What is an ACL Injury?

The anterior cruciate ligament (ACL) is one of the main ligaments within the knee. Located deep inside the middle of the knee joint, the ACL connects the thighbone (femur) to the shinbone (tibia) and is responsible for helping to stabilize the knee joint when twisting.

An ACL injury is the overstretching or tearing of the ligament itself. Tears in the ACL include both partial tears and full tears. In a partial tear, the ligament is not torn all the way through or is partially torn off the bone with some fibers remaining intact. In a full tear, the ligament tears in two pieces or completely off of the bone. ACL tears are one of the most common knee injuries. Between 30,000 – 60,000 cases are reported each year in the United States. During an ACL injury, it is also common to experience injury to the other knee ligaments or the meniscus. 

ACL injuries commonly occur during sports or physical activities. Such as football, basketball, soccer, downhill skiing, or even jumping on a trampoline. An ACL injury can be caused by several types of movement including:

  • Sudden stops or changes in direction.
  • Going from a still position to a sudden jump or turn.
  • Landing from a jump with extra rotation.
  • Overextending the knee joint. 
  • An impact to the knee, like a football tackle, which causes the knee to move away from the leg. 

Symptoms of an ACL injury

When an injury occurs to the ACL, many people say they hear or feel a pop in the knee itself. This is typically followed by pain and rapid swelling around the knee and thigh. Other symptoms of an ACL injury may include:

  • The knee feeling unstable or like it is going to give way when you attempt to put weight on it.
  • A loss of range of motion in the knee. This includes bending or straightening the knee.
  • Increased pain and an inability to continue normal activities.

If you experience an injury to the knee, seek immediate medical attention. It is important to properly and accurately diagnose and determine the severity of the injury. Medical imaging, such as an MRI or CT scan, may be required to determine appropriate next steps for repair and rehabilitation. 

ACL Injury Treatment

ACL care immediately after injury

The primary goal after an ACL injury is to control the natural swelling that occurs. Standard first aid procedures can help to reduce the initial swelling. The following first aid procedures should be followed when an ACL injury occurs:

  • Elevate the injured leg above the level of your heart. Try laying back and propping the injured leg up on a pillow. 
  • Apply ice to the injured area for 15 – 20 minutes, every hour for the first 24 hours.
  • Wrap the knee with an elastic bandage or ACE wrap.
  • Use pain relievers to help reduce the swelling per your doctor’s guidelines.

Copers vs. non-copers ACL injury

People with ACL injuries can be classified as either copers or non-copers based upon the need for surgical repair. Surgical repair of the ACL is the most common course of treatment. However, for some patients, surgery may not be needed.

Copers: Individuals with an ACL injury that are able to resume pre-injury activities without surgical repair. 

Non-copers: Individuals with an ACL injury that requires surgical repair to regain knee stability

Copers initially experience a range of motion loss, swelling, and instability in the knee; however, no surgical intervention is needed to repair the ACL. Instead, copers follow an intensive rehabilitation regimen to regain symmetrical strength, range of motion, and dynamic control in the injured knee.

Patients who are non-copers are unable to perform routine activities and are unable to control the knee. They may experience instability in the knee with regular episodes of the knee giving way. Non-copers will need intensive rehabilitation post-surgery to regain symmetrical knee function and return-to-sport. 

ACL Injury Rehabilitation

ACL rehabilitation is focused on developing symmetry in the patient’s lower body. Equal strength, range of motion, and control between both legs provide the best long-term results for patients. Achieving symmetry between the lower extremities allows patients a safe path to return to sport following an ACL injury.

Copers ACL Rehabilitation

Patients that do not need surgical ACL repair participate in a phased rehabilitation program. The rehabilitation program begins by focusing on any outstanding symptoms caused by the injury. Symptoms may include a loss in range of motion in the knee, weakness in the leg, and decreased function in the quadriceps muscle. Exercises included in the initial phases of copers ACL rehabilitation include:

  • Leg extensions 
  • Small squats on an unstable surface
  • Single leg step down

Patients move through the initial phase once they have a full range of motion and improved strength. Advance rehabilitation activities focusing on lower extremity strength, core strength, neuromuscular training, and cardiovascular conditioning are gradually introduced. Extra balance challenges are also introduced to help work on knee stability and muscle strength.  

Return to sport is the final phase of the copers rehabilitation program. This final phase introduces activities like cutting or pivoting along with sport-specific training like shooting or ball handling. Drill difficulty is gradually increased until normal and symmetrical function returns.

Post-Operative ACL Rehabilitation

Patients who undergo surgery begin a rehabilitation regimen immediately after surgery. This initial phase of rehabilitation focuses on developing a full range of motion in the injured knee. Once the inflammation and swelling from surgery has gone down, additional strength training activities can begin. These initial activities are focused on building the strength and control of the injured leg and are gradually advancing to full-body exercises. 

Return to sport is the final phase of the post-operative rehabilitation program as well. Rehabilitation activities during this phase focus on skills and drills that are sport-specific to the patient. Activities may include hopping, increased cardio, and ball-handling exercises. Drill difficulty is gradually increased until normal and symmetrical function returns.

ACL rehabilitation programs progress based on the patient’s ability and symptoms. Monitoring the symmetry in range of motion and strength will help determine how patients advance  through treatment. Returning to sport before symmetry has been achieved increases your chances for re-injury and ongoing physical limitations. Should we cite this? 

At Optimal Sports Physical Therapy, our ACL injury treatment plans follow evidence-based guidelines and are customized to ensure individualized care based upon your goals. Our rehabilitation milestones do not occur on a set timeline. We focus on ensuring that you have the best outcomes so that you can get back in your game –  safely.

If you have recently experienced an ACL injury, make an appointment to see one of our highly trained Physical Therapists. All of the Physical Therapists at Optimal Sports Physical Therapy have extensive training and experience helping patients (copers and non-copers) achieve their ACL rehabilitation goals. In the Helena, MT area, you can call our office at 406-502-1782 to schedule an appointment.

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