Cruciate ligament injury

Anterior cruciate ligament is a major ligament that connects femur and tibia. It serves to prevent the tibia going forward. Posterior cruciate ligament is to prevent the tibia going to the back. During the leg in flexion or extension, both cruciate ligaments will keep the knee in a correct position, which is very important for knee stability.

ACL injuries commonly occur during sports that involve sudden stops, change in direction, jumping and landing, such as soccer, basketball, football, skiing, gymnastics etc., which causes great strength and excessive twisting of the cruciate ligament.

In anterior cruciate ligament tear, a “pop” sound may be heard. The knee will get swollen within a few hours. Patients will experience severe pain and inability to continue activity. There will also be loss of range of motion and they will feel instability or “giving way” of the knee joint during weight bearing. In posterior cruciate ligament injury, majority of patient will feel pain but not have the sense of instability, but in severe case, it may cause osteoarthritis of the knee.

Doctor will perform a knee examination to check for the stability. X-ray will be used to look for any fracture. MRI will be used for diagnosis and to determine the degree of ligament tear.

Initial treatment will include resting, ice therapy and elevation of the affected leg.
Conservative management will be suitable for patient with partial tear of the ACL with good knee stability. A knee brace will be given to patient, which will be needed for around 6-8 weeks. Physiotherapy will be given for strengthening the muscles around the knee joint.

Operative treatment will be for those who wants to return to sports, has a higher functional demand, or have persistent instability of the knee. Orthopaedic surgeon will perform arthroscopic surgery to reconstruct patients’ ACL using his own tendon. Rehabilitation physiotherapy usually takes 4-6 months, including knee joint range of motion exercise, muscle strengthening and stability training.