By Andrew Lay, Physiotherapist
A Guide To ACL Tears: Diagnosis & Recovery For ACL Injuries
The ACL (Anterior Cruciate Ligament) is one of the major ligaments within the knee helping to hold the joint together during movement, preventing excessive rotation and hyperextension.
It has an important role in protecting the knee during sports that require quick movements in all directions, such as netball, basketball, football, rugby, soccer and skiing.
How ACL Tears Are Diagnosed
The best place to start is to see an experienced Sports Physiotherapist who can physically test your knee and make a judgment whether a scan is necessary to confirm what structures may have been injured and to what extent.
The exact events that occurred can also give a clue in determining whether an ACL injury has occurred, as it usually occurs during an instance rather than over time, and usually the knee has rotated too far or hyperextended during sporting activity.
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Do You Need A Scan For An ACL Tear?
An MRI scan is the best form of imaging for ligament issues.
If the Physiotherapist suspects an ACL injury is possible, they may recommend you see a GP for referral for the MRI, this is because MRI referrals are potentially bulk billable under Medicare if GP referred (at the time of writing) for adults aged 16-49 years old and children under 16 years old if an ACL injury is suspected.
Therefore the GP must also agree that an ACL injury is possible.
If these criteria are met, MRI of the knee for ACL injury may be attained without out of pocket expense.
MRI may also detect meniscus tears, MCL tears (medial collateral ligament) and bone injuries if present.
ACL Tear Recovery in Melbourne
Fully torn ACL injuries are no longer surgically reconstructed as a default. Over time, more research is coming out in support of physiotherapy for management of ACL tears without the need for surgery.
It is possible for the ACL to grow back and be stronger than it was before injury, with comprehensive physiotherapy management.
However, not all cases are the same and there are various important factors that surgeons and Sports doctors consider before determining whether somebody should have surgery to reconstruct the ACL.
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Surgical management of ACL tears in Melbourne
Management generally involves taking either a piece of the quadriceps tendon, hamstring tendon or patella tendon, and transferring that piece into the knee to physically replace the injured ACL.
At the same time, other procedures may need to be performed to enhance the stability of the knee or repair other structures which may be injured.
Before ACL surgery, the knee must be capable of fully straightening and be able to fully tolerate walking without the use of crutches.
After ACL surgery, it takes at least a minimum 10 months to be able to return to multidirectional sport with an excellent physiotherapy rehabilitation program.
During this time, specific range, strength, balance, power and sports training goals will need to be achieved to progress through the rehab and eventually progress through to competitive sport.
Straight line running can usually begin in month 4 at the earliest but adequate strength but also be achieved before that is permitted.
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Give Your Body The Best Care With ACL Physiotherapy In Melbourne
Rehabilitation without surgery generally takes a lot quicker, ranging from 6-8 months.
This is because there is no surgery to recover from. Aside from this, the goals and management is otherwise very similar to physiotherapy after ACL surgical reconstruction.
Over time more ACL tears are being managed successfully without the need for surgery.
It should also be noted that the decision to have surgery can be still made at any point if considered appropriate, even months after physiotherapy-only management has been performed.
Initial physiotherapy goals
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Full knee extension range of motion
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Walk without crutches
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Begin quads muscle activation
Initially after injury and/or surgery, it is likely that there will be a lack of full knee joint movement and crutches may be needed to walk due to pain, swelling and stiffness.
It is important to regain complete knee extension (straightening) as quickly as possible to prevent adhesions that cause the knee joint to have permanently restricted range of motion - called an arthrofibrosis.
Being able to gain full knee extension again is important for regaining good quadriceps muscle control during walking, which will in-turn help the knee to gradually tolerate walking without the need for crutches.
Exercises to help achieve these are essential, and hands on treatment can be useful to help assist regaining full knee extension.
It is also ideal to regain as much knee flexion (bending) as possible, however this is dependent on whether surgery was performed, particularly in the case of meniscus repair surgery which a surgeon may suggest restricted knee bending for the first 4-6 weeks to allow the meniscus time to recover.
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Early physiotherapy goals
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Full knee flexion range of motion (once allowed in the case of surgery)
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Continued strengthening via weight-bearing exercises
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Basic balance exercises
Return to running (4th month at the earliest)
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Single leg strengthening - full chain of movement from the trunk and pelvis down to the calves and ankles
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Appropriate pelvic and hip stability during single leg landing
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Ground impact (landing) exercises
Straight leg running involves repeated single leg impact, therefore it will be important to have good single leg strength and stability as well as adequate practice of ground impact exercises before returning to running.
Running should start with short bouts, for example 50m x 5 reps at 50% effort, where it is assumed that 100% effort would be a sprint at full pace.
Middle stage physiotherapy goals
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Continued strengthening
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Force generation at speed (power) and force absorption
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Increased running speed towards sprinting
Preparation for return to training
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Multi directional movement - change of direction, cutting, turning
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Ball/equipment drills
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Practice of sport-specific movements
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Individual training
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Practice of sports-specific drills helps to prepare the knee and body for the same movements during sport.
This can start slowly and build up to full pace and with balls and equipment. Individual training involves putting sports-specific movements together to form full sessions of independent training.
Return to training after ACL tear
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Non-contact team training progressing to gentle and then full speed team training
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Continued strengthening and power training
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Continued sport-specific movement training
Re-introduction to team training may start with non-contact aspects of training at full speed, with gradual progression to full team training.
An adequate amount of full sessions should be completed before consideration of returning to matchplay.
Return to sport after ACL tears with successful completion of:
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Rehab exercises
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Questionnaires
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Strength and functional testing
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Full team training
Specific criteria need to be met to be sure that a great physical and mental preparation has been completed before officially returning to competitive sport.
This helps to minimise the risk of re-injury and maximise physical performance as much as possible.
If you need help, or have questions about your ACL injury, please get in touch. We love helping people fix their ACL issues and return to sport, and we're more than happy to jump on a phone call to help decide if we are the best people to help you out.
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LEARN How OUR MELBOURNE SPORTS PHYSIO TEAM can help you?
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But, we also want you to actually move better and live a healthier, more active and fulfilling life!
If your sports, fitness training or work has been wearing your body down, book in with one of our expert massage therapists so we can help you reduce your pain or stiffness.
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