The 3 letters of doom! ACL injuries are very common in sports, including winter sports. The Anterior Cruciate Ligament (ACL) is one of 4 main ligaments that provide stability in the knee. It runs from the front of the tibia (shin bone) to the back of the femur (thigh bone), and functions to stop the tibia gliding forwards, and also contributes to controlling rotation.
The ACL is often injured with a hyperextension (over-straightening) mechanism, or with forceful rotation and inwards bending with the foot planted (e.g.in a ski boot). Most ACL injuries will result in moderate amounts of pain and a fast onset of swelling, and many patients describe feeling (and even hearing) a crack or pop. People will usually report difficulty walking due to the pain and/or instability.
A physical examination is often sufficient for diagnosis, however an MRI is the gold standard. Partial tears are far less common than are reported, particularly in Japan, so if there is damage to the ACL, the likelihood is that it is completely ruptured.
Initial management may involve modified weight bearing to allow the pain to settle. Due to the trauma required to rupture the ACL, there will often be bone bruising, and this is usually the limiting factor in terms of initial loading. The optimal long-term management of ACL ruptures is a topic of continued debate and research investigation. The current trend is to trial non-operative management. Although the ACL does have a major stabilising role in the knee, if we can optimise the muscular strength and control, often we can develop the capacity to handle athletic demands. There is also emerging evidence that, contrary to previous beliefs, the ACL can actually mend in some individuals.
Even with non-operative management, however, the time to recover is usually 6-9 months. Unfortunately this means the end of the season, but getting started asap with an appropriate rehab program is the best way to make sure you are back and ready to go for the next season.
If you have suffered a knee injury on the slopes then contact us now and let us help guide you on the path to recovery.
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