Understanding ACL Sprains
ACL sprains are one of the most devastating knee injuries, and can leave people sidelined for months. This blog looks at the anatomy of the ACL, symptoms, and treatment.
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BowTied Kobra, Rehab Guy
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When it comes to knee injuries, one of the most devastating is an ACL sprain
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
Whether you're a professional athlete or a weekend warrior, this injury can leave you sidelined for months to over a year
Lets break down an ACL sprain below pic.twitter.com/hPpljZG9Ij -
Lets start off with some quick anatomy
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
The ACL is the most important ligament in the knee for stability
It prevents anterior translation of the tibia
This is a function it shares with the hamstrings which will be relevant later in this thread pic.twitter.com/oa2Wiea3nv -
The ACL is innervated by the tibial nerve and has blood flow supplied by the middle genicular artery
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
This artery plays a major role in recovery as well as the symptoms when the ACL is damaged -
As with all ligaments, there are 3 grades of sprains
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
Grade 1 is a stretching of the tissue with minimal tearing
Grade 2 is moderate tearing
Grade 3 is a full rupture -
In terms of diagnosis, a Lachman's test is the gold standard for a clinical exam
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
A good clinician can tell if the ACL is torn before an athlete gets off the field
In this case the MRI confirms what the exam found as opposed to being the primary assessment pic.twitter.com/0f3rciVjbd -
This test looks for anterior translation of the tibia which the ACL prevents
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
If this motion exists then the ACL is not there -
Another ACL test is the anterior drawer
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
This looks for the same movement, however, the hamstrings get in the way of this test accuracy from guarding or spasm
As the hamstrings resist anterior translation as well, this test is not as reliable pic.twitter.com/Pnj0mmttY7 -
In terms of treatment options, in a grade 1-2 its the same for everyone
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
Conservative rehab will work
For an early knee injury guide, see herehttps://t.co/lRJkXCJRIz -
A grade 3 ACL does not heal on its own
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
This is mostly due to losing its blood supply when the genicular artery is torn with the ACL
In an athletic population, you're not gonna be able to compete without an ACL so surgery is always the option -
For surgery, the most common options are grafts from either your patella tendon or hamstring tendon
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
The patella is the gold standard as it heals faster and stronger -
Additionally, as the hamstrings help the ACL resist anterior translation, I don't recommend a hamstring graft
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
This is a motion you need to be able to resist to prevent future injury so making the hamstrings weaker is not ideal -
If you do not have a need to return to high level activities, you can get by without ACL repair
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
You can live a plenty enough normal life without an ACL if you strengthen everything else in the knee adequately -
Recovery time:
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
Grade 1 is a few weeks to a few months
Grade 2 is gonna be several months
Grade 3 if surgery will take 9 months on average. Lot of variables here -
For all of our current resources on knee injuries check out this linkhttps://t.co/PYf5Hoiupz
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023 -
That's it.
— BowTied Kobra, Rehab Guy (@bowtiedkobra) April 7, 2023
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