Anterior cruciate ligament of the knee joint Anterior cruciate ligament rupture is the most common knee ligament injury. At the time of injury in the knee joint, even a crackle can be heard. At the same time, there is quite a lot of pain, and the knee swells in a few minutes. ACL traumas are divided into contact and non-contact.
ACL is created of a couple of closely running bundles, which together provide 85% of resistance force to push rotation action of the femur on the tibia. It is also a major player in resistance to excessive movement in any direction especially for rotational loads. Together with Posterior Cruciate Ligament ACL is an epicenter in the movement of knee joint as such.
The ACLI is much more common type of trauma then the contact form. ACLI occurs more frequently among athletes.
ACLI is more prevalent in alpine skiing, soccer, American football rugby, basketball and martial arts.
One thing that these sports have in common is torque created on the knee by cutting movement of the athlete.
Statistically ACLI happens three times more in females than in males.
How ACL is injured. The mechanism
Rather often ACL ligament is injured:
• when an athlete is landing from a jump
• if an athlete is cutting with deceleration
• if a sportsman is pivoting with planted foot/feet
• if a person is pivoting with a straight knee.
Quality of the landing ground, model of the shoe and how worn it is, weather is a major factor as well.
The listed above biomechanical, neuromuscular, anatomical, metabolic factors as well as gender differences extrinsic factors make ACL trauma to be of multifactorial etiology.
ACL tear usually presents with a lot of pain and a large swelling. An athlete is taken of the field and cannot bear weight.
Clinical diagnosis can be made based on movement, which caused this injury. MRI is the best radiological modality in case of ACL tear. MRI is necessary to visualize the extent of an injury as well as to rule out damage to meniscus medial collateral ligament as those frequently occur together and commonly known as … triad.
The prognosis of patient with ACL injury depends on many variables. Such variables are: severity of ligaments damage, limits of acclivity, instability and neuromuscular compensatory capacity. When there is a partial ACL tear the nonsurgical intervention is favored, as patient with surgical repairs did not show better long-terms outcome with regards to developing knee arthritis.
Complete ACL tears have much less favorable prognosis for conservative rehabilitative treatment. Patients with complete ACLI whose occupation or athletic activities require pivoting and/or cutting will certainly require surgical repair, however repair does not guaranty a full return to their prior sport. Activity modification may be the only solution in some group patients/athletes post ACL repair.
The goal of physical therapy treatment after ACL injury is to restore motor control in all planes of hip, knee and foot motion in the context of dynamic movement resembling all possible mechanisms of ACL injury .In the past it was believed that restoring quadriceps’s muscle strength to ninety percent of the uninjured leg is the major criteria for ACL tear rehabilitation. This criterion was totally destroyed by variety of good quality controlled studies. This criteria being a small piece of the puzzle is still unfortunately practiced by many orthopedically driven physical therapy facilities.
The rehabilitation of ACL rupture whether the patient had surgical repair or not is a lengthy process which must be involve restoration of quality of movement of the whole lower chain, not just the knee from all aspects of movement control such as: proprioception, balance, motor control, muscle balance, shock absorption, ground reaction forces and etc., not just a mere muscle strength. We are talking about dynamic control of lower extremity kinetic chain. This process is a long road because the injury to the ligaments disrupt not only the structural constrains of the movement of the knee joint, but also disrupt proprioceptive feedback to the brain from the knee joint as well as the knee/hip musculature. The acquired gain in muscular control in directly proportional to reintroduction of sensation from the knee ligaments to the brain. We are talking about rebuilding motor patterns based on proprioceptive feedback. If this process is rushed, skipped the muscular strength achieved will not become functional and activation patterns necessary for control of pivoting and other complex movements which pertubate the knee in the context of sports or fitness performance will be delayed ant therefore insufficient. This may result in re-rupture or delayed osteoarthritis of the knee joint. Simplistic conventional approaches based only on regaining quadriceps and hip strength have failed to address this component and produce subpar results. Moreover, motor control needs to be tested during several stages of the rehabilitation process allowing the therapist, patient and physician to monitor gains, control and steer rehabilitation process as well as becoming an ultimate guide for return to field decision. This requires specific motion analysis technology and clinical experience in functional biomechanics and gait analysis.
Not less important is restoration of core musculature and concomitant control of trunk movement as trunks weight and lever can negatively influence the motion at the knee.
At NYDNRehab we have been combining top-notch technology, latest research and clinical expertise to deliver best treatment outcomes for patients with ACLI. With our unique CAREN (Computer Assisted Rehabilitation Environment) technology with can begin restoration of proprioception and balance much earlier then with over ground conventional physical therapy. CAREN also allows early raining of symmetrical weight bearing distribution. We use CAREN in different stages of ACL rehab. In later stages of ACL rehab we use CARENS perturbation capability to test and train knee stability in the controlled environment.
