ACL Grade 2 Injury ALL In & Out

An ACL grade 2 injury is a partial tear of the ACL. It means some ligament fibers have been damaged, but the ligament is not completely severed. Symptoms of a grade 2 ACL injury may include pain, swelling, and instability in the knee joint. Treatment options may include physical therapy, bracing, and in some cases, surgery to repair or reconstruct the ligament.

What are the causes of ACL grade 2 injury?

There are several common causes^[1][2] of an ACL grade 2 injury, including:

1. Sudden stops or changes in direction while playing sports, such as football or soccer.
2. Direct contact or collision, such as getting hit in the knee during a football tackle.
3. Landing or jumping incorrectly, such as landing on the knee in a twisted position.
4. Overuse of the knee joint, especially in activities that involve cutting or pivoting movements.
5. Weakness or tightness in the muscles that support the knee, such as the quadriceps or hamstrings.
6.  As people get older, the ligament can become less flexible and more prone to injury.

What are the risk factors for ACL grade 2 injury?

Several risk factors^[3][4] may increase the likelihood of suffering an ACL grade 2 injury; these include:

1. Participation in sports that involve cutting, jumping, or pivoting movements, such as football, soccer, basketball, and skiing.
2. A history of previous knee injuries, such as an ACL or meniscus tear.
3. Having muscle imbalances or weaknesses, particularly in the quadriceps or hamstrings.
4. Having poor flexibility or limited range of motion in the knee joint.
5. Poor neuromuscular control can increase the risk of landing or cutting movements that place excessive stress on the knee.

What are the symptoms of ACL grade 2 injury?

The symptoms^[5][6] of an ACL grade 2 injury can vary depending on the severity of the tear but may include the following:

1. Pain: The knee may be painful, especially when you try to walk or put weight on it.
2. Swelling: The knee may become swollen and tender to the touch.
3. Instability: The knee may feel loose or wobbly, especially when walking or pivoting.
4. Locking: The knee may catch or lock when you try to extend it fully.
5. Popping or snapping sound: You may hear a popping or cracking sound at the time of the injury, indicating that the ligament has been stretched or torn.

What is the preventive technique to keep in mind to avoid ACL grade 2 injury?

Several preventive techniques can be used to reduce the risk of an ACL grade 2 injury, including:

1. Strength training: Strengthening the muscles that support the knee, such as the quadriceps, hamstrings, and glutes, can help to improve stability and reduce the risk of injury.
2. Flexibility: Maintaining good flexibility in the knee and hip joints can improve the range of motion and reduce the risk of injury.
3. Neuromuscular training: Programs that focus on improving balance, coordination, and proprioception can improve body awareness and reduce the risk of injury.
4. Proper technique: Learning and practicing `proper techniques for activities such as landing, cutting, and pivoting can help to reduce the risk of injury.
5. Wearing appropriate gear: Wearing proper footwear and knee pads and using the right protective equipment can help to reduce the risk of injury.

When do I need to go to a doctor for an ACL grade 2 injury?

Suppose you suspect that you have an ACL grade 2 injury. In that case, it is vital to seek medical attention as soon as possible. Some indications that you should see a doctor include:

1. Pain: If you experience pain, swelling, or tenderness in your knee, especially after a sudden twisting or impact injury.
2. Instability: If your knee feels loose or wobbly, especially when you try to walk or pivot.
3. Locking: If your knee catches or locks when you try to extend it fully.
4. Limited range of motion: If your knee is stiff and difficult to straighten or bend.
5. Loss of strength: If you have difficulty standing or bearing weight on the affected knee.

What is the diagnosis process of ACL grade 2 injury?

The process for diagnosing an ACL grade 2 injury typically includes a combination of the following steps:

Medical history: Your doctor will ask about your symptoms, including when and how the injury occurred and any previous knee injuries you may have had.

Physical examination: Your doctor will examine your knee, checking for signs of pain, swelling, instability, and limited range of motion. They may also perform special tests such as the Lachman test, the pivot shift test, or the anterior drawer test to evaluate the stability of the knee and the integrity of the ACL.

Imaging tests: Your doctor may order imaging tests such as X-ray, magnetic resonance imaging (MRI), or arthroscopy to confirm the diagnosis and evaluate the extent of the injury. An X-ray can help to rule out bone fractures. At the same time, an MRI will provide detailed images of the soft tissue structures in your knee, including the ACL, and help to determine the grade of the injury. Arthroscopy is a surgical procedure that allows the doctor to view the inside of the knee joint and confirm the diagnosis and treatment.

Additional tests: Depending on the situation, your doctor may order further tests, such as blood tests to rule out other conditions or nerve conduction tests to check for nerve damage.

What is the medication plan for an ACL grade 2 injured patient?

The medication plan for an ACL grade 2 injury will typically include a combination of the following:

Pain medication: Over-the-counter pain relievers can help reduce pain and inflammation.

Anti-inflammatory medication: Your doctor may prescribe non-steroidal anti-inflammatory drugs (NSAIDs) such as naproxen and celecoxib to help reduce pain and inflammation.

