Bodyworks: Anterior Cruciate Ligament Injury
How to recognise it, how to overcome it
Posted: 5 June 2000
by Patrick Milroy
The majority of people possess both anterior and posterior cruciate ligaments, which form an X-shaped structure through the middle of the joint, their function being to prevent fore and aft movement of the tibia on the femur. Injury, in the form of a rupture, may be due to an accident in everyday life, or as a result of sporting trauma. If a tear occurs, nine times out of 10 it will be in the anterior cruciate ligament (ACL).
Symptoms
You are likely to have twisted your knee pretty severely or bent it backwards in a dramatic fashion to tear your ACL. There is no question of carrying on in the majority of cases, as the knee gives way, becomes painful and will swell with blood on the day of injury. It will be difficult to walk on, let alone run.
Signs
Comparison with the other knee will allow your doctor to confirm the swelling of blood within the joint, and they may or may not draw this off before using other tests on the knee’s stability. When a knee is freshly swollen following injury, it is notoriously difficult to be sure of the exact diagnosis by simple examination, though tests to pull the tibia forward of the femur may be strongly positive if the excess fluid is first removed.
Medical investigations
X-rays are going to give scant help in demonstrating what is soft-tissue damage, though arthrography, in which the knee is filled with opaque fluid, will often be helpful. Scanning techniques, which have been refined over the last 20 years into a really effective diagnostic aid, have made X-rays largely redundant, though if an orthopaedic surgeon has any doubt about the injury, visualisation through arthroscopy will provide the ultimate proof.
What else could it be?
Any condition that fills a knee joint with fluid, be it blood or excess lubrication from the lining synovium must be considered in the differential diagnosis. The injury will limit movement of the knee, as may damage to the cartilages, the collateral ligaments that allow the joint to hinge, the patella, or the formation of a bursa. On occasions, even the most experienced surgeons have got the diagnosis wrong!
Self-treatment
Sometimes the ACL is merely stretched and becomes lax, rather than ruptured; sometimes the patient does not realise the severity of the injury and does not obtain treatment; and sometimes the knee settles down and you can return to sport. Part of the function of the ACL is replicated by the hamstring muscles, so if these are strong and you work hard to maintain power and tone, you might get away without surgery. It is said that six out of the 30 touring All-Black Rugby players last autumn did so without ACLs, though their hamstrings are reminiscent of the trunks of the Giant Sequoia!
Medical treatment
Twenty years ago ACL reconstruction was not really an option, but giant strides have been made in the use of human, animal and mineral substances to rebuild the ligament. Not only is the tissue used important, but the angle at which it is inserted is crucial, and the operation now resembles precision engineering to ensure that the biomechanical integrity of the joint is maintained. Rehabilitation under the watchful eye of a physiotherapist should ensure that a full range of movement is obtained and that those all-important hamstrings are developed to further support the artificial ACL.
Can you run through it?/Recovery time
ACL rupture is a severe trauma to the knee and even attempting to run through it invites the knee to give way and cause further damage to the menisci and articular cartilage. Luckily, it is likely to be far too painful for you even to attempt it, though even professional sportspeople should prepare for the best part of a year off if their ACLs need reconstruction.
Discuss this article
All, I have read this with interest and feel a little inspired and glad to hear peole have managed to get back to fitness. Thanks.
I had left knee ACL reconstruction (ruptured it playing rugby) using a bit of my hamstring on 4 Aug 05. Tore my hamstring when I banged my leg into a car door 2 weeks ago. However, I did a lot of leg strengthening prior to the op. Hamstring well on the way to being post-op 'normal' and knee is improving all the time. I have some physio exercises to do and I am walking as normal.
Anyone looking to get a reconstruction, I strongly recommend you do the max possible to strengthen your leg muscles prior to the op.
Post-op, patience is key. My physio reckons light jog/walk on treadmill by Novemember, jog/running at 6 month point. Full strength can take up to 2 years. At the one year point, for those who need to, you can run with rucksacks/weight bearing, but surface is key - no twisting, so choose your routes carefully throughout the rehab process.
