Cargle 1Alexis CargleMrs. CorbettSenior Project Research Paper17 November 2011 ACL Injuries The anterior cruciate ligament, more commonly known as ACL, is the mostcommon knee ligament injury. An ACL injury mainly affects athletes or thoseparticipating in athletic activities. Over the years, sports have become more popularwhich has led to an increase in anterior cruciate ligament injuries. This increase ledorthopedic surgeons to create many operations over the past fifteen years that reconstructthis ligament. The anterior cruciate ligament is located in the center of the knee joint where itruns alongside the back of the femur and then connects to the front of the tibia. In thearticle “A Patient’s Guide to Anterior Cruciate Ligament Injuries,” it says, “An ACLinjury usually occurs when the knee is forcefully twisted or hyperextended. Manypatients recall hearing a loud pop when the ligament is torn, and they feel the knee giveway” (Medical Multimedia Group, LLC, 4). The ACL is the main controller of how farthe tibia can move under the femur. If the tibia moves too far forward, it can cause theACL to rupture. When straightening the knee, the ACL is the first ligament to becometight. The major cause of an ACL injury is sports related. Sports that require the foot tobe planted and then the body to shift rapidly in direction carry a high risk for injury, suchas basketball, football, and downhill skiing. In the article “A Patient’s Guide to Anterior
Cargle 2Cruciate Ligament Injuries,” it states “Usually, the knee joint swells within a short timefollowing the injury. This is due to bleeding into the knee joint from torn blood vessels inthe damaged ligament” (Medical Multimedia Group, LLC, 4). The knee can also feel as ifit is giving out whenever direction is being changed. It may feel like the knee is slippingbackwards. The swelling and pain from the injury last for two to four weeks, but the kneecan still feel unstable. The instability of the knee is what requires treatment. If the kneeremains unstable for a long time, it can lead to early arthritis. Doctors diagnose an ACL injury based on treatment and history of the knee. In anacute injury, swelling is a major indicator of a tear. If tense swelling occurs within hoursof the injury, it usually means blood is in the joint. If swelling occurs the next day, it ismost likely the inflammation which creates fluid to form in the joint. A doctor can place aneedle into the joint and drain the fluid; this reduces the swelling and relieves the pain.This can be beneficial to the doctor because it gives important information on the knee. Ifblood is found in the fluid, there is a seventy percent chance that it is torn. Another wayto diagnose an ACL injury is by an MRI, or magnetic resonance imaging. This requiresno needles and is painless. Initial treatment is to reduce the swelling and pain. This is treated by rest andmedication such as Tylenol. Crutches can be used until walking without a limp isobtained. Physical therapy is then done to help recovery. Therapists use ice, electricalstimulation, and elevation to reduce the swelling. Range-of-motion exercises should bedone as soon as possible in order to gain back one hundred percent usage of the knee.Stationary bikes, stretching gently, and application of pressure are included. An ACLbrace is suggested by the therapist and has to be custom made. The brace is to prevent
Cargle 3further knee injury. However, it does not fully protect the knee while doing physicalactivity or competing in sports. Wearing a brace a year after fixing the injury is alsoadvised. Many types of surgeries can be done to reconstruct the ligament as well.Medscape states that “Approximately 60,000-75,000 ACL reconstructions are performedannually in the United States” (Gammons and Ho). A patellar tendon graft, a hamstringgraft, and allograft reconstruction are the types of grafting used. In a patellar tendon graft,a tendon from the knee cap is stripped and used to replace the ACL. In a hamstring graft,a tendon from one of the hamstrings that runs from the inside of the thigh and knee istaken to replace the ACL. An allograft is tissue from another person. The allograft can befrom many different types of tendons. It takes less time because the tendon does not haveto be harvested from another location in the body. Rehabilitation of the knee can take up to nine months. Rehabilitation is needed toimprove balance, reduce pain and swelling, restore range of motion, and regain strength.In the article “Anterior Cruciate Ligament Inuries: Treatment and Rehabilitation,” itstates that the major goals of rehabilitation are “Restoration of joint anatomy, provisionof static and dynamic stability, maintenance of the aerobic conditioning andpsychological well being, and early return to work and sport”(Cross). It is important tofind the right balance in rehabilitating the knee. Being too aggressive can damage therepair done by surgery and cause the ligament to tear again, but not doing enough canmake the healing process longer than necessary. More than eighty percent of patients
Cargle 4who have surgery return to a normal lifestyle and only close to ten percent developpermanent knee instability. There are many ways to prevent ACL injuries. These ways include strengtheningthe thigh muscles and maintaining a balance between the quadriceps and hamstrings.Also, increasing flexibility and agility will reduce potential injury. In the article “AnteriorCruciate Ligament (ACL) Injuries,” it states that people can “avoid wearing shoes withcleats in contact sports, avoid wearing high-heeled shoes, and avoid sports that involvelots of twisting and contact” (Anterior Cruciate Ligament) to prevent an ACL injury.There are also prevention programs that can be attended. These programs includeplyometrics, balance, and strengthening and stability. Lately, women’s sports have become more popular. In the article “ACL Injuriesin Female Athletes,” it reads “Over the last decade, torn and ruptured anterior cruciateligament (ACL) in female athletes have increased at an alarming rate” (Kaselj). It isshown that women are two to four times more likely to injure the ACL than men in thesame sports. Women are not able to tighten the thigh muscle to the same degree as menare. The knees are not able to hold as steady as they should which give less kneeprotection during physical activity. The quadriceps and hamstrings in a woman workdifferently than a man’s do. Women have to work harder than a man when bending theknee. The tibia is pulled forward which puts the knee at risk for an ACL tear. Thehamstring muscles also respond slower than a man’s hamstrings. This may allow the tibiato slide forward placing a strain on the anterior cruciate ligament. Many say that estrogencan affect the weakness of the muscles as well.