Steroids: Sometimes, your doctor may prescribe a short course of oral steroids or administer a corticosteroid injection to help reduce inflammation and pain.

Physical therapy: Physical therapy is an integral part of the recovery process. Your doctor may refer you to a physical therapist to help you regain strength and mobility in your knee.

Bracing: Your doctor may recommend wearing a knee brace to help support and stabilize the knee, especially during the early stages of recovery.

Surgery: Surgery may sometimes be necessary to repair or reconstruct the damaged ligament. Your doctor will discuss the pros and cons of surgery with you and help you decide if it is the right option.

What is the rehabilitation process for ACL grade 2 injury?

The rehabilitation process for an ACL grade 2 injury typically includes a combination of the following steps:

Rest and protection: During the initial phase of recovery, it is essential to rest the knee and protect it from further injury. Your doctor may recommend crutches and wearing a knee brace to help support and stabilize the knee.

Physical therapy: Physical therapy is an integral part of the recovery process. Your doctor may refer you to a physical therapist to help you regain strength and mobility in your knee. Physical therapy may include exercises to improve range of motion, strength, and flexibility.

Bracing: Your doctor may recommend wearing a knee brace to help support and stabilize the knee, especially during the early stages of recovery.

Pain management: Your doctor may prescribe medications to help manage pain and inflammation during recovery.

Progressing activity: As your knee begins to heal and regain strength and range of motion, your physical therapist will help you gradually increase your activity level.

Return to sport: Once you have regained significant strength and range of motion, your physical therapist will work with you to develop a plan for returning to your sport or activity of choice.

Surgery: Surgery may sometimes be necessary to repair or reconstruct the damaged ligament. Your doctor will discuss the pros and cons of surgery with you and help you decide if it is the right option. In the case of surgery, the rehabilitation process will be more intense and longer, and the physical therapist will be involved more heavily to ensure the best recovery.

A grade 2 ACL injury is a partial tear of the anterior cruciate ligament, which can cause pain, swelling, and instability in the knee. Treatment for this type of injury typically includes a combination of rest, physical therapy, and rehabilitation exercises to reduce pain and swelling, regain strength and range of motion, and return to normal activities. Surgery may not be necessary, but it’s essential to consult a doctor for a proper diagnosis and treatment plan. 

Reference

1. Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee–the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am. 1976;58:583–594.

https://pubmed.ncbi.nlm.nih.gov/946969/

2. Griffin LY, Albohm MJ, Arendt EA, Bahr R, Beynnon BD, Demaio M, Dick RW, Engebretsen L, Garrett WE, Hannafin JA, Hewett TE, Huston LJ, et al. Understanding and preventing noncontact anterior cruciate ligament injuries: a review of the Hunt Valley II Meeting. 2005. pp. 1512–1532.

https://pubmed.ncbi.nlm.nih.gov/16905673/

3. Bates NA, McPherson AL, Rao MB, Myer GD, Hewett TE. Characteristics of inpatient anterior cruciate ligament reconstructions and concomitant injuries. Knee Surg Sports Traumatol Arthrosc. 2014:Epub ahead of print.

https://pubmed.ncbi.nlm.nih.gov/25510363/

4. Eberhardt C, Jäger A, Schwetlick G, Rauschmann MA. [History of surgery of the anterior cruciate ligament] Orthopade. 2002;31:702–709

https://pubmed.ncbi.nlm.nih.gov/12426748/

5. Zysk SP, Refior HJ. Operative or conservative treatment of the acutely torn anterior cruciate ligament in middle-aged patients. A follow-up study of 133 patients aged 40 and 59 years. Arch Orthop Trauma Surg. 2000;120:59–64.

https://pubmed.ncbi.nlm.nih.gov/10653106/

6. Herbort M, Lenschow S, Fu FH, Petersen W, Zantop T. ACL mismatch reconstructions: influence of different tunnel placement strategies in single-bundle ACL reconstructions on the knee kinematics. Knee Surg Sports Traumatol Arthrosc. 2010;18:1551–1558.

https://pubmed.ncbi.nlm.nih.gov/20461359/

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Dr. M Shahadat Hossain

Physiotherapy Specialist at ASPC Manipulation Therapy Centre

BSPT (DU), MSc PT(DU), PhD-fellow (JU), Dip. in-Manipulation Therapy (Certified ETOMG-Belgium), McKenzie (A&B), Mulligan and dry Needling (India) Faculty Member of Bangladesh Health profession Institute (CRP), Savar.
Assistant professor, Dhaka College of Physiotherapy
Chief Consultant(Ex): Popular Medical college Hospital, Dhanmondi- 2.
Chairman and Chief Consultant: ASPC Manipulation Therapy Centre, Nurjahan Road, Mohammadpur.
Founder and conceptual inventor: Structural Diagnosis and Management (SDM) concept.
Secretary: Centre for the Rehabilitation of Autism and Person with Disabilities (CARD).
Secretary-General: Bangladesh Physiotherapy Association (BPA).
Phone +88 01712-867364
Email aspc.dhaka@gmail.com
Website https://aspc.com.bd

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