Anterior knee ligament injury or ACL injury (anterior cruciate ligament) is a break or tear in the anterior knee ligament. The anterior knee ligament is the ligament that connects the lower femur to the shin to keep the knee stable.
When compared with other knee injuries, anterior knee ligament injuries are the most common knee injuries. The anterior knee ligament can tear when the foot makes a sudden change in motion, such as a sudden stop, or when the knee and foot are hit by a sudden hard object.
Symptoms of Anterior Knee Ligament Injury
People with anterior knee ligament injuries will usually hear a “pop” sound when the ligament is torn. In addition, there are some common symptoms experienced when experiencing an anterior knee ligament injury, including:
- Severe pain in the knee
- Knees are difficult to move and stretch
- Knee feels unstable
- Difficulty walking
- Knee swelling quickly in 24 hours
Symptoms that appear are also influenced by the severity of the injury. The following is a breakdown of anterior knee ligament injuries based on the degree of anterior cruciate ligament damage:
- Level 1The anterior knee ligament was slightly damaged. At this stage, ACL injuries generally do not affect the knee's ability to support weight.
- Level 2The anterior knee ligament is pulled and partially torn. At this stage the knee joint begins to become unstable. People with grade 2 ACL injuries will need some time to stabilize the knee before walking or standing.
- Level 3The anterior knee ligament was severely damaged and completely torn. A person with a grade 3 ACL injury will experience a very unstable knee.
- AvulsionThe anterior knee ligament is pulled and detached from one of the bones that flank it, both the femur and shinbone.
When to go to the doctor
Check with a doctor or orthopedic doctor who specializes in hip and knee when symptoms appear as mentioned above. It is important to know the severity of the occurrence and get treatment as soon as possible.
See a doctor immediately if your feet feel cold and look bluish after a knee injury. This could indicate that the knee joint is dislocated or injured in the leg veins. This is an emergency that requires immediate treatment.
Causes of Anterior Knee Ligament Injury
The anterior knee ligaments are the ligaments that cross in the middle of the knee. The anterior knee ligament serves to connect the lower femur to the shinbone. These ligaments will keep the knee stable.
Anterior knee ligament injuries often occur when a person performs sports that put pressure on the knee. Movements that are at risk of causing an ACL include:
- Move quickly then stop suddenly
- Change the direction of movement of the legs and knees suddenly
- Change the position from rest to a sudden jump or spin position
- Stretching the knee too much
- Doing jumps and landing with the wrong foot position
- Getting a crash or impact in the knee area, for example getting a tackle while playing soccer
Risk factors for anterior knee ligament injury
There are several things that increase a person's risk of suffering an anterior knee ligament injury, including:
- Female gender
- Decreased muscle mass due to aging or lack of exercise and exercise
- Exercising or playing on slippery surfaces, such as artificial grass
- Play football, rugby, basketball, gymnastics or skiing
- Have an unbalanced leg muscle size
- Wearing ill-fitting footwear or shoes
Anterior Knee Ligament Injury Diagnosis
Anterior knee ligament injuries can be treated by a sports medicine specialist. The doctor will ask about the patient's symptoms and complaints, including a history of movement, exercise, and previous activities.
Then the doctor will perform a physical examination in the area of the legs and knees. Several examinations will be carried out, including seeing and comparing normal and problematic knees, and assessing ROM (range of motion) or the range of motion the patient is capable of.
To confirm the diagnosis, the doctor will perform the following investigations:
- X-rays, to check for cracks or fractures in the knee area
- MRI, to see bone and soft tissue problems
- arthroscopy, to examine the joints and the resulting damage with a special tool that has a lens
Anterior Knee Ligament Injury Treatment
Treatment of anterior knee ligament injuries is tailored to the symptoms experienced and the severity of the injury. Treatments that can be done include:
First aid
If the injury is minor, you can perform the following first aid. The goal is to reduce pain and swelling in the area where an ACL injury is suspected. First aid steps that can be taken are:
- Take a break to reduce the burden on your knees
- Compress the knee with ice for 20 minutes to relieve swelling
- Bandage the knee with an elastic bandage to compress the knee
- Lie down and support your knees on pillows to reduce swelling
Drugs
Your doctor can give you medicines to reduce the inflammation and pain you feel, such as ibuprofen, ketorolac, or paracetamol. If needed, the doctor may inject corticosteroid medication into the patient's knee to reduce inflammation.
Knee braces and crutches
Patients with anterior knee ligament injuries will be given a knee brace to provide extra protection for the knee. In addition, the patient will also be advised to use a crutches to reduce pressure on the knee.
Physiotherapy
Physical therapy (physiotherapy) is done to restore muscle strength and function of knee movement. Physiotherapy needs to be done several times a week to strengthen the muscles around the knee, as well as restore knee mobility.
Physiotherapy can also be done to strengthen the quadriceps and hamstrings before undergoing knee surgery.
Operation
Surgery will be performed if the person with an ACL injury has the following conditions:
- Anterior knee ligaments are severely torn or avulsed
- There is more than 1 torn ligament
- Knee pads (meniscus) are damaged
- Knees can't support body weight when walking
- Injuries occur in active athletes
Surgery is usually only done after there is no improvement in knee function within a span of 5 months. This long waiting time is also done to reduce the risk of scar tissue forming around the knee (arthrofibrosis) after operation.
This surgical procedure is performed by a surgeon by removing the damaged knee ligament and replacing it with a muscle ligament (graft) the new one. The graft can be taken from the knee (hamstring) or the kneecap tendon (patellar tendon), both from the patient's own muscle and from a donor. After surgery, the patient needs to undergo rehabilitation.
The length of rehabilitation time required to restore muscle function after surgery may vary. However, in general, patients who have undergone surgery and rehabilitation can return to normal sports within 1 year.
Complications of Anterior Knee Ligament Injury
Patients with anterior knee ligament injuries are at risk of developing knee osteoarthritis, even after undergoing ligament reconstruction surgery. Surgery performed to treat anterior muscle ligament injuries also carries the risk of the following complications:
- Pain around the kneecap
- Infection of the graft used to replace the damaged ligament
- Damage to the graft used to replace the damaged ligament
- Stiff knee due to lack of active movement after surgery
Prevention of Anterior Knee Ligament Injuries
Anterior knee ligament injuries are difficult to prevent. However, there are several things you can do to reduce the risk of knee ligament injuries, including:
- Do exercises to strengthen the leg muscles and knee muscles regularly to maintain a balance of leg muscle strength.
- Do exercises to strengthen the hips, pelvis, and lower abdomen, regularly.
- Do the exercise to determine the position of the feet when landing after jumping.
- Use footwear and if necessary protective (padding) that fits during exercise.
- Always warm up before exercising.
- Make changes to the intensity of the exercise slowly and gradually, do not suddenly change the exercise to be more intense.