Football and fall soccer seasons have just begun. As they progress, we’ll see more injuries to the knee with all of the cutting, twisting, and pivoting required by these two sports, which is than most other sports. Of all major injuries to the knee, anterior cruciate ligament (ACL) tears are the most common.
The ACL is a strong fibrous tissue that connects the shinbone (tibia) to the thigh bone (femur). The function of the ACL is to help stabilize the knee by resisting translational and rotational forces acting on the knee. If you are performing straight ahead activities like running, the ACL plays a minor role. However, with cutting, twisting, and pivoting activities, the ACL plays a major role. The ACL is the primary restraint to resist forward (anteriorly) directed forces of the shinbone (tibia) on the thigh bone (femur). It is also the primary restraint resisting rotational forces about the knee. Your knee also has secondary restraints, which include the meniscal cartilages, the shape and contour of the bones, and the collateral ligaments.
When the forces applied to the knee are greater than the forces that the ligament can handle, the ligament tears. This can be seen not only in contact injuries, but also increasingly in non-contact injuries where approximately 70% of ACL tears occur. When the ligament tears, the patient will typically feel a giving way, shifting, or buckling type of sensation. This shifting sensation is not only felt, but many times is also heard as a loud pop. Other symptoms include pain with standing or walking, swelling, decreased range of motion, and a feeling of looseness about the knee.
Every time that the knee gives way, there is a 70% chance that some other structure in the knee will also be injured. The other structures include the ends of the bone and soft tissues such as the meniscal cartilages, the joint surface, and other ligaments. These injuries can be evaluated with a thorough history, physical exam, and imaging studies such as an MRI. Repeated episodes of instability can lead to devastating consequences over time including osteoarthritis for young people. Therefore, if your goal is to return to cutting, twisting, and pivoting type activities, stabilizing the knee is crucial.
There are various methods of treatment to stabilize the knee ranging from conservative, non-operative measures to operative treatment. Conservative treatment includes rehab, bracing, and activity modification to avoid cutting type activities. Braces tend to work well with lower level activities; however, you can still have giving way episodes with higher- level activities. Bracing also does not address related injuries such as meniscal tears or joint surface injuries. Operative treatment involves anatomic reconstruction of the ACL. An extensive rehab program follows surgery. Typical time to return to play is six to nine months. Reconstruction gives you your best chance to return to your sport.
If you have concerns that you may have injured your knee, I would recommend that you be seen and evaluated by a fellowship trained Sports Medicine Orthopaedic Surgeon with extensive experience treating knee injuries.
Dr. Deneka is a Fellowship Trained Sports Medicine Orthopaedic Surgeon with OrthoMemphis. For more information on knee injuries visit orthomemphis.com or call (901) 261-7828.