ACL tears happen when the knee is put in a disadvantaged position while playing or falling from a bike. The most common mechanism is twisting of the knee joint while the foot is fixed firmly on the ground leading to stress on the ACL which finally tears due to excessive forces. In patients who are obese or lead a relatively sedentary lifestyle, minor twisting injury can also cause this injury due to bad mechanics, muscle fatigue/wasting, and lack of proprioception in the joint due to lack of training.
HOW DOES AN ACL TEAR FEEL LIKE:
Most of the ACL tears in Indian patients are seen in people who engage in sports occasionally (weekend warriors) due to lack of improper conditioning of muscles. They are also common in two-wheeler drivers who often sustain skidding injuries while driving in our haphazard traffic. The most common sign that patients often complain of is a popping sound in the knee followed by an inability to stand. They often give a history of someone supporting them to walk following the injury. After some time they notice swelling and pain in the knee joint and episodes of instability when they try to walk again.
WHAT TO DO IF YOU HAVE A SUSPICION OF ACL TEAR:
You must remember the acronym R.I.C.E. anytime you have a soft tissue injury anywhere in the body. The same is the case with an ACL tear. Give Rest to the affected knee by applying a long knee brace. Apply an Ice pack to the knee joint at least 5 times daily with each application lasting up to 15 minutes. Apply a Compression bandage such as a Crepe bandage around the knee to decrease the swelling and finally put the limb in Elevation. Use any over the counter anti-inflammatory drugs such as Diclofenac or Aceclofenac provided you are not allergic to them. You can schedule a visit to your local Orthopaedic surgeon at the earliest for further evaluation and management
HOW DO YOU CONFIRM AN ACL TEAR:
A preliminary doubt about ACL tear can be made from a history of giving away of knee coupled with laxity of the knee on examination (Anterior Drawer Test).To confirm the clinical diagnosis, an MRI scan is ordered which can confirm the diagnosis. We can also diagnose other coexisting injuries such as meniscus tears, cartilage injury, or other ligament injuries. The existence of these injuries can often determine the type of treatment (operative versus non-operative) that best suits the patient
DOES AN ACL TEAR HEAL WITH REST:
Unfortunately, a torn ACL does not heal on its own spontaneously even when we put the injured knee in absolute immobilization. This is because ACL does not have cells that contribute to the healing of tissue called fibroblasts and is also located in a harsh environment in the joint wherein any attempt at healing by the torn ends is undone by the enzymes in the synovial fluid. However, not all patients with an ACL tear complain of instability and hence not all patients require surgery mandatorily
HOW DO YOU PREVENT AN ACL TEAR:
Many ACL injuries can be prevented if the muscles around the knee are trained to be strong and flexible by regular warm-up exercises by following a proper training program. The goal of this training program will be to increase the core strength and muscle balance to optimize the control of the knee.
The following tips when followed while playing can help prevent ACL injuries:
1. Perform strength training of ACL and the muscles around the knee using high intensity jumping plyometric exercises under the supervision of a trainer to strengthen the quadriceps and hamstring muscles
2. Practice proper landing after jumping. It is advisable to keep a wide foot position when doing sudden pivoting movements or crouch when landing to minimize the risk of injury to the ACL
3.Use proper footwear and practice proper technique while playing
4. Work in tandem with a trainer or sports medicine specialist who is well versed with the functioning of the joints and can identify the weakly functioning muscles and guide your to strengthen or balance them. For young athletes, injury prevention programs have been designed and should be incorporated into their training program early. One well-established injury prevention program is the FIFA 11+ for Kids. Studies have shown that kids who complete this program can reduce football-related injuries by half and also demonstrate improved muscle control, strength, and agility compared to other children.