Broken ACL – does it always have to end in surgery?

The anterior cruciate ligament is able to withstand loads of up to 2160 N. So what can damage such a strong structure? How to choose the right treatment method? You’ll find the answer in this post!

 

 

 

Let’s start with the structure in question.

Anterior cruciate ligament (ACL) is one of the most important passive 
stabilising intra-articular structures knee-joint. It runs from the 
posterior surface of the femoral lateral condyle to the anterior surface 
of the intercondylar tibia. The length of the ligament is usually between 
3.7 cm and 4.2 cm, and about 5 mm thick.

It performs very important functions affecting the stability of the joint:

  • prevents anterior translation (displacement) of the lower leg relative to the femur,
  • prevents rotation of the tibia relative to the femur,
  • reduces excessive flexion and hyperextension of the knee joint,
  • reduces bleeding and valgus.

In addition, the anterior cruciate ligament, thanks to the content of deep sensation receptors, is primarily responsible for coordinating the movements of the lower limb and controlling and regulating muscle tone during joint movement.

As mentioned before, ligament strength reaches an average of 2160 N. Comparatively, when performing activities related to everyday life, for example when climbing or descending stairs this load is about 450 N.

Although it is a very durable structure, its damage occurs not only in athletes, but also in supporters of recreational activities.

What are the most common mechanisms responsible for ACL damage?

  1. Rotation mechanism
    With the foot fixed on the ground, the torso suddenly turns, especially with the presence of bending in the knee joint
  2. Hypothalamic mechanism
    It includes the application of force from the front of the knee

Is reconstruction of broken ACL the only method of treatment?

An broken ACL does not mean a necessary operation. During joint stability, surgery is not an indication. However, since 1980, no clear evidence has been collected to date showing a better treatment – surgical or conservative? Therefore, the patient should consult a doctor for an accurate and very thorough assessment of the condition of the injured joint. In particular using high resolution magnetic resonance imaging.

It has not yet been shown that the reconstruction of a broken ligament reduces the likelihood of osteoarthritis (the most common chronic disease of the musculoskeletal system). The possibility of future damage remains at high risk regardless of previous treatment. However, it has been proven that surgical treatment reduces the risk of secondary damage to menisci and articular cartilage.

However, before and after surgery, as well as in conservative treatment, work with a physiotherapist is necessary. Depending on the method chosen, there are different standards of rehabilitation that will be appropriately and individually selected to the patient’s needs. The physiotherapeutic effect is primarily to restore the patient’s fitness.

So if you are a person who has ACL damage or are already after / during treatment, be sure to contact a professional physiotherapist! Remember that you may not now feel frequent / severe pain, but over time damage, abnormal adhesions build up and you may experience a significant deterioration in your performance.