of the injury are greater than the strength of the anterior cruciate, resulting in rupture of the ligament fibers. Ligament rupture is usually accompanied by injury to other elements of the knee, such as some damage to the menisci or collateral ligaments (unfortunate triad).
To separate the mild from the more severe tears, there are some degrees of classification of them. When the percentage of damaged fibers of the ligament show a break in the continuity of part of the ligament, then the tear is partial. But when there is a complete tear, then all the fibers are damaged. This separation can be seen graphically in an MRI, but also arthroscopically.
But a good clinical examination with good history taking and application of special evaluation tests is more important, because what really matters is not the percentage of damaged fibers, but the overall stability of the knee and the functionality of the anterior cruciate ligament.
The symptoms of an ACL tear depend on the healing phase the injury is in. In the acute phase, pain and swelling in the knee are predominant. Patients often report that during the injury, they heard a “crack” in the knee.
In the chronic phase, the swelling usually subsides and instability during rotational movements of the knee and sudden changes of direction now begins to manifest itself. Patients have the feeling that their knee is not stable or “leaves” during activities such as going up and down stairs, running, etc.
Depending on the degree of rupture, the patient’s age, his functional requirements, etc., it is decided whether the therapeutic approach will be surgical or non-surgical. However, whatever this approach is, it should be combined with an appropriately designed physical therapy plan, which aims to strengthen the muscles of the area (eg quadriceps) which will significantly help to restore instability, improve proprioception, but of course the patient’s analgesia.
