A chronic ACL injury refers to a tear or sprain of the anterior cruciate ligament (ACL) that has not healed accurately and continues to cause problems over a prolonged period. Symptoms may include knee pain, instability, and a feeling of the knee giving out. The injury may require surgical intervention and physical therapy to alleviate symptoms and improve function.
What are the reasons behind Chronic ACL Injury?
The most frequent reason for a chronic ACL injury is a prior ACL injury that wasn’t ideally treated or given enough time to heal before being put back into action. Other causes[1][2] of chronic ACL injury include:
- Repetitive stress on the knee, such as from playing sports or doing other physical activities that involve twisting or pivoting
- Overuse of the knee, such as from running or jumping
- Weakness or imbalances in the muscles that support the knee
- Poor technique or form when performing physical activities
- Wearing shoes with poor support
- Wearing out of the knee cartilage
- Genetics, certain people are more prone to certain types of injuries.
What is the warning bell of a chronic ACL injury?
The signs and symptoms[1] [2] [3]of a chronic ACL injury include:
- Persistent knee pain, particularly with activities that involve twisting or cutting
- Knee instability or “giving way” during physical activity
- Swelling or stiffness in the knee, which may persist for weeks or months
- Loss of range of motion in the knee
- A feeling of the knee “catching” or “locking.”
- A popping or snapping sensation in the knee
- A sense of the knee is unstable or “wobbly.”
How many types of chronic ACL injuries?
There are several chronic ACL injuries, each with specific symptoms and treatment options.
- ACL Strain: It occurs when the ligament is stretched or partially torn, causing pain and swelling in the knee.
- ACL Sprain: It occurs when the ligament is completely torn, causing significant instability in the knee.
- ACL Rupture: It occurs when the ligament is completely torn, causing significant instability in the knee.
- ACL deficiency occurs when the ligament is torn and not repaired, leading to chronic instability and arthritis in the knee.
- ACL reconstruction: This occurs when the ligament is torn and repaired. Still, surgery did not heal, or the repair failed to lead to chronic instability and arthritis in the knee.
How can we reduce pain from a chronic ACL injury at home?
Treatment for a chronic ACL injury at home typically includes a combination of rest, ice, physical therapy exercises, and medications to manage pain and inflammation. Some specific things you can do at home to manage your chronic ACL injury include:
Rest: Avoid activities that cause pain or instability in your knee. This may include high-impact sports or activities that involve twisting or cutting.
Ice: Apply ice to your knee for 15-20 minutes daily to reduce swelling and pain.
Compression: Wear a compression bandage or wrap to help reduce swelling in your knee.
Elevation: Keep your knee elevated as much as possible to help reduce swelling.
Physical Therapy Exercises: A physical therapist can teach you exercises to help strengthen the muscles around your knee and improve your knee’s range of motion.
What is the diagnosis process of a chronic ACL injury?
The diagnosis process for a chronic ACL injury typically includes a combination of a physical examination and imaging tests. The following are the steps that a doctor or physical therapist may take to diagnose a chronic ACL injury:
- Medical history: The doctor will ask about your symptoms, when they started, and how they have affected your daily activities.
- Physical examination: The doctor will perform a physical exam to assess the stability of your knee, range of motion, and any signs of swelling or tenderness.
- Lachman test: The doctor will use this test to check the knee’s stability by applying force to the thigh while holding the lower leg.
- Anterior Drawer test: The doctor will use this test to check the knee’s stability by applying force to the shin while holding the thigh.
- Pivot shift test: The doctor will use this test to check the knee’s stability by rotating the thigh while holding the shin in place.
What is the treatment plan for chronic ACL injury?
The treatment plan for a chronic ACL injury will depend on the specific symptoms and severity. In general, treatment options include:
Physical therapy: A physical therapist can teach you exercises to help strengthen the muscles around your knee and improve your knee’s range of motion.
Medications: Over-the-counter pain relievers, such as ibuprofen or naproxen, can help manage pain.
Bracing: Wearing a knee brace can help provide support and stability to the knee and help alleviate pain.
Surgery: Surgery[3] [4] may sometimes be necessary to repair or reconstruct the ACL. This can include arthroscopy or open surgery and may be done with other procedures such as meniscus or cartilage repair.
Rehabilitation: After surgery, rehabilitation[3] [4] is necessary to regain knee strength and range of motion, help control pain and swelling, and prevent further injury.
What precautions need to take for a chronic ACL-injured patient?
If you have a chronic ACL injury, there are several precautions you should take to prevent further damage and manage your symptoms:
- Avoid high-impact activities: Running, jumping, or sports involving cutting or twisting can put extra stress on your knee and worsen your symptoms.
- Wear appropriate shoes: Wearing shoes with good support and cushioning can help reduce the stress on your knee.
- Use a knee brace: Wearing a knee brace can help provide support and stability to your knee, reducing the risk of further injury.
- Follow a physical therapy program: Following a physical therapy program can help you regain strength and flexibility in your knee, reduce pain and improve your knee’s range of motion.
- Maintain a healthy weight: Being overweight or obese can put extra stress on your knee, so maintaining a healthy weight can help reduce your symptoms.
A chronic ACL injury is a long-term condition that can cause persistent pain, instability, and loss of function in the knee. It can significantly impact an individual’s quality of life and ability to participate in physical activities. Proper diagnosis and treatment are essential to manage the symptoms and prevent further injury. The treatment plan will depend on the specific symptoms and severity of the damage. Still, it may include physical therapy, medications, bracing, or surgery. Working closely with a doctor or physical therapist to develop a comprehensive treatment plan that addresses your needs is important. Additionally, several preventive techniques can be used to reduce the risk of developing a chronic ACL injury, such as strengthening, flexibility, balance, and plyometric exercises, warming up before physical activity, avoiding overuse, and wearing appropriate gear.
Reference
1. Cheung EC, McAllister DR, Petrigliano FA. Anterior cruciate ligament injuries. In: Miller MD, Thompson SR, eds. DeLee, Drez, & Miller’s Orthopaedic Sports Medicine. 5th ed. Philadelphia, PA: Elsevier; 2020:chap 98. https://www.limamemorial.org/health-library/HIE%20Multimedia-TextOnly/1/007208
2. Kalawadia JV, Guenther D, Irarrazaval S, Fu FH. Anatomy and biomechanics of the anterior cruciate ligament. In: Prodromos CC. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100442/
3. The Anterior Cruciate Ligament: Reconstruction and Basic Science. 2nd ed. Philadelphia, PA: Elsevier; 2018:chap 1. https://ufhealth.org/anterior-cruciate-ligament-acl-injury
4. Nyland J, Mattocks A, Kibbe S, Kalloub A, Greene JW, Caborn DN. Anterior cruciate ligament reconstruction, rehabilitation, and return to play: 2015 update. Open Access J Sports Med. 2016;7:21-32. PMID: 26955296 pubmed.ncbi.nlm.nih.gov/26955296/.
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