ACL Surgery - Symptoms of a Torn Anterior Cruciate Ligament

When it comes to knees, things are more complicated on the inside than they look on the outside. There are a lot of parts that connect and move it different ways in order for the knee joint as a whole to function the way it is supposed to. What this also means is that there are more parts that can potentially get damaged or injured as a result of accidents or strenuous physical activity.

When things start to not feel right in the knee during certain specific movements or trying to carry out normal activities, it is important to identify the cause of the pain or discomfort. And preferably sooner rather than later. The knee contains numerous soft tissue parts, some of which require restriction of activities in order to heal, and some which actually don't heal at all if torn.

Of the different ligaments, tendons, muscle, cartilage and bones that can be injured within the knee area, one of the more serious is the Anterior Cruciate Ligament, commonly referred to as the ACL. This ligament, if torn, does not heal and may result in ACL Surgery being required. Listed here are symptoms that may point to a torn Anterior Cruciate Ligament:

1. Instability Pivoting - pivoting or twisting is one of the easiest ways to tear your Anterior Cruciate Ligament. It can happen while playing sports such as soccer, netball, tennis and oztag, and it can in happen in your own home from twisting too quickly or twisting too far. If you find that pivoting on one particular leg causes your knee to feel like it's not going to hold in its place, it could well be that you have a torn ACL. The best thing to do is to see a Physiotherapist to assess the severity of the ACL tear. The Physiotherapist may send you to an Orthopaedic Surgeon who may then send you for an MRI scan. Depending on the extent of your injury, an ACL Reconstruction may be required.

2. Instability changing direction - While running or walking quickly, it is inevitable that you will sometimes need to change direction. This can happen while walking around corners or while suddenly changing direction while playing sport in order to manoeuvre around the challenger. Such changing of direction is a common cause of ACL injuries when the strain of the change is born by the ligaments rather than sufficiently trained and activated muscle groups in the knee. If changing direction causes the knee joint to feel like it slips a bit, or unstable, this could very well point to a torn Cruciate Ligament.

3. Instability going down stairs - If you feel that you are unable to walk down stairs without holding on to a handrail or without putting two feet on each step, it may be another sign that you have a torn Anterior Cruciate Ligament. This ligament is what prevents the top part of your leg (thigh bone) from slipping forward past the bottom part of your leg (shin bone). When the ACL is torn, there is no longer any firm link to prevent this from happening, resulting in a feeling of instability.

4. Instability walking/running down hills: In a similar way to walking down stairs, the ACL prevents the thigh bone from slipping forward over the shin bone. With a torn ACL, instability will be very noticeable while walking down hills, and while good muscle strength may mask this to a certain extent, it will feel near impossible to run down hills. Any future walking or running down hills will remain a challenge until either muscles are significantly strengthened in order to bear the stress on the knee from this activity, or as is more commonly the solution, ACL Surgery is performed and an ACL Reconstruction Recovery program is completed.

5. Pain or weakness kicking a ball - now for those that love to play a kicking based sport, you may find yourself with an ACL injury if you are unable to kick a ball as hard as you normally would, without feeling some pain in your knee. In particular, you may notice more pain when trying to kick-pass a soccer ball with the inside of your foot. Note that a torn or injured Medial Ligament can also give you the same discomfort and limitations with the side footed kick pass, so that would require a different form of treatment to a torn ACL.

6. Clicking or crunching sounds in your knee - When you hear the dreaded clicking or crunching sound while walking or crouching, it's a clear sign that something in your knee is not functioning the way it should. Sometimes this points to an issue with the knee cap being out of place as a result of muscle tightness or an injury. However, it is also possible that there is torn cartilage inside the knee which commonly occurs at the same time as an injury to the Anterior Cruciate Ligament. While an experienced Physiotherapist or Orthopaedic Specialist can almost certainly diagnose a torn ACL using some physical tests, it can be a bit trickier to identify torn or loose cartilage in the knee. They will generally send you have an MRI scan which will reveal any damage to cartilage as well as any damage to the ACL and other ligaments in the knee.

7. Swelling around your knee - If you have sustained a knee injury and find that you have swelling on the inside of your knee or at the back of your knee, it is possible that you have a ruptured ACL. Swelling following an ACL injury will generally appear within 4 hours of the injury. Until a doctor or Physiotherapist is consulted, it is best to follow the old R.I.C.E advice: Rest, Ice, Compression, Elevation.

8. Pain or difficulty squatting - apart from the challenges that come with aging, there may be signs of cruciate ligament damage if you are unable to crouch down at all or as far as you know you would normally be able to without experiencing pain. Or you may be feeling that it just not possible. You may also feel pressure on the front of your knee more than pain or simply find that you cannot maintain your balance once you have squatted. You may also find it difficult to stand up again from a squatted position or experience pain when trying to stand upright. Until you see a specialist to have it diagnosed formally, refrain from squatting beyond a 90 degree bend in your knees, and be careful not to put too much load on your other knee if you do need to squat for any reason.

If you are experiencing one or more of these symptoms, it would be worthwhile to consult an experienced Physiotherapist or an Orthopaedic Surgeon who will be able to run some specific tests to confirm whether the Anterior Cruciate Ligament is been damaged and to give your more information on the nature and extent of your specific injury. If you find that you have a torn ACL, your doctor may advise that you consider an ACL Reconstruction. There are options that you will need to understand prior to having ACL Surgery (eg. Allograft vs. Autograft, Patella vs Hamstring) and it is critical to ensure you are prepared to go through a complete ACL Reconstruction Recovery Program in order to return to your normal activities, sports, and hobbies.

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