Anterior Cruciate Ligament Tear: the classic knee injury

We lay claim to the title of the world’s greatest sporting nation and it is true that sport is a national obsession, both as spectators and getting onto the field of play at every level. Yet, it is also true that sport and injury go hand in hand.

The knee is the most common joint to incur injury during sport and injuries to the ligament account for approximately 40% of all knee injuries. Of the four ligaments that stabilise the knee joint, the anterior cruciate ligament, commonly known as the ACL, is the most necessary and the most vulnerable, accounting for almost half of all knee ligament injuries.

The ACL is a band of tough, fibrous tissue that connects the thigh bone to the shin bone, running through the knee joint. The cruciate ligament is essential for balancing the knee joint when twisting, pivoting and landing, as it prevents the tibia from rotating and sliding forward.

Here are some of the common questions about ACL injury:

1. How will I know if I have torn my ACL?

An ACL tear is usually the result of a sudden injury. Typically, you will feel and even hear a ‘pop’, accompanied with sudden pain. Once the initial pain abates, it is usually succeeded by stiffness, swelling and discomfort. There is often instability in the knee and it may ‘give way’ or buckle when turning or landing.

2. Why does the ACL often fail to heal?

Unlike the other ligaments that support the joint, the ACL passes through the middle of the joint and is surrounded by joint fluid. Synovial fluid in the joint is designed to dissolve and prevent blood clotting in the joint so scar tissue on the ligament cannot form, making healing of the ACL challenging.

3. Can I live with a torn ACL?

Every component of the knee joint works together; if the ACL tears then there is increased strain on the meniscus. If the meniscus gets worn down then we are left with just articular cartilage to protect our bones and, over time, this can deteriorate, resulting in osteoarthritis.

If you have incurred an ACL injury, then you have a number of treatment options:

• Live with it! If you modify your activities so you do not engage in sporting pursuits that involve twisting motions then many people find it is possible to perform all normal, everyday activities without an intact ACL. However, patients that partake in competitive sports such as hockey, football and rugby, may find that lack of stability in the knee is hampering their ability to play.
• A rehabilitation programme aimed at strengthening the supporting muscles can help provide the stability the knee requires.
• A tear, either partial or total, to the anterior cruciate ligament can be resolved with surgical intervention. Mr Jonathan Webb, an orthopaedic surgeon that specialises in knee surgery, sees many ACL injuries in his Bristol and London knee clinics.

4. What is the rationale for treatment of the ACL?

The approach adopted by London and Bristol orthopaedic surgeon Mr Jonathan Webb is to return the patient to a level at or approaching their former level of activity. This can be achieved either through conservative treatment or, if required, with surgery.

He takes into account your age and activity level, while also assessing the degree of tear and resultant instability. Surgery will usually return you to full participation and may also prevent future problems such as osteoarthritis developing.

5. Who should I see for ACL reconstruction?

An ACL reconstruction is performed by an orthopaedic surgeon who has specialised in treating the musculoskeletal system. A consultant orthopaedic surgeon that has focused on the knee and has an interest in treating sports injuries can also be fundamental to achieving a successful ACL reconstruction. Former England rugby player and orthopaedic surgeon Mr Jonathan Webb only treats knee injuries and conditions. For more information or to book a consultation, call 08450 60 44 99 to speak to one of his team.