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| Anterior Cruciate Ligament Injury, Causes, Diagnosis, Treatment, Prevention, Complications |
An anterior cruciate ligament (ACL) injury is a break or tear in the anterior knee ligament. The anterior knee ligament is the ligament that connects the lower femur to the shin to keep the knee stable.
When compared with other knee injuries, anterior knee ligament injuries are more common. The anterior knee ligament can tear when the foot makes a sudden change in motion, such as stopping suddenly while running, or when the knee and foot are hit by a hard object.
Causes of Anterior Knee Ligament Injury
The anterior knee ligament is the ligament that crosses the middle of the knee. This ligament serves to connect the lower femur to the shinbone and maintain stability of the knee.
Anterior knee ligament injuries often occur when a person performs a movement that puts pressure on the knee. Movements that are at risk of causing an ACL include:
- Run fast then stop suddenly
- Change the direction of movement of the legs and knees suddenly
- Change the position from rest to a sudden jump or spin position
- Overstretching the knee
- Jumping and landing with the wrong foot position
- Having a knock in the knee area, for example being hit by a tackle while playing soccer
Risk factors for anterior knee ligament injury
There are several things that can increase a person's risk of suffering an anterior knee ligament injury, including:
- Female, due to possible differences in muscle strength with men and hormonal factors
- Decreased muscle mass due to aging (sarcopenia) and lack of exercise
- Exercising or playing on slippery surfaces
- Play soccer, basketball, badminton or gymnastics
- Have an unbalanced leg muscle size
- Wearing shoes that don't fit
Symptoms of Anterior Knee Ligament Injury
People with anterior knee ligament injuries will usually hear a “pop” sound when the ligament is torn. In addition, there are some common symptoms that are felt when experiencing an anterior knee ligament injury, including:
- Severe pain in the knee
- Knees are difficult to move and stretch
- Knee feels unstable
- Difficulty walking
- Knees swell quickly in 6 hours
Symptoms that appear are also influenced by the severity of the injury. The following is a breakdown of anterior knee ligament injuries based on the degree of anterior cruciate ligament damage:
- Level 1
The anterior knee ligament was slightly damaged. At this stage, ACL injuries generally do not affect the knee's ability to support weight.
- Level 2
The anterior knee ligament is pulled and partially torn. At this stage the knee joint begins to become unstable. People with grade 2 ACL injuries will need some time to stabilize the knee before walking or standing.
- Level 3
The anterior knee ligament was severely damaged and completely torn. People with a grade 3 ACL injury will experience a knee that is completely unstable.
- Avulsion
The anterior knee ligament is pulled and detached from one of the bones that flank it, both the femur and shinbone.
When to go to the doctor
Consult a doctor or an orthopedic doctor who specializes in the hip and knee if the symptoms mentioned above appear. The doctor will find out the severity of the occurrence and provide treatment as soon as possible.
Immediately consult a doctor if the foot feels cold and looks bluish after the injury. This could be a sign that the knee joint is dislocated or an injury to the leg veins. Joint dislocation or injury to blood vessels is an emergency that needs to be treated immediately.
Diagnosis of Anterior Knee Ligament Injury
Anterior knee ligament injury can be diagnosed by a doctor, one of which is a sports medicine specialist. The doctor will ask the patient's complaints, including a history of movement, exercise, and previous activities.
Next, the doctor will perform a physical examination of the leg and knee area by checking for swelling, measuring strength, and assessing the patient's range of motion.
To confirm the diagnosis, the doctor will perform the following investigations:
- X-rays, to check for cracks or fractures in the knee area
- MRI, to see bone and soft tissue problems
- Arthroscopy, to examine joints using a special tool in the form of a small tube (arthroscope) equipped with a camera
Treatment of Anterior Knee Ligament Injury
Treatment of anterior knee ligament injuries is tailored to the symptoms experienced and the severity of the injury. Treatments that can be done include:
First aid
The first aid that can be done when an anterior knee ligament injury occurs is the RICE method, namely:
- Rest: Resting the knee
- Ice: Compressing the knee with ice wrapped in a clean cloth for 15-20 minutes
- Compression: Bandage the knee with an elastic bandage
- Elevation: Lie down and position your knees higher by propping them up with pillows
Drugs
Doctors can give medication to reduce inflammation and pain. These drugs include ibuprofen, ketorolac, or paracetamol. If needed, the doctor may inject corticosteroid medication into the patient's knee to reduce inflammation.
Knee braces and crutches
The patient will be given a knee brace to provide extra protection to the knee. In addition, the patient will also be advised to use crutches to reduce pressure on the knee.
Physiotherapy
Physical therapy (physiotherapy) aims to restore muscle strength and function of knee movement. Physiotherapy needs to be done several times a week to strengthen the muscles around the knee, as well as restore knee mobility.
Physiotherapy can also be done to strengthen the quadriceps and hamstring muscles before undergoing knee surgery.
Operation
Surgery will be performed if the patient has the following conditions:
- Anterior knee ligament is severely torn (avulsed)
- There is more than one ligament torn
- Knee pads are also damaged
- Knees can't support body weight when walking
- Injuries happen to athletes who want to stay active
Surgery is usually only done if there is no improvement in knee function within a span of 5 months. This long waiting time also aims to reduce the risk of scar tissue forming around the knee (arthrofibrosis) after surgery.
This surgery is performed by doctors by removing the damaged knee ligament and replacing it with a new muscle ligament (graft). The graft can be taken from the knee (hamstring) or kneecap tendon (patellar tendon) from the patient's own muscle or from a donor. After surgery, the patient needs to undergo rehabilitation.
The length of rehabilitation time required to restore muscle function after surgery may vary. However, in general, patients who have undergone surgery and are undergoing rehabilitation can return to exercise within 6–9 months.
Complications of Anterior Knee Ligament Injury
Patients with anterior knee ligament injuries are at risk for knee osteoarthritis, even after undergoing ligament reconstruction surgery. In addition, the knee joint can be damaged if the patient experiences a buildup of blood (hemarthrosis) in the knee joint.
Surgery to treat anterior muscle ligament injuries also carries the risk of the following complications:
- Pain around the kneecap
- Infection of the graft used to replace the damaged ligament
- Damage to grafts used to replace damaged ligaments
- Stiff knee due to lack of active movement after surgery
- Deep vein thrombosis
Prevention of Anterior Knee Ligament Injuries
Anterior knee ligament injuries are difficult to prevent. However, there are several things you can do to reduce the risk of knee ligament injuries, including:
- Do exercises to strengthen the leg muscles and knee muscles regularly to maintain balance and leg strength.
- Do regular exercises to strengthen your hips, pelvis, and lower abdomen.
- Do the exercise to determine the position of the feet when landing after jumping.
- Use proper footwear and protective equipment when exercising.
- Be sure to warm up before exercising.
- Make changes to the intensity of exercise slowly and gradually, and do not suddenly change the exercise to be more intense.
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