Anterior Cruciate Ligament (ACL) Tear: Symptoms, Causes, Treatment, and Cost

One of the sturdiest tissue bands that join the thigh bone to the tibia is the anterior cruciate ligament. Any sprain or injury in the anterior cruciate ligament is regarded as an ACL tear. The majority of the time, it is seen in athletes or persons who engage in physical activity.

Summary- The thigh bone and shinbone are connected by the ACL, which is made up of several ligaments.

Any tear in the anterior ligament is called an ACL tear. This ligament is one of the strongest groups of tissues found in the body that effectively connect the bone in our thigh to the shinbone.

An ACL tear can commonly be seen in sports or other physical activities that require a sudden change in direction or a sudden halt while landing or jumping. Football, basketball and skiing can be perfect examples of sports where an ACL tear can often occur.

Most people who have suffered from ACL tears have complained about hearing a ‘popping’ feeling when the injury occurs. The knee becomes unstable, can swell up and can also become unbearably painful if any pressure is applied. Lifting something heavy may further aggravate it.

The knee joints are complex sets of tissues, muscles and ligaments. Immediate attention of a medical professional is advised in case of an ACL tear. The doctor will advise the medical course of action needed. However, if the tear is severe, surgery will be the only way to fully treat the injury.

Summary- Anterior cruciate ligament tear refers to the damage of one of the strongest ligaments of the knees.

To check the severity of an ACL tear that can occur, there are mainly three:

• Grade 1: This is the stage of least ACL tear. It essentially means the ligament has stretched but has not torn. The ligament at this stage can still hold the knee joint together.
• Grade 2: This is the stage of a partial ACL tear. In this stage, the ligament has stretched quite a lot, causing it to become loose. The ligament fails to find support and stability for the joint.
• Grade 3: In a complete ACL tear injury, this is the highest grade and severity. It indicates a full or a nearly-full tear. The ligament has been torn in half in this stage. Most people experience this type of complete ACL tear injury.

Summary- ACL tear is categorized into different grades according to the severity of symptoms.

When you suffer from an ACL tear injury, certain signs and symptoms can be seen or felt. They could be the following:n

• The person may hear a loud pop or experience a 'popping' sensation in the knee right when the injury occurs.n
• Rapid swelling in the injured arean
• Severe pain and inability to continue any kind of heavy physical activityn
• A sensation of instability and weight bearingn
• Loss of movement or inability to move

Summary- Some commonly experienced symptoms by ACL-injured patients are swelling, recurring pain, inability to move, etc.

People involved in any kind of physical activity or sports can sustain an ACL tear during any moment of their activity. The other causes of ACL tear are as follows:n

• Being female: Women more than men are comparatively affected by ACL tear more. This could be due to differences in the anatomy of men and women, core muscle strength and hormonal influences that take a toll on women’s bodies.
• People, both men and women, participating in sports like basketball, soccer, gymnastics, football and downhill skiing are at more risk.
• Incorrect or faulty movement patterns, such as moving the knees inward during a squat or lifting weights heavier than the body permits can cause a severe ACL tear.
• Wearing unruly or unfit shoes or any other kind of heels that do not help with the body posture and movement.
• Using ski bindings that are poorly maintained and not adjusted properly can lead to injuries like an ACL tear.

Summary- People involved in some physical activities or athletes are at higher risk of developing ACL tear injuries.

People associated with sports or any other form of physical or fitness activities can suffer from ACL tear. This is because vigorous sports sand activities can put extreme or unprecedented stress on the knee:

• Jumping and landing awkwardly with a jolt
• While sprinting or running, suddenly coming to a halt or changing direction of movement
• Receiving a direct blow or hot on the knee or having a collision during any kind of game.
• Coming to a sudden halt while running

In case of an ACL injury, there will not be a tear in all cases. In case of damage, there may be a partial tear as well. A milder ACL tear may cause the ligament to stretch but leave it fully intact without tearing.

Summary- Some activities that can lead to ACL tear injury are sudden falls, accidents, jolting, etc.

By keeping the muscles around the knee area flexible and strong, frequent or sudden ACL tear injuries can be prevented. To keep the surrounding knee muscles strong, a consistent and free-slowing daily workout routine should be followed.

By controlling the level of physical fitness by keeping oneself engaged with some form of physical activity, injuries like ACL tears can be prevented. Exercise helps us to not only stay in good shape but also improves the body’s balance and makes people aware of their bodies better.

