ANTERIOR CRUCIATE LIGAMENT TEARS
HOW ACL TEARS HAPPEN
The anterior cruciate ligament, or ACL, is the ligament that attaches from the femur to the anterior portion of the tibia. The ACL prevents the tibia from translating forward. This ligament is one of if not the most important ligament of the knee when considering stability. As such the ACL is very important for athletes. An ACL tear generally will present as an acute injury. The injury may or may not be traumatic in nature. Non-contact ACL injuries are more common and often present a very serious issue for the patient who suffers from the condition. Non-contact ACL injuries most commonly happen when one is decelerating and or rotating on the leg to change direction. While the injury takes place a pooping sound is commonly heard. The joint then swells and one is often unable to stand on their injured leg with any weight. If one is able to stand on the leg it will likely feel unstable and be very painful. When one injuries their ACL it is possible that they also injure their mcl and medial meniscus at the same time. This is referred to as the unhappy triad. ACL tears can also come about after being overstressed for a long period of time. One who presents with a chronic ACL tear is less likely to complain of pain. Their main reason for presentation is usually instability.
HOW IS A TEAR DIAGNOSED?
ACL tears can often be diagnosed, at least on a preliminary basis, through ones history and examination findings. Patients at Tauberg Chiropractic & Rehabilitation presenting with an ACL tear will usually have a history such as described above. Palpation of the knee around the joint lines will often reveal tenderness and swelling. The knee can then be assed in office using orthopedic tests. One of the most commonly used tests is the Lachman’s test. In this test the practitioner takes the femur and tibia in each hand and move them in opposite directions. When positive this test will reveal laxity and forward translation of the tibia. There may also be pain. Usually this is enough to diagnose an ACL tear. To determine the grade of the tear and whether other structures have been compromised an MRI may be used.
HOW CAN ACL TEARS BE TREATED?
Just like most other sprains ACL tears occur in 3 grades. Grade 1 is a small tear, 2 is a partial tear, and 3 is a full tear. All three grades can be treated using conservative rehabilitative techniques. That said if one wants to continue participating at high levels of athletic competition then reconstructive surgery is often highly recommended for a grade 3 tear. For an athlete in Pittsburgh & Fox Chapel with a grade 1 or 2 tear the consensus is less clear. When ACL tears are treated conservatively the usual treatment plan involves plenty of therapeutic exercise to strengthen the surrounding musculature and restore proprioception to the joint. This helps to protect the joint from further damage. Deciding when to undergo surgery vs going the conservative route should essentially be left in the patients hands as the research has not shown one method to particularly superior to the other.
- Souza, T. A. (2016). Differential Diagnosis and Management for the Chiropractor. Burlington: Jones & Bartlett Learning.