Anatomy & Background
Ligaments are connective tissues made up of collagen fibrous bands that help stabilize joints and decrease excess motion. The medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL), and posterior cruciate (PCL) ligaments are the four main ligaments in the knee. Each of these serves a specific purpose in the knee’s stability. Injury to a ligament can severely hamper the function and stability of the knee.
Anterior Cruciate Ligament (ACL)
The Anterior Cruciate Ligament is crucial because it is one of the primary stabilizers of the knee joint. It is attached to the back of the femur (thigh bone) and runs to the front of the tibia (lower leg). The ACL prevents the tibia from sliding forward on the femur and limits the knee’s rotational movement.
Anterior Cruciate Ligament Tear
An ACL injury can range from a partial to a complete tear. If the ACL is torn, the stability of the knee is put in jeopardy. The loss of the ACL will result in a sliding forward and twisting movement of the tibia over the femur, which can be extremely painful. This movement can produce increased friction on the meniscus and cartilage in the joint. ACL tears occur more often in women than in men. Adults typically tear the ACL mid-ligament. Tears in children may result in a piece of the leg bone tearing off with the ligament intact where it is inserted onto the bone.
Anterior Cruciate Insufficiency
When the ACL is partially or completely torn, the knee’s stability may be compromised; also known as an ACL Insufficiency. ACL Insufficiency may also cause excessive sliding forward and twisting movement of the tibia on the femur. This may result in an increased amount of friction on the meniscus and cartilage of the knee. Individuals with an ACL Insufficiency may be more likely to experience meniscus and cartilage damage after the original ACL injury, mainly when the individual participates in sports or other activities that involve strenuous movements on the knee joint.
The ACL can be injured when:
- The knee experiences a hyperextended (bent backward), side-to-side or twisting motion. This normally occurs when the foot is planted;
- The knee experiences a high impact blow directly to the joint;
- A sudden cutting, stopping, or twisting motion occurs, or a hard landing from a jump.
An ACL band injury in the knee is usually caused by sports or fitness activities that put a lot of strain on the joint.
Signs and Symptoms
Any of the following symptoms may indicate an ACL injury and warrant an appointment with one of Redefine Healthcare’s specialists:
- Pain and swelling of the knee following the injury can be caused by bleeding following the tear of the ligament;
- A “pop” in the knee may be heard or felt at the time of the injury;
- Difficulty walking, with a feeling of the knee “giving out”;
- Loss of motion when attempting to bend and extend the knee.
If the injury is not treated, the affected knee may develop chronic instability, resulting in it giving way during weight-bearing.
In response to this type of injury, one should initiate the RICE protocol: Rest, Ice, Compression, and Elevation, in addition to the following:
- Rest by stopping activity immediately;
- Immobilization of the knee to keep the ligament from enduring more stress;
- Ice, compression, and elevation to reduce inflammation and pain for the first 48-72 hours. Do not apply ice directly to the skin. Only use ice intermittently throughout the day and apply for 20 minutes at a time. Do not apply any form of heat while icing your knee;
- Contact a pain management specialist for a complete diagnostic evaluation of the injury and to identify the proper plan of care.
Call one of our offices for more information concerning available ACL injuries treatment options or use our convenient online booking system to make an in-person appointment with one of our leading specialists.
After the ACL is injured, you should seek a full evaluation from a pain management specialist or licensed healthcare provider. Treatment may consist of the following, depending on the severity of the injury:
- Clinical evaluation, including a physical exam, X-rays, and MRI in more severe Grade III and Grade IV injuries;
- Use of ice and immobilization to help stabilize and rest the joint;
- Anti-inflammatory medication and other pain medications;
- “Progression” an immobilizing device to help stabilize the joint;
- Surgery may be needed for certain ACL tears.
The medical treatment of an ACL tear will depend on several different variables, which include:
- Severity, which can be a partial or a complete tear of the ACL ligament;
- The possibility that other structures were affected;
- The patient’s activity level, lifestyle, occupation, etc.;
- Your age is a factor when deciding whether to have surgical reconstruction.
Treating an injured ACL surgically is usually the best option for patients with active lifestyles. During a surgical procedure, the specialist replaces the damaged ligament with a tendon from another part of the body. If the patient has a full knee extension, the procedure can be performed immediately after the injury.
A Conservative Treatment Plan
Following a complete examination of the knee, our pain management and injury doctor may recommend a course of physical therapy for the following reasons:
- Taking into account the individual’s age, activity level, lifestyle, occupation or amount of instability, and pain management, physical therapy may be the best option. This is especially true for a partial ACL tear;
- If there is a lot of swelling, pain, or loss of range of motion, it is recommended that the individual seek the opinion of a pain management specialist to improve the condition of the knee in preparation for surgery or to determine if a surgical intervention is necessary;
- Once the proper diagnosis is made, the specialist and the patient can develop a plan of care on how to permanently alleviate the pain;
- If deemed necessary, the pain management specialist can then provide the necessary intervention for immediate pain relief.
Our top-rated pain management doctors and specialists in New Jersey provide pain relief and rehabilitation care. Visit our injury clinic in New Jersey and meet leading pain doctors and specialists. Our rehabilitation centers are among the best in the region. Our doctors are affiliated with the top-rated hospitals in New Jersey, including RWJ Barnabas and Morristown Medical Center. Physicians working at Redefine Healthcare contribute to many prominent media outlets and are the best injury doctors in NJ.