DOs:

• No matter what, keep your knees straight. Bending them or folding them in any manner will only aggravate the pain.
• Putting any kind of weight on the knee should also be avoided. This means any form of lifting or walking should be strictly avoided until the orthopaedic says it is okay to indulge in some lightweight pressure.
• Instead of eating three full meals, focus on smaller but frequent meals through the day
• Wearing a knee brace, however uncomfortable and itchy it may feel, should always be a priority. A knee brace assists in speedy recovery. It helps in keeping the knee joint stabilized.
• Swimming, cycling and even bending should not be done.
• Follow-ups and check-on on due dates with the doctor should not be missed.

• Some people go ahead of themselves and try to put ice on their knees. Although this might soothe the pain temporarily, icing may cause the injured muscle to contract, thus causing more complications. Visit the doctor and let him handle it professionally.
• Avoid falling asleep with your knee bent. This can cause the formation of scar tissue which can later pose a problem by extending to the entire knee area.
• Do not try to compensate for one knee for the other good one. This may overwork the excellent knee and cause damage to the other one too. Stay rested and follow the words of the doctor until fully recovered.
• If there is any kind of pain that the doctor has not mentioned will be happening, do not be afraid to share it with him to help him diagnose better.

Summary- ACL tear injury can be prevented by following some simple distinct steps. However, we must be vigilant about the activities that need to be excluded.

Your doctor will check your injured knee in comparison to your uninjured knee. The injured knee will likely to be swollen and tender. The doctor can also move the knee in several positions to assess the range of motion and how poorly the joints have been injured.

The diagnosis that the doctor conducts is often enough for determining the condition of your knee, however, some other tests may also be performed to check the gravity of the injury. The nature of the tests may be:

• X-rays: X-rays use technology that does not allow us to see soft tissues such as ligaments and tendons. However, in the case of a fracture, X-rays are helpful
• Magnetic resonance imaging (MRI): MRI uses the technology of radio waves and magnetic souled in order to produce images of both hard and soft tissues in your body. MRI tests can be suggested by the doctor to check the grade and severity of the injury and the signs of ACL damage it has caused to other tissues or cartilage.
• Ultrasound: Ultrasound uses the technology of sound waves to help visualize the internal structures of the body. An ultrasound test helps determine the condition of the muscles and joints around the ACL tear.

Summary- Some diagnostic tests applied for the detailed diagnosis of ACL tear include x-rays, lab tests, MRI, etc.

ACL injury patients are more likely to get osteoarthritis in their knees. It is one of the most prominent complications faced by patients.

Summary- The most possible complications of ACL tear include osteoarthritis.

Prompt first-aid care right after the injury can reduce pain and swelling. For self-care at home, the R.I.C.E model can prove to be helpful:

• Rest: If the injury is not severe, generally resting at home with no heavy work is advisable.
• Ice: Icing every two hours for twenty minutes may bring relief from pain and inflammation.
• Compression: A compression wrap or an elastic bandage around your knee will help keep the pain controlled.
• Elevation: Lying down on your bed, keep your leg on a pillow at an angle to get relief from pressure.

Summary- Some of the commonly used home remedies are icing, elevation, compression, etc.

Some food items should be included in your diet for faster recovery:

• High protein foods: Chicken, fish, eggs, milk and cheese should be included in your daily diet. Protein is associated with muscle building. In the case of gaining strength back, protein is proven to be the most effective. Vegetarians can opt for cheese, milk, chole, sprouts, rajma, soybean, legumes, and pulses.
• Fibre: Fresh leafy greens should be heavily included. Try spicing it up by making caesar’s salad or a plain salad with fresh seasonings. Both raw and cooked vegetables should be consumed.
• Fresh fruits: Fresh and seasonal fruits should be eaten. Apples, oranges, bananas, and other fruits with high potassium and iron will help you gain strength back and speed your recovery process.

Summary- We should increase the intake of fibre-rich vegetables and fruits to combat the ACL tear.

• Avoid fast food: Until fully recovered, avoid consuming fast foods like burgers, pizza and the lot. Try eating healthy, home-cooked food.
• Red meat: Chicken and eggs are good, but avoid red meat altogether. Avoiding red meat will also affect your overall health positively.
• Cut down on caffeine: Caffeine has more negative than positive effects. Instead of a cup of strong espresso, switch to green tea for overall health improvement as well.

Summary- We must exclude fast foods, caffeine, alcohol, red meat, etc. while recovering from an ACL tear.

Although surgical treatment is necessary to repair ACL tears completely, there are some non-surgical treatments also available out there. Some of them are-

• Bandaging the knee
• Icing on the affected area of the knees
• Using knee braces
• Taking anti-inflammatory drugs such as ibuprofen

Summary- Non-surgical treatment options take more time to heal the ACL tear.

