March 8, 2024
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ACL Injury
Description of ACL Injuries
The anterior cruciate ligament, or ACL, is one of the four major ligaments that provide stability to the knee joint. Ligaments play a crucial role in stabilizing the knee, connecting the femur (thigh bone) to the tibia (shin bone).
The ACL is essential for maintaining knee stability, especially during activities that involve pivoting, cutting, or sudden changes in direction. ACL injuries are prevalent among athletes across various sports and competitive levels. In the United States alone, approximately 200,000 ACL injuries are reported annually. Sports such as soccer, football, skiing, lacrosse, and basketball pose a higher risk of ACL injuries. Notably, the incidence of ACL tears is higher among female athletes compared to male athletes across most sports.
Symptoms of an ACL Injury:
Patients with an ACL tear commonly experience instability in the knee and a sensation of it “giving out” or popping out of place. The knee may feel unstable during activities that involve twisting, pivoting, or sudden stops.
In many cases, patients opt for ACL surgery to address the injury, particularly if they wish to resume participating in contact sports or activities involving twisting movements, such as skiing. Around 50 percent of ACL injuries occur in conjunction with damage to other knee structures, such as the meniscus, articular cartilage, or other ligaments.
Aside from its role in knee stability, the ACL also provides protection for the menisci of the knee. Persistent instability episodes in the knee can increase the risk of meniscal tears. However, the presence of a meniscal tear significantly heightens the risk of developing osteoarthritis. Therefore, Dr. Ravi Teja Rudraraju typically recommends ACL reconstruction for young or active patients, those with meniscal tears, and individuals experiencing instability during twisting or turning activities.
Dr. Ravi Teja Rudraraju assesses ACL injuries through a comprehensive evaluation, including clinical tests, x-rays, and MRI scans. The MRI scan helps identify any associated injuries to other knee ligaments, the meniscus, or articular cartilage.
To confirm the presence of an ACL tear, Dr. Ravi Teja Rudraraju performs the Lachman’s test. A torn ACL typically results in increased forward movement between the tibia and femur, which feels soft and mushy upon examination. Additional tests, such as the Pivot Shift Test, may also be conducted to assess for anterolateral instability of the knee. For expert evaluation and treatment of ACL injuries, individuals can consult with Dr. Ravi Teja Rudraraju at https://drraviteja.com.
Degrees of an ACL Injury:
Grade I Injury: A Grade I ACL injury involves minor stretching of the ligament without a tear. Patients may experience swelling and tenderness in the ligament, but they can usually resume normal activities. While there is discomfort, it is manageable, and patients can typically function well.
Grade II Injury: This injury indicates a partially torn ACL, often involving one of the two bundles of the ligament. Patients with a Grade II injury experience inflammation, knee soreness, and walking may become more challenging. Surgery may be recommended to address the partial tear.
Grade III Injury: A Grade III ACL injury occurs when the ligament is completely torn. Patients typically experience severe pain, significant inflammation, and swelling, making walking without a limp difficult or impossible.
Treatment for an ACL Tear:
For patients with Grade II or Grade III ACL tears, especially those with concurrent meniscus tears, there is a heightened risk of developing osteoarthritis in the future. Dr. Ravi Teja Rudraraju typically recommends a combined approach of meniscus repair and ACL reconstruction. ACL reconstruction is also advised for young or active patients and those experiencing instability during twisting or turning activities.
Over the past decade, significant advancements have been made in ACL surgery techniques. Previous reconstructions placed grafts more centrally on the tibia and femur, leading to ongoing issues with rotation instability. Extensive clinical and biomechanical research has prompted a shift towards more anatomically placed reconstruction tunnels, resulting in improved knee stability. Dr. Ravi Teja Rudraraju and his research team have played a key role in defining this anatomical approach, contributing to enhanced ACL reconstruction techniques.
Post-Operative Care:
Have you sustained an ACL injury?
There are two ways to initiate a consultation with Dr. Ravi Teja Rudraraju
You can provide current X-rays and/or MRIs for a clinical case review with with Dr. Ravi Teja Rudraraju
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Frequently Asked Questions
Experiencing an ACL tear can vary depending on the circumstances leading to the injury and the type of physical activity involved. In approximately 70% of cases, ACL tears occur without direct contact and often involve twisting or turning movements. Many individuals report feeling a pop at the time of injury, which may be attributed to a bone bruise resulting from the knee slipping and causing friction between the femur and tibia. Typically, those with isolated ACL tears do not encounter significant difficulties with straight-ahead movements but may struggle with activities involving twisting, turning, and pivoting. Difficulty with straight-ahead activities could suggest additional knee injuries contributing to the issue.
ACL tears occur when the knee is subjected to biomechanically unfavorable positions, exceeding the ligament’s capacity to withstand the forces involved. Factors contributing to ACL tears include muscle fatigue, poor biomechanics, or diminished proprioception. In elite sports, where precision is critical, even minor deviations in knee positioning can predispose individuals to ACL injuries. Additionally, individuals with poor conditioning or faulty mechanics are at higher risk, as the ACL may be more susceptible to injury under such circumstances
ACL tears rank among the most prevalent knee ligament injuries, with an estimated 350,000 ACL reconstructions performed annually in the United States alone. This high incidence is partly attributed to the surge in sports participation. Female athletes, in particular, face elevated risks, with sports like soccer, basketball, and volleyball being notably high-risk activities for ACL tears.
The ACL’s limited blood supply and its location within the knee’s intra-articular environment hinder its ability to heal. While the knee joint lining secretes enzymes that facilitate blood clot dissolution (plasmin), which aids in maintaining joint health, this process inhibits the formation of blood clots necessary for ligament healing. Consequently, ACL tears rarely heal spontaneously, necessitating surgical intervention in most cases.
The anterior cruciate ligament primarily stabilizes the knee by preventing forward displacement of the tibia relative to the femur. It is most effective when the knee is flexed at approximately 20-30 degrees, a position commonly assessed during clinical examination using the Lachman test to detect ACL tears. Additionally, the ACL plays a crucial role in preventing internal rotation of the tibia on the femur. This rotational stability is vital for activities involving planting the foot, twisting, turning, or pivoting, as ACL tears can result in partial dislocation (subluxation) of the knee, leading to significant functional impairment. For comprehensive care and treatment of ACL injuries, individuals can consult Dr. Ravi Teja Rudraraju at https://drraviteja.com.
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