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Published by Better Health Osteopathy on 10 April 2016, Knee Pain
The Anterior Cruciate Ligament (ACL) is one of the most commonly injured ligaments of the knee. It is injured mostly in those who engage in sporting activities such as rugby, soccer, skiing, and snowboarding.
Approximately 50% of ACL injuries involve damage to other parts of the knee including the meniscus, other ligaments or the articular cartilage. Sometimes unfortunately, people can suffer from O’Donoghue’s Unhappy Triad, which involves injury to the ACL, medial meniscus and the medial collateral ligament.
Symptoms of Injury
Immediately after the injury, patients normally experience pain and swelling around the knee, which can also feel unstable. Within a few hours patients can experience a large amount of swelling, pain, loss of range of movement in the knee and difficulty walking.
Your osteopath will examine your knee and after some orthopedic testing a diagnosis of an ACL or meniscus injury can often be made. To confirm the diagnosis your osteopath will often refer you for a scan (X-ray/ Ultrasound / MRI) of your knee.
Not all patients with ACL injuries will require surgery. The need for surgery depends on many factors; the degree of injury and instability symptoms, and the patient’s activity levels.
Non-surgical management of isolated ACL tears maybe suitable for patients:
ACL reconstruction has remained the gold standard of care for ACL injuries, especially for young individuals and athletes who aim to return to high-level sporting activities.
Surgical management of ACL tears is likely to be suitable for patients who:
It is important to note that levels of activity rather than age is an important determinant on whether surgical intervention will be suggested.
The goal of the ACL reconstruction surgery is to prevent instability of the knee and restore the function of the torn ACL creating a stable knee. Patients who undergo reconstruction surgery of their ACL have long-term success rates of 82-95%. Recurrent instability and graft failure are seen in approximately 8% of patients.
The surgery is performed arthroscopically as an outpatient or during an overnight stay. The ruptured ligament is removed and generally replaced by a substitute graft made of tendon, taken from the patients’ knee, such as the patellar, hamstring, or quadriceps tendon. The graft is prepared to take the form of a new tendon and is passed through small 1 cm drill holes in the front of the knee. The graft is placed in almost the same position as the torn ACL. The new tendon is then fixed into the bone with various devices to hold it into place while the ligament heals into the bone, which usually takes 6 months. Any other damage to the knee such as a torn meniscus is repaired at the same time. The wounds are then closed and a dressing applied.
Physical therapy plays a critical role in rehabbing either a partial or complete ACL tear. A partially torn ACL may require a rehabilitation period of at least 3 months which involves mobilising and strengthening exercises. Surgery may not be required, however some patients may still have instability issues. Much of the success of ACL surgery often depends on the patient’s dedication to rigorous physical therapy. Treatment is usually recommended to start as early as possible.
Pre-operative Physical Therapy
Physical therapy is helpful to better prepare the knee for surgery. The early goal is to regain range of motion, reduce swelling and achieve full weight bearing. Osteopathic treatment can be used to achieve these goals before undergoing surgery.
The goals for rehabilitation of ACL reconstruction include:
Professional athletes may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored. This usually takes around 6 months, provided the patient is fit and has adhered to the rehabilitation. Recreational athletes may take 10 -12 months to return to sports, again depending on motivation and time put into rehabilitation.
As your Osteopath we will work closely with your orthopedic surgeon to ensure the best possible recovery outcome for you.
[Legal Disclaimer: This blog provides general information and discussion about medicine, health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as direct medical advice. By reading this blog, you agree not to use this blog as medical advice to treat any medical condition in either yourself or others, including but not limited to patients that you are treating. If you have any specific questions about any medical matter you should consult your doctor, osteopath or other professional healthcare provider]
Lorraine Herity is the Clinic Director of Better Health Osteopathy in Christchurch, New Zealand. She previously worked in Osteopathic clinics in London and Ireland, before moving to New Zealand. Lorraine trained at the British School of Osteopathy in London, where she gained her Master of Osteopathy (M.Ost). Lorraine is a dedicated and passionate Osteopath. Her main aim is to help her patients regain their health and to return her patients back to their everyday activities, in as quick a time as possible. Lorraine is also a clinic tutor on the Osteopathic Course in Ara and relishes the opportunity to teach the next generation of osteopaths.
10 June 2018
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