KNEE PAIN

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ANTERIOR CRUCIATE TEARS

Girls, pick your sports with care, especially if you have knock-knees.  Over 175,000 ACL tears were operated on in 2000, costing over 2 billion dollars.  The injury rate is 2-6 times more common in female athletes; in basketball it is 8 times more common in women.  Over 90% of these injuries occur without contact in women, as compared to 67% in men.

Females tend to have different leg alignment with an increase in knock-knees and a widened notch resulting in less space for the ACL.  While still young, after 10-20 years, over 50% of injured patients will get osteoarthritis.

Most sports need a functioning ACL to allow sudden turns, pivoting and cutting.  To do one’s daily activities. a normal ACL is not necessary. 

The anterior cruciate ligament (called the ACL) is one of four ligaments that stabilize the knee joint.  Other are the posterior cruciate ligament (where the knee is overextended by a player falling on it), the medial( where the outside of the knee is clipped and the inside of the knee is opened up) and lateral collateral ligaments

If one can continue to play, and there is no swelling,  you probably have a partial posterior tear or collateral ligament tear.  If swelling occurs the next day,  you have a meniscus tear.

 A ligament is a tough fibrous material that controls excess motion by limiting your joint mobility.   The ACL prevents the shinbone, tibia, from sliding too far forward.  The thigh bone, femur,  sits on top of the shinbone and stabilizes the rotation at the knee.

When the ACL is injured, the knee becomes unstable, and can’t make sudden pivoting movements.  The knee feels like it will give out, because the joint is sliding forward too much.  The tear often results in a popping sound, early swelling, because of bleeding, and inability to keep playing. 

Immediate treatment is” RICE”: rest, ice, compression, and elevation of the leg.  Noninflammatory drugs are prescribed, and physical therapy is instituted to regain normal range of knee motion, quad muscle control, and a normal gait.

You don't need a normal ACL to walk normally and climb stairs, bike, and jog.  Usually you can’t pivot and cut 90 degrees, and find soccer, basketball, lacrosse, tennis singles, football, gymnastics, hockey, and mogul skiing to be problems.

 If you can’t do the normal things or want to continue your sport. you may need ACL restoration surgery. Surgery involves drilling into the tibia and femur and attaching a tendon graft, from your hamstring or patella, to both ends.  Care is taken to avoid nerve damage, infection and deep blood clots.  Chain-based and weight exercises are done for 6 months until recovery.

Be good to your knees when you are young, and they will be good to you when you age.  

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There are currently no published professional guidelines to manage these ACL tears.  Souce: NEJM Nov.13, 2008