What Are ACL & PCL Injuries?
Torn Posterior Cruciate Ligament (PCL)
A posterior cruciate ligament tear occurs when the posterior cruciate ligament (PCL), a band of tissue that connects the femur to the tibia inside the knee joint, becomes torn or worn away. A torn PCL causes pain and instability of the knee.
Torn Anterior Cruciate Ligament (ACL)
An anterior cruciate ligament (ACL) injury occurs when the ACL ligament within your knee is torn. Knee-twisting or hyper-extension can lead to ACL tears. This occurs most commonly while playing high intensity sports that involve a lot of quick, powerful changes in direction. People who play sports like basketball, tennis, volleyball, and soccer are most likely to suffer an ACL knee injury.
From soccer stadiums to downhill race courses around the world, crowds gather to support their favorite athletes. These athletes are among the best—the strongest, the quickest and the most agile. While most viewers will recognize the extraordinary amount of athleticism, they may not recognize the risk to the knee. An injured ACL is one of the most common knee injuries for athletes, especially for soccer players and ski racers.
Although ACL injuries are certainly not unusual outside of athletics, they are one of the most common knee injuries suffered by collegiate and high school athletes. The American Academy of Orthopaedic Surgeons reports that around 200,000 ACL injuries occur annually.
The most common injury is a non-contact pivoting injury, which usually involves a rapid deceleration, such as landing from a jump or a cutting-type movement. This type of movement applies particularly to soccer, basketball players and skiers, who make quick twists and pivots in fastpaced games. For sports like long-distance running, ACL injuries are possible but may be less of a risk because of the absence of certain movements that place added stress on the ligament. Less common is a contact ACL tear. A contact ACL injury typically involves a blow to the back of the knee, which usually results in additional injuries to the knee. Contact ACL injuries are more common in sports such as football, soccer and rugby.
ACL Injuries in Women
For reasons that are not fully understood, ACL tears are much more common in women than in men. An estimated 100,000 female collegiate athletes suffer ACL tears annually. Post-adolescent female soccer players are two to eight times more likely to seriously injure their ACLs during practice or games. There are a number of anatomical and physiological differences that may predispose women to having their knees internally rotated and placing them at a higher risk of ACL injury. Some of those risks include increased flexibility in the knee, and differences in muscle strength ratios and different jumping mechanics.
Diagnosing an ACL Injury
ACL tears can generally be recognized by hearing or feeling a pop, followed immediately by swelling, difficulty with weight bearing, decreased range of motion and pain along the joint line.
It is important to be evaluated following a knee injury to make sure there are no associated injuries, such as a fracture. A doctor’s examination with an X-ray will determine if any fractures or dislocations have occurred. The physical examination remains the most important aspect of the evaluation to assess for associated injuries. The doctor may also obtain an MRI to confirm the diagnosis and to evaluate the extent of the damage to other structures in the knee.
Types of Treatment
When considering treatment, factors to consider include the extent of the injury, the patient’s activity level and comfort level. A torn ACL should be treated by a medical professional immediately. The first course of action will be to reduce your pain through medication. Typically, after an acute ACL tear, patients will require two to six weeks of physical therapy to allow for swelling to subside and for range of motion to normalize. During this time, patients should avoid cutting, pivoting or twisting. As swelling subsides and range of motion improves, patients often feel much better.
Following an ACL tear, there are always two treatment options: non-operative conservative treatment and surgical reconstruction. Non-surgical treatments can be effective in patients who have only partial tears and no instability; patients with complete tears who are willing to modify their lifestyle to avoid twisting-, cutting- and pivoting-type activities; and patients who do minimal physical work and lead more sedentary lifestyles.
Non-surgical treatment in a young, active patient who participates in direction change sports usually produces unsatisfactory results. In the ACL-deficient knee, it changes the contact stress in the knee, increasing the risk of meniscal damage and, in theory, causing increased cartilage wear and arthritis. For athletes who rely on cutting, pivoting and twisting movements, surgery is recommended, primarily to stabilize the knee and prevent further joint damage.
An ACL reconstruction surgeries require the use of a graft—either an autograft or an allograft. Autograft refers to tissue obtained from the patient’s body—usually the hamstring tendons, patellar tendon or quadriceps tendon. When an allograft is used, it is obtained from a cadaver. Allografts offer the advantage of eliminating the pain of the surgery involved in obtaining the graft, but they have some risks.
Deciding which graft to proceed with can be a difficult decision and is an important topic to discuss with your orthopaedic surgeon.
The surgery is typically performed as an outpatient procedure and requires crutches and a brace for a period of time. If the patient had an isolated ACL reconstruction, he or she can often bear weight as tolerated with the assistance of crutches and a brace. If meniscal or cartilage repair is required, his or her recovery may include a period of non-weight-bearing to protect the repair. The patient will typically begin formal physical therapy within a few days to a week after surgery, and the recovery takes six to nine months before a return to sports. Physical therapy involves a progression of exercises aimed at re-establishing full range of motion and strength to the affected knee.
Preventing ACL Injuries
ACL injury prevention is gaining popularity throughout the country. These programs are typically twice a week for six weeks and focus on high-intensity plyometrics, agility drills, pivoting and landing, and they are aimed at athletes of all levels, from high school to professional sports. These programs may be especially important for the skeletally immature female athletes. An ACL tear can be a difficult, painful injury—but with the right information and a trained, skilled orthopedic surgeon, it doesn’t have to be an injury that keeps you off your feet and out of the game for long.
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To learn more about treatments for a torn anterior or posterior cruciate ligaments, please request an appointment online, or call 888-660-2663.
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