Cargle 5 In basketball, women are five to seven times more likely to injury the anteriorcruciate ligament than a man playing basketball. Also, in 2009, female soccer playerswere known to suffer more than twice the injuries as men while playing the game.Between the ages of fifteen and twenty-five, women athletes are likely to suffer an ACLinjury. This is five years earlier than when a man initially injures his ACL. Anatomydifferences are one of the key factors of this. In the article “ACL Injuries in FemaleAthletes,” it says “Women have lesser muscle strength and slower muscle reaction timeswhen compared to men. A strong and fast-reacting hamstrings is vital to keep the ACLintact during abrupt changes of direction” (Kaselj). A woman’s pelvis is wider than aman’s which causes a more tilted femur near the hips, and the shin is more angled to theknee which places more strain on the ACL. The ACL comes through a notch, and womenhave a narrower notch than men which weakens the ACL. The ACL itself is also smallerin women which makes it more vulnerable. When women are on their menstrual cycle,the chance for an ACL injury is higher because the hormonal levels are greater. Also,women have weaker leg strength. These five factors create a greater risk of tearing theanterior cruciate ligament. An anterior cruciate ligament injury is a very common knee injury in athletes. Thegrowing popularity of women’s sports has led to an increase in ACL injuries. Females arealso more prone to this type of injury than a male is. Proper care can be done to preventan ACL injury and is suggested by doctors. Surgery is recommended for the bestreconstruction of the ligament, and rehabilitation is also key for the proper restoration.With the right care and dedication to make these injuries better, restoring this ligament isan easy process.
Cargle 6 Works CitedAhmad, Christopher S, MD, and William N Levine, MD. “Anterior Cruciate Ligament Injury in Skeletally Immature Athlete.” Sports Medicine July-Aug. 2008: 2-7. Web. 14 Oct. 2011. <http://www.orthonurse.org/portals/0/ACL%20in %20youth.pdf>.American Orthopaedic Society for Sports Medicine. “Anterior Cruciate Ligament (ACL) Injury Prevention.” AOSSM Sports Tips. N.p., 2008. Web. 17 Oct. 2011. <http://www.sportsmed.org/uploadedFiles/Content/Patient/Sports_Tips/ST %20ACL%20Injury%2008.pdf>.“Anterior Cruciate Ligament (ACL) Injuries.” WebMD.com. N.p., 14 May 2010. Web. 14 Oct. 2011. <http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl- injuries-topic-overview>.Cross, Mervyn J. “ANTERIOR CRUCIATE LIGAMENT INJURIES: Treatment and Rehabilitation .” Encyclopedia of Sports Medicine and Science. N.p., 1998. Web. 17 Oct. 2011. <http://www.sportsci.org/encyc/aclinj/aclinj.html>.Gammons, Matthew, MD, and Sherwin SW Ho, MD, eds. “Anterior Cruciate Ligament Injury .” Medscape. N.p., 22 Sept. 2011. Web. 17 Oct. 2011. <http://emedicine.medscape.com/article/89442-overview>.Kaselj, Rick, MS. “ACL Injuries in Female Athletes.” Exercises For Injuries. N.p., 19 Aug. 2010. Web. 17 Oct. 2011. <http://exercisesforinjuries.com/acl-injuries-in- female-athletes/>.
Cargle 7Medical Multimedia Group, LLC. “A Patient’s Guide to Anterior Cruciate Ligament Injuries.” eOrthopod.com. Orthopod, n.d. Web. 14 Oct. 2011. <http://www.soar- physicaltherapy.com/pdfs/knee/Anterior_Cruciate_Ligament_Injuries.pdf>.Rogers, Kenneth, PhD. “Anteiror Cruciate Ligament (ACL) Injuries.” Kids Health. N.p., June 2009. Web. 17 Oct. 2011. <http://kidshealth.org/parent/medical/bones/acl_injuries.html#>.Souryal, Tarek O, MD. “ACL Injury, ACL Tear, ACL Surgery .” Texas Sports Medicine and Orthopedic Group. N.p., n.d. Web. 17 Oct. 2011. <http://www.txsportsmed.com/emedicineacl.php>.Wedro, Benjamin, MD, and William C Shiel, Jr, MD, eds. “ACL injury (cont.).” MedicineNet.com. N.p., 4 Nov. 2010. Web. 17 Oct. 2011. <http://www.medicinenet.com/torn_acl/page5.htm>.