Anterior Cruciate Ligament (ACL) Injury

The anterior cruciate ligament is made up of two parts and connects the center of the shinbone (tibia) and the inner back of the thighbone (femur). The part in the center front prevents the knee from sliding forward or backward while the inner back part of ACL prevents the knee from turning sideways. In a way, ACL sets the range for knee movements and stabilizes the joint.

Anterior Cruciate Ligament Rupture: How and Why Does ACL Rupture?

More often than not, ACL rupture occurs without contact. In other words, there is no need for impact on the knee for ACL injury to take place. ACL tears and ruptures are commonly observed in football players especially when they are about to kick the ball. Interestingly enough ACL injuries occurs in the non-kicking foot (plant foot) as the rotation of the knee of the fixed leg, which rotates alongside the body, ruptures the ACL. Below is a list of factors that facilitate this injury:

• Poor pitch conditions
• Use of unsuitable equipment
• Weak muscle structure
• Unsuitable anatomical structure

How to Detect ACL Rupture?

• A ripping sound is heard with the rotation of the knee.
• Rupture causes severe pain.
• The person feels as if s/he has a dislocated knee.
• Swelling can be observed.
• Bending the knee may feel impossible.

What Should Be the First Response in case of ACL Rupture?

• First of all, the injured person must stop the physical activity (whatever it might be) immediately.
• S/he should not step on the injured leg.
• Cold compress should be applied with a piece of cloth or towel to wrap the ice around the joint. The compression should continue for 20 minutes and repeat every two hours.
• The patient should see an orthopaedist immediately.

Treatment of the Anterior Cruciate Ligament

ACL injuries generally require surgery. Surgery is planned in accordance with the patient’s age and active sporting career or exercise habits. There is a high probability that ACL rupture patients under the age of 35 or those who are actively involved in sports will be treated with surgical intervention. For older individuals with joint abrasion related ACL injuries, non-surgical methods can be discussed. Non-surgical options can be considered for younger patients, albeit rarely.

Anterior Cruciate Ligament Surgery

For ACL surgery, we prefer arthroscopy (keyhole surgery), a minimally invasive closed surgical procedure. In this method, the ruptured ligament is replaced with tendons taken from the periphery of the knee using small incisions for access. The procedure lasts for about 45 minutes. Accompanying injuries can also be addressed during the same operation. Healing process is considerably short in arthroscopy and patients can stand on their feet the day following. Patient with desk job can return to work within 3 to 7 days. Also, patients undergoing arthroscopy can drive a car within 3 weeks, walk with one crutch for the first 2 weeks and without the need for crutches 3 weeks after the operation. A professional athlete, however, may need to wait for four months to return to sporting activities. For more information on this surgical method and the post-operative period, please refer to our article on knee arthroscopy.