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Knee
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ACL/PCL Rupture
Ligaments are very strong bands of tissue that connect one bone to another. The knee has four major ligaments that attach the thigh bone (femur) to the lower leg bone (tibia). The Medial and Lateral Collateral Ligaments are the most commonly sprained ligaments in the knee, but they will usually heal in a short period of time and with no permanent disability.
The two major ligaments contained within the knee joint itself, the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament), when sprained may be stretched to the point where they no longer function normally, or they may be completely ruptured. These two powerful ligaments are responsible for stabilizing the knee and keeping the tibia from sliding away from the femur during twisting motions. These ligaments are most commonly injured while participating in sporting activities that involve jumping, twisting, or sudden changes in direction, but may also occur when the knee is hyperextended. Clipping type injuries in football or soccer are also typical mechanisms of injury.
The ACL is injured much more frequently than the PCL. In fact PCL injuries are relatively rare and usually occur as the result of major trauma involving knee dislocations. Surprisingly, women tear their ACLs at a much more frequent rate that males, especially in basketball. Immediate symptoms include hearing or feeling a loud "pop," pain, and giving way in the knee. The knee may not support your weight. There will usually be significant swelling that occurs within 2 hours of the injury. After the initial injury has healed, there may be persistent weakness and giving way during twisting and pivoting movements.
Evaluation will include the history and physical examination. X-rays may be taken to exclude bony injury. An MRI will usually be done to confirm the diagnoses and evaluate the knee for other soft tissue injuries.
Treatment initially will include bracing, icing, rest, range of motion and strengthening exercises. Crutches may be needed. If your ACL/PCL is completely torn or no longer functioning properly your Physician will discuss surgical reconstruction with you. The decision to undergo surgical reconstruction depends on the physical demands you place on your knee. The techniques for reconstruction are varied and your surgeon will discuss your options with you.
Rehabilitation prior to surgery focuses on the restoration of full range of motion and quadriceps and hamstring strength. This assures an optimum positive outcome and reduces the incidence of post-operative complications. Rehabilitation after ACL/PCL reconstruction is specifically staged depending on the surgical techniques employed and your surgeon's preference. Bracing, crutches, CPM machines, and formalized physical therapy are commonly used. Full recovery and return to sports typically take 6 months or longer. Dedication to the post-operative rehabilitation schedule is necessary to achieve a normally functioning knee and rapid return to sporting activities.
APPROACH TO REHABILITATION
- Ice frequently (every 3-4 hrs) for 20 minutes during the first 3 days after the injury and then several times daily to control pain and swelling.
- Elevate the knee as much as possible to help reduce swelling.
- Use an elastic wrap to help control swelling, and use a brace to stabilize the knee if prescribed by your physician. Use crutches as necessary.
- Begin the range of motion exercises as soon as the pain and swelling begin to subside, at least 3 times daily. Begin the strengthening exercises when instructed by your physician, at least daily.
- Consult your Physician or PA about returning to regular activities and sports.
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