Several actions may lead to an ACL rupture. Most often, it is a twisted knee when jumping or during a change of direction while running. Skiing accidents while performing a turn or because of a fall can also lead to a sprained ACL. Also, an unexpected impact to the front of the knee that causes it to be bent backwards can result in a sprained or ruptured ACL.
A ruptured anterior cruciate ligament causes a decrease in the stability of the knee. While it is not utilised when a person is sedentary, it is involved in activities where the legs are used significantly, particularly ones that require the knee to twist, such as ball games or combat sports.
The classic tri-sign of a ruptured ACL rupture is cracking – dislocation – immediate swelling. The individual feels a cracking or tearing sensation in the knee. The dislocation is extremely painful and the knee will look physically deformed. Shortly after the injury has occurred, the knee begins to swell significantly and walking is difficult or impossible.
Unfortunately, in some cases, these signs do not exist, the knee does not swell, for example. Pain is also not always a good sign because in some breaks, it is minimal or absent. That is why a specialist consultation is necessary when knee sprain.
The ACL rupture diagnosis is a clinical diagnosis. If the ACL is intact, the knee is stable, if it is broken, we say the knee is lax (moves abnormally when examined). Thanks to specific tests (Lachman test), the specialist can usually tell if there is a breach or not.
X-rays may be required to rule out a bone fracture, while an MRI scan can identify the extent of the damage to the ACL. A subsequent ultrasound may also be used to check for injuries in the ligaments, tendons and muscles of the knee.
Two treatments for a ruptured ACL exist: functional treatment and surgical treatment.
1. Functional treatment
The objective of functional treatment is to compensate in the absence of an ACL and facilitate muscle proprioceptive rehabilitation. This will allow the knee to remain stable.
Progressive physiotherapy and rehabilitation can help restore the knee to a condition close to that of how it was before the incident that damaged the ACL.
2. Surgical treatment
Surgical treatment is to reconstruct the anterior cruciate ligament with an
other tendon. The tendon most used is the patellar tendon. Another
technique uses the tendons of the crow’s feet.
Functional ACL treatment benefits:
• Avoids surgery
• No complication
• Possible surgery secondary
Functional ACL treatment disadvantages:
• ACL is not repaired
• Does not allow the resumption of all sports
• Muscles have to be trained regularly
Surgical ACL treatment benefits:
• ACL is fully repaired
• Allows recovery of all sports
• Definitive treatment
Surgical ACL treatment disadvantages
• Operative risks
• Possible complications
• In case of failure, complex surgery required
Fortunately, the ACL is not part of the vital organs of the human being. The vast majority of people can live normally without anterior cruciate ligament. For these individuals, the functional treatment is often enough.
However, patients who need a perfect stability in their lives or because of sports or a job should choose surgical treatment. Surgical treatment is indicated when there are significant lesions associated with anterior cruciate ligament rupture causing instability in everyday life.