With good physical examination, the ACL (Anterior Cruciate Ligament of Knee) injury can be identified. However when the knee is acutely swollen and painful, it may be difficult to examine.
X-ray. X-ray is often performed by medical professionals to rule out any bone injuries. Ligaments are not visible on the X-ray.
MRI Scan. MRI Scan is the gold standard investigation to identify the type and extent of the ACL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are affected in addition to the ACL injury and need attention as well.
First Aid for ACL injuries involves the typical R.I.C.E therapy for the first week.
Rest. It is important to minimize walking for the first week.
Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling.
Compression. Crepe bandage is sufficient to help with compression.
Elevation. Keeping it elevated on a pillow when resting helps.
ACL Prehab exercises can be started once the pain and swelling improve. These exercises help in regaining the knee movements and keep the muscles in a good condition.
Surgery is recommended in people leading an active lifestyle and are physiologically fit. Without surgery one can manage, however will have to limit the activities and be cautious on uneven surfaces to not twist again.
ACL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue usually a tendon. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred as the healing and take up of the material is better. Hamstring muscles from the inner side of the thigh are one of the common choices for graft. The spare muscle tendons are harvested through small keyholes. The whole surgery is performed with the help of a camera and small keyholes. Usually on one side the graft is fixed with a small titanium button and on the other side with a bio-composite screw. In some instances to increase the thickness of the graft, an all-inside technique where both sides small titanium buttons are used to fix the graft.
In some instances, we use internal bracing technique. It is used only to augment the primary repair/reconstruction by expanding the area of tissue approximation during the healing period and is not intended as a replacement for the native ligament. The Internal Brace technique is for use during soft tissue-to-bone fixation procedures and is not cleared for bone-to-bone fixation.
Post-surgery, you are allowed to walk on the same day evening. If your meniscus is intact and only ACL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg. Initial one week you may need the support of a walker. Within a week most people manage to walk without support. Physiotherapy exercises are started early. In the first 6 weeks the focus is mainly on getting the full range of movement and help regain the muscle strength. The whole rehabilitation process will take about 6 to 8 months before returning back to playing sports on the ground or court.