Christopher Powers PT, PHD one of the world leaders in testing, prevention and rehabilitation of ACL injuries, invented another methodology we use successfully. This methodology also involves technology. A set of high speed motion capture cameras, force plate and special software allows registration of forces going through the knee joint as patient performs different maneuvers which resemble biomechanical risk situation leading to ACL tear. We also use this system during regular ACL physical therapy sessions for feedback purposes. This methodology allows us to monitor and test the progress of rehabilitation process so that patient does not return to field until he is 100% ready.
Before explaining what types of sprained ACL treatment plans exist, it is important to discuss what exactly this ligament is and why it’s so important. The ACL is a wide ligament that connects the anterior tibial plateau to the posterior femoral intercondylar notch. The ACL is made up of many different non-parallel fibers, with each serving a unique purpose from one another. There is the anteromedial, posterolateral and intermediate bundles to name a few. Of course, the fiber lengths and rotations brought upon by flexion varies from one movement to the next.
However, as far as what purpose the ACL serves in the body, there are so many to talk about. For starters, the ACL holds back the anterior translation of the tiba and stops the hyperextension of the knee. It also behaves as a secondary stabilizer to valgus stress by supplementing the medial collateral ligament. Lastly, the ACL regulates rotation of the tibia on the femur in femoral extensions.
While there can be a bunch of different factors that cause an ACL rupture, the most common reason for this is a strong forceful blow impacting the knee, resulting in a twisting movement. This can either come from a direct hit or an indirect hit. In fact, this may come as a surprise, but around half of the times there’s an ACL injury there was no contact at all. An ACL injury can happen when doing simple actions like side-stepping, landing from a jump or even just pivoting. Obviously, an ACL rupture can happen to anyone if the circumstances are right, but some people are just overall more predisposed to it. In fact, a lot of times patients suffer bilateral ACL tears or this even ends up becoming a familial thing.
Keep in mind, when an ACL is injured, there are various ACL strain treatment plans that when employed will leave the individual in top shape once again. However, to decide which treatment for a torn ACL is best, there are certain factors that have to be considered. These factors are age, functional disability and requirements. That is because there are some people in this world who can survive perfectly fine with a torn ACL. It is these specific factors, though, that can help doctors make a final decision if there should be ACL treatment without surgery or with it. Remember, different surgical problems may arise depending on how old or young the individual is. Besides age, functional disability is also an important factor to keep in mind because there are certain individuals whose knees give out often and then those who have an undiagnosed asymptomatic rupture altogether. Each of these will affect the exact treatment for ACL tear. Then, with functional requirements, it is vital to know if the individual is someone who lives a sedentary lifestyle or if this is a person who is always on the go.
As with any type of injury, each case is going to differ from individual to individual. The overall type of patient, though, will either be able to be treated with surgery on demand or need no surgery whatsoever. However, it is best to get some kind of treatment for ACL tear performed right away to avoid any issues down the line from this injury. While most do need to be operated on, here at NY Dynamic Neuromuscular Rehabilitation, we do not believe that is the only option. There are many long-term therapy programs that can be implemented instead.
Since this is a very serious injury, it is important to note that it won’t heal on its own overnight. To get back in top shape, the patient will need to put in a lot of hard work and have patience. Typically, once ACL sprain treatment is in place, the individual will be repaired in anywhere from six to nine months. However, with our help here at NY Dynamic Neuromuscular Rehabilitation, we will focus on a regenerative ACL tear treatment without surgery. We also offer partial ACL tear treatment and other kinds of similar programs to restore the patient back to their original condition. Unfortunately, too many times in the past, patients do not allow themselves enough time to truly recover. This ends up causing individuals to get re-injured. With NY Dynamic Neuromuscular Rehabilitation by your side, we will make sure that you are treated the right way, the first time around.
We will not only be able to diagnose your ACL tear but also help restore your sprain with treatment for a torn ACL, so that you can function fully again. We will help patients fix any imperfections in their movements, as well as correct any movement that originally led to the ACL sprain treatment. Other than this, the ACL tear treatment without surgery works to make the muscles stronger, so that they don’t leave them self vulnerable to such a sprain. In particular, the quadricepts and gluteals are strengthened. By simply doing these kinds of exercises to build the muscles, patients are preventing an ACL sprain from happening in the future.
The newest ACL treatment without surgery that we’ve been employing here at New York Dynamic Neuromuscular Rehabilitation is biofeedback motor control training. This is the most advanced sprained ACL treatment offered, as it takes real-life force plate analysis into play. From there, we can see exactly how patients are progressing and developing, so that we can make the necessary tweaks and adjustments right away. This helps make the ACL strain treatment as efficient as possible, so that recovery and results can happen quick. Give us a call today to schedule your consultation.