Anterior/Posterior cruciate & Medial collateral

Specialist ACL and knee injury physiotherapy treatment in Auckland

Anterior cruciate ligament (ACL) injuries are one of the more well-known sporting injuries sustained at the knee. Many of us may remember a famous sports star being cut down during a season or limping off the field unceremoniously. This particular knee injury can have a lasting effect on an individual and is something that we deal with on a daily basis at KneeCare.

The anterior cruciate ligament is one of two ligaments that sit within the knee joint. It is important in maintaining joint stability during dynamic activities such as cutting, turning, pivoting and changing direction. The ACL is responsible for limiting the forward movement of the tibia or shin bone when the knee is bent, thus a tear of the ACL allows uncontrolled movement of the tibia. As you might expect, many ACL injuries occur on the sports field, particularly in sports such as netball, soccer and basketball. However, a similar amount also occurs around the home (Gianotti et al. 2009). Most ACL injuries are reported from non-contact situations, such as when an individual is landing from a jump, pivoting, or slowing down suddenly. Such injuries can be accompanied by an audible ‘pop’ and rapid swelling of the joint.

If you have sustained an ACL injury in the past, and there are literally thousands of people out there like this, it is worth being aware of potential long-term issues. There is clear evidence that an ACL injury increases the risk of developing knee osteoarthritis compared with an un-injured knee (Lohmander et al., 2007), particularly if this was associated with damage to the meniscus (Øiestad et al., 2009; Pernin et al., 2010). It is therefore important to look at ways to minimise this risk through appropriate rehabilitation after your knee injury.

International researchers have made some interesting observations that can help tailor treatment to individuals. One study identified that despite undergoing ACL reconstructive surgery, individuals demonstrated increased loading to their knee joint when walking (Butler et al., 2009). This coupled with altered muscle activity and pain could contribute to the development of osteoarthritis. Other studies similarly showed that thigh muscle weakness observed 2-15 years after injury was associated with increased knee osteoarthritis and pain (Oiestad et al., 2010). The good news is that pain and/or weakness can be treated. The challenging part is that generalised or traditional exercise does not necessarily normalise knee function and this is where your KneeCare provider can help.

There is still much debate in the wider medical community about the best form of treatment for ACL injuries in the long term – Is it best to operate or treat conservatively with rehabilitation? How can we prevent or slow the onset of osteoarthritis? How can we optimise return to activity?