Ultimately, I am looking to run a marathon, ski again and lose some of the weight I have put on since I stopped running post-injury ! All of which, I am assured by my surgeon, doc and physio are achievable. However, I reiterate, patience is key. As normal, some discipline and dedication to regaining full fitness are required !
I am not a doctor, so this is not a cure, or me recommending you should take supplements, but I am taking Glucosimine with chondroitin, normal vitamin supplements, including Cod Liver Oil and you might want to check out a supplement called Serrapeptase on-line. (As I don't want to have legal action taken against me (!), please speak to your doctor if you are going down the supplements route.)
I hope this helps anyone who is about to go through the process.
Posted: 14/09/2005 at 13:15
If anyone had offered me a reconstruction, I'd have signed up on the spot! I was told at the time that it was unlikely to help and offered painkillers, physio and strengthening exercises. I did damage both my cruxiate and medial ligaments, so it was a fairly bad injury.
I love running and hill walking so I have followed this regime for years, trained carefully and ran on. It has been manageable with care, but in the long run (sorry for pun!) it hasn't helped. My knee joint has now deteriorated and I've got bad osteoarthritis, as well as a wonky knee. I've been told I can't hope to run again, ever, and I have to have a knee replacement. If ligament repairs give you less than perfect outcomes, the chances are so much more successful than knee replacements. From what I've read since I got the bad news, I'll be lucky to walk up and down stairs, let alone run up and down mountains. I think the human knee has a few basic design flaws. Injuries happen when you run, but getting the best advice sounds really vital. I wish I'd tried harder to get things fixed earlier. H
Posted: 02/09/2007 at 18:28
adam, I had acl surgery in mid sep 07 after tearing my acl and damaging meniscus playing football. I am now beginning to run again and my knee is improving literally on a daily basis. you are on the right track now that you are seeing a consultant and are going to have surgery. I'm not going to kid you, it's tough for the first couple of weeks post surgery and you are going to continue to have aches and pains in different parts of your knee. However, if you follow the advice of your surgeon and physio and work hard doing the rehab exercises you will start to see results. hoepfully you'll be back running after 3 months. I would suggest that you wait 12 months to play footy though as from what I've read and from what my physio and surgeon have said you are at high risk of re-injury if you come back within this period. however, you should be back to normal after this period (stats suggest a 95% success rate for return to sport) good luck with the surgery
Posted: 10/01/2008 at 16:02
Hi I've just had an arthroscopy to sort out a suspected meniscal tear but when I was in the recovery room post op they told me they found i'd ruptured my ACL. ( This is what the Italian doctors told me 6 weeks ago after I twisted my knee skiing) They didnt tell me anything else, like whether they had done anythingwith the meniscus or not. It was late evening and i guess they wanted to get home, i was also very woozy still. So I'm back home and attempting to do the post arthroscopy exercises but not having a clue really how bad my ACL rupture is, whether I still have meniscal problems or not and what I should be doing to prepare myself for a ACL repair. I'm meant to be going back to the clinic in 2 weeks time. Advice welcome
Posted: 01/04/2008 at 14:25
Reading peoples stories here, I think that there is a lot to be said for winning the mental battle to return to doing what you love. I had surgery last December for a ruptured ACL and a ruptured lateral collateral ligament / posterolateral corner after a high speed mcycle 'high side' on a race day. At 43 I maybe shouldnt be doing such daft things (I hear the missus saying) Anyway, 3 months post op in March I took my first steps in anger and by June I could run for 20 mins without stopping. Being reassured by my physio that the pain was not doing any internal damage, I have built up my miles to around 20 pw and I chose for my first race, a gentle re introduction to running this November 4th: Hellrunner! No point in settling for a 5k when you can go for it big style! An hour 47 for 11 plus miles of bogs and hills has given me newfound confidence that my knee won't just collapse and I have 2 more race entries in the bag with a 1/2m due in mid January. Both I and my surgeon never thought that was possible this time last year, so set your sights high but take heed of professional advice before pushing to the limits. Mega thanks to my physio for pummeling me week after week and teaching me how to walk again!
Posted: 29/11/2008 at 18:57
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