Your doctor may advise you to undergo surgery if you belong to the following categories:

• Athletes, especially the ones who are involved in jumping, pivoting or cutting due to their career, may be advised to get the surgery done.
• Ligament or fibrous cartilage plays an important role in keeping the knee stable. The doctor may advise surgery if either of them, one or more, have suffered injuries.
• If the injury is causing your knee to pain or buckle during everyday activity, your doctor might suggest getting a surgery immediately

During the ACL reconstruction procedure, the surgeon does away with the damaged ligament and replaces it with a segment of the tendon, the tissue similar to the ligament that connects bone to muscle. This replacement tissue is called a graft. Your surgeon will use a piece of tendon from another part of your knee or a tendon from a deceased donor. After surgery, you'll resume another course of rehabilitative therapy. An ACL reconstruction procedure successfully carried out when paired with properly conducted rehabilitation can usually restore functionality and stability to your knee within a given time.

The medication course for ACL injuries mainly comprises analgesics. They are a group of pain relievers or pain killers associated with diminishing pain. Preoperative drugs may include:

• Cyclooxygenase-2, also known as COX-2 inhibitors and opioid agents
• Nonsteroidal anti-inflammatory drugs (NSAIDs) and opioid and opioid analgesics may be given to patients post-op to get over or lessen the pain

Summary- Some best medicines often prescribed for ACL tear surgery are NSAIDs, COX-2, opioids, etc.

The aim of ACL surgery is to effectively repair the anterior cruciate ligament tear and bring it back to its original state, as it was before the injury. Total ACL tears are usually tackled by orthopedic doctors with an ACL reconstruction surgery, in which the torn ligament is substituted with a tissue graft to mimic the natural ACL:

• Patellar tendon autograft: This type of grafting involves using the patient's middle third of the patellar tendon, in addition to the bone plug from the shin and the kneecap. It is often named by surgeons as the 'gold standard' for ACL restoration and is recommended for athletes and patients who have a high demand and whose jobs do not require a significant amount of kneeling.
• Hamstring tendon autograft: The hamstring tendon on the inner part of the knee is used in creating the hamstring tendon autograft for ACL reconstruction surgery. Some doctors prefer using an additional tendon, the gracilis, which is then attached below the knee within the same location. Doctors often advise undergoing hamstring tendon autograft because it supposedly has fewer complications or post-op healing issues as compared to patellar tendon autograft including:
  1. Less postoperative stiffness problems
  2. Fewer problems with anterior knee pain or kneecap pain after surgery
  3. Faster recovery

Summary- ACL tear surgery is executed by following some well-planned distinct processes.

It can take 6-9 months on an average to fully recover after an ACL tear surgery.

Summary- 6-9 months are required for complete recovery from ACL tear surgery.

The cost of ACL tear surgery can depend on a variety of factors and the place you are getting the surgery from. On an average, the surgery may take Rs. 85,000 to Rs. 1,70,000 in Delhi. All the detailed information is laid out on the website of Pristyn Care. You can find out every single detail about ACL surgery and the expenses it holds. Pristyn Care website also lists down some of the best orthopaedic doctors in your area, along with visitation charges and surgical charges.

Summary- The treatment of ACL treatment is high-priced and lies between 85,000-2,00,000 rupees.

Yes. Under most circumstances, the positive effect of getting better can be seen a few days post-op. The doctor may advise you to return to normal activities like gentle walking or strolling after a few weeks. However, to fully see your knee function properly, may take several months. Certain hardcore sports and activities should be kept away for at least 6 months and let the knee rest for full recovery.

Summary- The results of ACL treatments are often regarded as permanent.

• While sleeping, use a pillow to keep your leg elevated at an angle of 45 degrees.
• You can also place pillows or cushions in a manner that your knee is elevated at least 10 inches above the heart.
• If the doctor has suggested crunches, make sure only the minimum effort is put on the knee.
• Take care of what you eat. Lots of lean protein and healthy greens are crucial in your diet.

Summary- We must follow some post-treatment guidelines to smoothen the recovery process.

The injury may not completely heal and may reoccur in future, if proper surgery is not administered on the patient. Patients with poor treatment may face the risk of suffering from osteoarthritis. Although there are several factors that determine the risk of arthritis, ACL tear and its related traumas like severity of the tear and how much rest the patient gets after surgery are related to keep arthritis at bay.

Summary- ACL treatments possess some adverse effects like that of arthritis.

ACL tears are not life-threatening and can easily be prevented or treated at the right time. However, injury of any kind is not a fun thing to flow with. If your doctor feels that surgery in necessary in your case, get it done so that the recovery comes ahead faster.

Summary- ACL tear often possesses an overall positive outlook if detected earlier.