What to do following a ACL injury

Scans will often be performed to help in the diagnosis of an ACL injury, and these are mostly requested following an appointment with an orthopaedic specialist. The scan that is most frequently requested is an MRI, which provides images of both the hard and soft tissues of the knee so that it is easier to visualise the extent of the ACL injury and to see if any other structures in the knee are injured.

An X-ray might be requested in the early stages following a knee injury to rule out a fracture to the bone. X-rays do not show ligaments and cartilage, and this is why an MRI is often preferred.

Sometimes a specialist may wait for a few days before having an MRI as it is important to try to reduce the amount of swelling around the knee. Too much swelling might distort or reduce the quality of the images provided and this can make it difficult to make an accurate diagnosis.

How is an ACL injury managed?

There are a few options with regards to managing an ACL injury. If, following an assessment and MRI, it is decided that the ACL is only partially torn and there are no significant associated injuries then it is typically managed conservatively. This involves a progressive rehabilitation approach under the guidance of a physiotherapist. However, if the ACL is completely torn then a direct surgical opinion may be sought.

Initially, the swelling and pain can be controlled by following the RICE (rest, ice, compress, elevate) or POLICE (protect, optimally load, ice, compress, elevate) protocols. It might be beneficial to follow both of these protocols at different times following an ACL injury. RICE can help to manage pain and swelling within the first few days following the injury. POLICE, which could involve using a knee brace and crutches to control the amount of weight going through the knee, should be followed as the knee begins to settle down and you become more mobile.

In the early stages following a diagnosis of an ACL injury, it is important to see a physiotherapist so that they can assist in reducing the swelling, improving the movement, and strengthening the muscles around the knee. This can help to reduce the pain associated with an ACL injury, as well as helping to improve the knee function, stability, and general quality of life.

A full ACL rupture rarely heals itself as the ligament ends are not in contact and are separated by joint fluid, so the most common type of management for a completely torn ACL is to have reconstructive surgery. It is possible to manage a complete ACL tear without surgery, but there are many factors that need to be considered when making the decision to manage the ACL injury surgically or conservatively.

When is surgery needed following an ACL injury?

There are many factors that need to be considered when deciding whether to have surgery following an ACL tear. Generally, the decision to have an ACL reconstruction will depend on the extent to which the ACL injury affects quality of life.

The extent of the injury is often a significant factor in determining if an ACL reconstruction is required. Injuries to other structures i.e. other ligaments, cartilage, and bone surfaces, along with the ACL will often lead to a recommendation of surgery. This is to prevent further damage to the knee joint that could result in complications and further surgeries later in life, as injury to multiple structures in the knee can have a negative impact on its stability and function.

If the knee is unstable or collapsing during every day activities, then reconstructive surgery is usually recommended to improve knee joint stability and prevent injury to other structures in the knee. This is especially important for people that work in manual labour or have physically demanding occupations.

Age can affect the likelihood of needing an ACL reconstruction with there being less of a need in an older and less physically active population. However, this is a generalisation and factors mentioned above should still be considered, along with the level of physical activity that is required or wanted to be maintained by the individual.

One of the most important factors that needs to be considered prior to opting-in for an ACL reconstruction is the level of physical activity that the individual wants to maintain and if they are wanting to return to sport. An ACL reconstruction is often recommended if the goal is to return to a high level of physical activity or competitive sport, especially if the sport involves jumping, twisting, change of direction, and contact. This links back to the function of the ACL in controlling and stabilising the knee joint in these movements and trying to return to sports that involve these components without an ACL could result in further damage to the knee.

Once all of these factors have been considered and discussed, the decision whether to have an ACL reconstruction needs to be a shared decision between you and your orthopaedic surgeon.

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