At any point in time there are approximately 35 persons injured for their ACL per 100,000 in a society and the easiest way to rupture an ACL is a direct blow to the knee.
But it’s no surprise that most ACL injuries are caused by non-contact events such as sharp twists, a sudden jerk while running or an acute turning of the knee joint when playing.
Add to it the fact that females are 2 times more likely to get the ACL injury than males.
Why is it so, the most obvious reason is the reduced knee and hip bending during landing while participating in an event, or an increased internal rotation of the thigh bone and in some cases influence of menstrual cycle.
But first detail out, what’s an ACL?
Three bones - the shinbone, thighbone, and patella come together at the knee and four ligaments help them hold in their right place while tendons connect the bones to muscles. Here an Anterior Cartilage acts as a shock absorber and promotes easy movement, while inside the knee is an ACL [Anterior Cruciate Ligament] which is one of the two cross-shaped ligaments that connect the thigh bone to the shinbone and help stabilize the knee. So, when this gets torn for any reason a person can’t stand his own weight. It’s an excruciating experience.
How do you tell it’s a torn ACL?
There is more consistency than one would imagine of how patients describe their ACL injury experience. It goes like a twisted knee, a tear and a pop sound which people hear, and with that it’s all agony and pain and the person simply can’t continue the activity and comes down on his knees. The point of tear quickly fills with blood as the ACL has an abundant supply of it.
What comes next is a pleasant surprise since the patient doesn’t find any fracture in the X-Rays, because the first sound he hears gives a feeling that something has broken inside. The next few weeks feel much better. As the pain subsides, walking and running becomes easy except when attempting to turn or sidestep the knee to which it starts to feel wobbly again. This experience can be detrimental to one’s career if it relates to sports, essential services, or national duty in physical form.
World over physiotherapists provide an evidence-based treatment to it. More recently a study of randomized controlled trials was published that compared the outcomes of immediate operations versus delayed operations of ACL. What it concluded was that a two years’ delay post injury showed no difference in outcome whether the surgery was performed immediately or at a later date or even not at all. More importantly about two-thirds of the wait and see cases found no unstable knee.
Two important points to mention here are that the subjects were not professional sportsmen, which means it can happen to anyone, and yet rehabilitation was required. But if you pause and think the same is true for surgeries too, they also need substantial postoperative rehabilitation.
The good news is that more than 60% of patients return to their pre-injury level activity in 2 years.
So what’s the suggestion: who should one go for surgery or wait?
When an ACL injury is confirmed, consider if it’s actually symptomatic, which means whether the knee will give way before rushing into a reconstruction surgery.
ACL reconstructions are aimed at stabilizing an unstable knee but the deeper question is if it’s unstable in the first place, which only the patient can tell.
ACL injuries are serious which mostly happen during sports activities that involve sudden start and stop, turning, or jumping and may be detrimental to one’s career,
Females are more at risk of ACL injuries than males. Treatment for an ACL injury may be limited to physical therapy and knee support, or even a surgery for more active people, and recovery from an ACL injury takes almost 7 months before the knee starts to feel normal.
Sunil Kumar Kalra
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Sunil Kumar Kalra, LLB from Delhi University practiced as an Advocate in the Supreme Court of India, New Delhi and NCDRC Delhi. He was formerly a Vice President at Dr Reddy’s Labs and Genpact Inc.