Anterior Cruciate Ligament Tear

with Rehab

ExitCare ImageThe anterior cruciate ligament (ACL) of the knee is one of the four major ligaments of the knee. The ACL is responsible for preventing the shinbone (tibia) from moving to far forward (anteriorly) in relation to the thigh bone (femur). An ACL tear (sprain) is a common injury for athletes. The ACL is most important for sports in which pivoting, changing cutting (direction), or jumping and landing is necessary. In general, ligaments do not heal well, and these injuries often require surgery. Approximately 50% of people who tear their ACL also tear the cartilage of their meniscus at the same time.

SYMPTOMS

  • "Pop" or tear heard or felt at the time of injury.

  • An inability to continue playing after the injury.

  • Swelling of the knee within 48 hours.

  • Inability to straighten knee.

  • Knee giving way or buckling, particularly when trying to pivot, cut (rapidly change direction) or jump.

  • Occasionally, locking when there is concurrent injury to the meniscus cartilage.

CAUSES

An ACL tear occurs when the ligament is subjected to a greater force than it can withstand. ACL tears commonly occur from contact (being tackled at the knee) or non-contact (ie. landing awkwardly) events.

RISK INCREASES WITH:

  • Sports that require pivoting, jumping, cutting, or changing direction (ie. basketball, soccer, or volleyball) or contact sports. (football, rugby or lacrosse).

  • Poor strength and flexibility.

  • Women tend to be at a higher risk than men.

  • Improperly fitted or padded equipment.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Thigh, leg, and knee flexibility.

  • Muscle strength and endurance.

  • Cardiovascular fitness.

  • Learn and use proper technique.

  • Wear properly fitted equipment (appropriate length of cleats for surface).

PROGNOSIS

ACL tears do not heal on their own. However, most people will be able to perform activities of daily living after completing a rehabilitation program. For individuals who desire to return to activities that require pivoting, cutting, or jumping and landing, surgery is usually required.

RELATED COMPLICATIONS

  • Frequent recurrence of symptoms, such as knee giving way, instability, and swelling.

  • Meniscus injury, which may cause locking and swelling of the knee.

  • Injury to other structures of the knee.

  • Arthritis of the knee.

  • Knee stiffness (loss of knee motion).

TREATMENT

Treatment initially involves ice and pain medication to help reduce pain and inflammation. It is often recommended that one walk with crutches until your knee will allow walking without a limp. Rehabilitation programs that involve strengthening and stretching exercises to regain strength and a full range of motion are necessary to regain proper functioning of the knee. These exercises may be completed at home or with a therapist. Your caregiver may give you a knee brace to help support the instable joint. Rehabilitation programs also will educate you on how to avoid further injury to the joint. If you want to return to sports involving pivoting cutting, or jumping and landing, then surgery is necessary to replace (reconstruct) the torn ligament.

MEDICATION

  • If pain medication is necessary, then nonsteroidal anti-inflammatory medications, such as aspirin and ibuprofen, or other minor pain relievers, such as acetaminophen, are often recommended.

  • Do not take pain medication within 7 days before surgery.

  • Prescription pain relievers may be given if deemed necessary by your caregiver. Use only as directed and only as much as you need.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours for inflammation and pain and immediately after any activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used prior to performing the stretching and strengthening activities prescribed by your caregiver, physical therapist or athletic trainer. Use a heat pack or a warm soak.

SEEK MEDICAL CARE IF:

  • Symptoms get worse or do not improve in 6 weeks despite treatment.

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects).

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Anterior Cruciate Ligament Tear

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may resolve with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image RANGE OF MOTION - Knee Flexion, Active

  • Lie on your back with both knees straight. (If this causes back discomfort, bend your opposite knee, placing your foot flat on the floor.)

  • Slowly slide your heel back toward your buttocks until you feel a gentle stretch in the front of your knee or thigh.

  • Hold for __________ seconds. Slowly slide your heel back to the starting position.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Knee Flexion, Supine

  • Lie on the floor with your right / left heel/foot lightly touching the wall (place both feet on the wall if you do not use a door frame).

  • Without using any effort, allow gravity to slide your foot down the wall slowly until you feel a gentle stretch in the front of your right / left knee.

  • Hold this stretch for __________ seconds. Then return the leg to the starting position, using your healthy leg for help, if needed.

Repeat __________ times. Complete this stretch __________ times per day.

