Anterior Cruciate Ligament (ACL) Injuries
The anterior cruciate ligament or ACL is one of the most common injured ligaments of the knee, especially in sports such as basketball and football. The ACL stabilizes the knee for cutting, twisting and jumping and pivoting activity. The anterior cruciate ligament is in the center of the knee joint.
When you tear an ACL, you will often feel or hear a pop. You will also feel the knee shift out of place and develop significant swelling in just a few hours. The initial treatment should consist of ice to the knee, leg elevation and crutches. A sports physician, orthopaedic surgeon or physiotherapist should evaluate the injury.
If the ACL has been torn, surgical reconstruction of the ligament may be indicated, as the ligament rarely heals by itself. In this type of surgery, the most common procedure is to take either the hamstring tendons, or the patellar tendon of the same leg and place it in the original location of the injured ACL. After a period of proper rehabilitation following surgery, the athlete can return safely to active participation in four to six months.
Notice how “loose” the knee is. (This is called the Lachman’s test) Torn ACL during knee arthroscopy.
Posterior Cruciate Ligament Injuries
The posterior cruciate ligament is in the back of the knee. As a rule of thumb, it is usually not as disabling as ACL injuries. Most PCL injuries can be treated with physiotherapy except for very severe tears. Uncommonly, PCL tears can be associated with tears of the structures on the lateral (outside) of the knee. This is known as a Posterolateral Complex injury (PLC).
The meniscus is a shock-absorbing cartilage in the middle of your knee. There are two menisci – one on the inside (“medial”) and another on the outside of the knee (“lateral”).
Patients with meniscus tears will complain of pain on either side of the knee. Sometimes there is associated swelling of the knee. Twisting or squatting can cause increased pain. Occasionally, if there is a large meniscus tear, a patient can complain that their knee locks, that is, it gets stuck in a certain position then needs to be “wiggled” to get it back into place.
The meniscus can be torn in two main ways.
Meniscal tears are usually diagnosed from the patients history and physical examination but a Magnetic Resonance Imaging (MRI) scan is very useful for confirming the diagnosis. If your knee continues to produce pain, your physician may recommend keyhole or arthroscopic surgery. However, not all people with a meniscus tear require surgery. Some people are able avoid surgery if they can cope with their symptoms.
A bucket handle tear of the meniscus causing the locking of the knee.
Anterior Knee Pain
Anterior knee pain or pain at the front of the knee is a common problem that affects both the competitive sportsmen and also the recreational athlete. There are many reasons for developing this pain.
The location of the pain, type of aggravating activities and any associated clicking, giving way or swelling will help your doctor to pinpoint the diagnosis. Patients with anterior knee pain typically present with a diffuse ache over the front part of the knee. This is also known as the retro patellar region.
It may be precipitated or exacerbated by either prolonged sitting (‘movie-goer’s knee’) or activities which involve bending the knee such as climbing , kneeling or squatting. It is often insidious but it may present after an acute traumatic episode (e.g. falling on the knee). Activities such as basketball and volleyball which involve jumping can also contribute to the problem.
The mainstay of treatment for anterior knee pain is physiotherapy and medication for pain relief. It is also important that patients modify their lifestyle to avoid the activities that make the symptoms worse. In selected cases, surgery can be helpful.
Video of ACL Reconstruction