| The Anterior Cruciate Ligament or ACL, lies deep | | | | to what is called a haemarthrosis - bleeding within the |
| within the knee joint, connecting the thigh bone with | | | | joint. This swelling provides a protective function by |
| the shin bone. Its function is to prevent excessive | | | | not allowing the person to use their knee. |
| forward movement of the shin in relation to the thigh | | | | Treatment |
| and also to prevent excessive rotation at the knee | | | | During the acute stage of the injury (the first 48-72 |
| joint. | | | | hours) exact diagnosis is very difficult due to the |
| The ACL can be injured in several different ways, | | | | gross swelling around the joint. Once the initial |
| most notably by landing from a jump onto a bent | | | | treatment to decrease the swelling has taken affect |
| knee then twisting, or landing on a knee that is | | | | the clinical diagnosis may be possible. This may be |
| over-extended. In collision sports, direct contact of | | | | achieved by the medical personnel performing stress |
| the knee from opponents can cause damage to the | | | | tests on the knee ligaments - the degree of laxity |
| ACL. Because of the amount of force that is required | | | | within the joint will allow the clinician to estimate the |
| to damage the ACL it is not uncommon for other | | | | degree of damage. If there is any doubt, or to |
| structures within the knee such as the meniscus or | | | | confirm the clinical tests, the patient is sent for |
| medial ligament to also be damaged and could require | | | | further investigations. Most commonly an MRI scan is |
| a professional diagnosis. | | | | used to ascertain the level of knee injury. In some |
| A moderate impact against the inner side of the | | | | cases the MRI scan may not give a clear picture of |
| knee joint causes the Lateral Collateral Ligament to | | | | the damage and it may be necessary to survey the |
| rupture. A more violent impact causes the Anterior | | | | joint with an arthroscope. The combination of these |
| Cruciate Ligament to also rupture. In severe cases | | | | findings allows the orthopaedic consultant to build a |
| the Posterior Cruciate Ligament ruptures. | | | | picture of the extent of the damage. |
| ACL injuries have been reported to occur more often | | | | The treatment of the ACL injury is dependent upon |
| now than ever before, which may be due to the | | | | the amount of damage and the subsequent functional |
| increased intensity of sporting activity. In soccer, it is | | | | impairment, the age of the patient and the level of |
| reported that for every 1000 hours of soccer played | | | | sporting activity. If the diagnostic investigations reveal |
| (training and matches) there are between 4 and 7 | | | | only a partial tear of some of the fibres of the ACL, |
| ACL injuries. Many high profile professional players | | | | and there is minimal instability, then a conservative |
| have suffered this injury including Paul Gascoigne, | | | | approach with a physiotherapist is usually indicated. |
| Alan Shearer, Gustavo Poyet, Roy Keane and Ruud | | | | This option is also more likely for adolescents and |
| Van Nistelroy. | | | | more sedentary individuals. In the case of individuals |
| Signs & Symptoms | | | | who are involved in a high level of sport where a |
| At the moment of injury the person may experience | | | | degree of instability is functionally unacceptable, |
| a snapping sensation deep within the knee. There will | | | | surgical reconstruction of the ligament is the surest |
| be pain, proportional to the force and degree of | | | | way to restore normal function. |
| damage to other structures within the knee joint. In | | | | Surgery to reconstruct the ACL has evolved beyond |
| some cases the person may feel able to continue | | | | recognition since the first ACL repair in 1963. By 1980, |
| playing, but as soon as the ligament is put under | | | | Cambridge surgeon David Dandy had begun using an |
| strain during sports activity, the knee joint will | | | | arthroscopic technique. Development has continued |
| become unstable. A classic example of this was Paul | | | | since then and the latest surgical technique is an |
| Gascoigne during the 1991 FA Cup Final, who | | | | arthroscopic procedure where a strip of the patella |
| attempted to continue playing before being | | | | tendon from the patient's knee is removed and used |
| stretchered off. | | | | as a graft to replace the ACL. |
| The reason the person is unable to carry on is that | | | | In addition to advances in the surgical procedure, |
| the restraining function of the ACL is absent and | | | | there have been advances in post-operative |
| there is excessive rotation and forward movement | | | | rehabilitation that have seen a return to full activity in |
| of the shin in relation to the thigh. After a couple of | | | | most cases in less than six months. |
| hours the knee joint will become painfully swollen due | | | | |