ExitCare Image RANGE OF MOTION - Knee Flexion and Extension, Active-Assisted

  • Sit on the edge of a table or chair with your thighs firmly supported. It may be helpful to place a folded towel under the end of your right / left thigh.

  • Flexion (bending) : Place the ankle of your healthy leg on top of the other ankle. Use your healthy leg to gently bend your right / left knee until you feel a mild tension across the top of your knee.

  • Hold for __________ seconds.

  • Extension (straightening): Switch your ankles so your right / left leg is on top. Use your healthy leg to straighten your right / left knee until you feel a mild tension on the backside of your knee.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Knee Extension Sitting

  • Sit with your right / left leg/heel propped on another chair, coffee table or foot stool.

  • Allow your leg muscles to relax, letting gravity straighten out your knee.*

  • You should feel a stretch behind your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

*Your physician, physical therapist or athletic trainer may instruct you to place a __________ weight on your thigh just above your kneecap to deepen the stretch.

ExitCare Image STRETCH - Knee Extension, Prone

  • Lie on your stomach on a firm surface, such as a bed or countertop. Place your right / left knee and leg just beyond the edge of the surface. You may wish to place a towel under the far end of your thigh for comfort.

  • Relax your leg muscles and allow gravity to straighten your knee. Your clinician may advise you to add an ankle weight if more resistance is helpful for you.

  • You should feel a stretch in the back of your right / left knee. Hold this position for __________ seconds.

Repeat __________ times. Complete this __________ times per day.

*Your physician, physical therapist or athletic trainer may instruct you to place a __________ weight on your ankle to deepen the stretch.

STRENGTHENING EXERCISES - Anterior Cruciate Ligament Tear

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Progress the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does worsen, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH - Quadriceps, Isometrics

  • Lie on your back with your right / left leg extended and your opposite knee bent.

  • Gradually tense the muscles in the front of your thigh. You should see either your knee cap slide up toward your hip or increased dimpling just above the knee. This motion will push the back of the knee down toward the floor/mat/bed on which you are lying.

  • Hold the muscle as tight as you can without increasing your pain for __________ seconds.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Hamstring, Isometrics

  • Lie on your back on a firm surface.

  • Bend your right / left knee approximately __________ degrees.

  • Dig your heel into the surface as if you are trying to pull it toward your buttocks. Tighten the muscles in the back of your thighs to "dig" as hard as you can without increasing any pain.

  • Hold this position for __________ seconds.

  • Release the tension gradually and allow your muscle to completely relax for __________ seconds in between each exercise.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Quadriceps, Straight Leg Raises

Quality counts! Watch for signs that the quadriceps muscle is working to insure you are strengthening the correct muscles and not "cheating" by substituting with healthier muscles.

  • Lay on your back with your right / left leg extended and your opposite knee bent.

  • Tense the muscles in the front of your right / left thigh. You should see either your knee cap slide up or increased dimpling just above the knee. Your thigh may even quiver.

  • Tighten these muscles even more and raise your leg 4 to 6 inches off the floor. Hold for __________ seconds.

  • Keeping these muscles tense, lower your leg.

  • Relax the muscles slowly and completely in between each repetition.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Hip Extensors, Bridge

  • Lie on your back on a firm surface. Bend your knees and place your feet flat on the floor.

  • Tighten your buttocks muscles and lift your bottom off the floor until your trunk is level with your thighs. You should feel the muscles in your buttocks and back of your thighs working. If you do not feel these muscles, slide your feet 1 to 2 inches further away from your buttocks.

  • Hold this position for __________ seconds.

  • Slowly lower your hips to the starting position and allow your buttock muscles relax completely before beginning the next repetition.

  • If this exercise is too easy, you may cross your arms over your chest.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Hip Abductors, Straight Leg Raises

Be aware of your form throughout the entire exercise so that you exercise the correct muscles. Sloppy form means that you are not strengthening the correct muscles.

  • Lie on your side so that your head, shoulders, knee and hip line up. You may bend your lower knee to help maintain your balance. Your right / left leg should be on top.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Lift your top leg up 4 to 6 inches, leading with your heel. Be sure that your foot does not drift forward or that your knee does not roll toward the ceiling.

  • Hold this position for __________ seconds. You should feel the muscles in your outer hip lifting (you may not notice this until your leg begins to tire).

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.