Anterior cruciate ligament (ACL)
The anterior cruciate ligament (ACL) is located in the center of the joint. Starting from the lower end of the femur, it crosses it diagonally, then attaches itself to the upper part of the tibia.
1) A LITTLE ANATOMY:
Rupture of the anterior cruciate ligament (ACL) is one of the most common knee injuries in athletes. It affects 0.3 in every 1000 people.
In the anatomy of the knee, the anterior cruciate ligament (ACL) is located in the center of the joint. Starting from the bottom end
of the femur, it crosses it diagonally, then attaches itself to the upper part of the tibia.
We speak of a “cruciate” ligament because the ACL crosses another ligament, the posterior cruciate ligament.
These two ligaments play an important role in the stability of the knee (antero-posterior drawer and rotation).
2) WHAT IS THE ACL LESION, AND WHAT ARE THE DAMAGE MECHANISMS?
It is estimated that over 2 million ACLs are injured each year. These lesions have an incidence of 3.5% in female athletes, and 2% in male athletes.
During a trauma, this ligament can be torn or even ruptured. This lesion can be isolated, or combined with the injury of other structures of the knee (menisci, collateral ligament, etc.). This then leads to impaired knee function.
The vast majority of ACL injuries are traumatic in origin. This can be direct trauma, such as a direct blow, or, more commonly, indirect trauma. The mechanism generally found consists of a twisting movement of the knee when the foot is blocked on the ground.
Such trauma most often occurs:
Upon landing a jump
During a violent change of direction
During a pivot movement
3) IS IT SERIOUS?
In the event of an ACL tear, several symptoms can occur just in the hours following the trauma:
-Decreased joint mobility
-Temporary blockage of the knee
A few days/weeks later, the symptoms tend to fade, allowing the injured person to regain some autonomy. But the knee will still remain unstable, creating at the same time a feeling of discomfort in the joint.
Clinical examination and medical imaging (MRI) can determine the severity of the lesion. This also makes it possible to observe any associated lesions, which will have an impact on the healing time and the therapeutic choice.
4) IS SURGERY MANDATORY?
Depending on the clinical picture, surgery may be offered as a treatment option. This is particularly effective in the case of complex and/or associated lesions.
It is also mainly offered to young and athletic populations, in particular to athletes practicing sports with specific movements including significant changes of direction and pivots.
Surgical intervention makes it possible to improve the stability of the knee, and therefore reduces the risk of pathologies resulting from this instability in the future (osteoarthritis, meniscal lesion, etc.).
Conservative treatment can, however, be offered to patients whose sporting objective is less, or when they have a lower level of activity.
5) HOW DOES THE REHABILITATION TAKE PLACE?
Conservative and post-operative treatment come together on many points. The difference will mainly be in the first days following the possible surgery.
While respecting the healing process, the work will focus on:
-Recovery of normal joint amplitudes
-Gradual rehabilitation of the joint
-Recovery of a correct gait pattern
-Overall muscle strengthening (strength, neuromuscular control, stability, etc.)
-Re-athleticization and rehabilitation in the sporting gesture
The rehabilitation of the ACL follows an evolution based on skills criteria evaluated by means of tests, as well as on time criteria in order to respect the healing and the ligamentization of the graft.
6) CAN I CONTINUE TRAINING?
Initially, stopping sporting activity is most of the time essential in order not to aggravate the lesion. Consulting a health professional then makes it possible to determine the procedure to follow in order to return to your sports practice as quickly as possible in complete safety.
Depending on the diagnosis, a plan will be put in place to gradually return to your sporting activity.
7) WILL I RETURN TO MY PRE-INJURY LEVEL?
Provided you follow the instructions and recommendations given by your surgeon and your therapist, you will more than likely find your level in a few months!
However, it will be important to strengthen the knee as well as the lower limbs as a whole in order to avoid relapses.
8) WHAT CAN I DO TO SPEED UP THE PROCESS?
In order to speed up the healing process, be sure to follow the recommendations of the health professionals you work with as much as possible. Laziness or, on the contrary, overzealousness, will be your enemies.
Conversely, discipline, rigor, perseverance as well as a positive and voluntary state of mind will help you get back in top shape as soon as possible!