The anterior cruciate ligament of commonly abbreviated as ACL is one of the primary stabilizing structures that support the knee providing for its forward and backward motion of the femur and tibia and injury to this supporting ligament is known as ACL tear which is a very common sport related injury that affects many athletes. This ligament crosses in the center of the knee and injury usually occurs when the foot is firmly planted with the knee being hyper-extended and the person suddenly twists his/her torso and femur.
The individual who suffers an ACL tear typically reports a “popping” sound or feeling a tearing sensation upon the sudden twisting motion immediately preceding the injury. If the individual experiences significant swelling of the affected joint within two to four hours after the injury, the anterior cruciate ligament may be suspected and the clinical symptoms progress within the first 24 hours and the patient experiences acute pain, joint instability and discomfort when moving and ambulating.
Immediate emergency treatment of ACL tear
Immediate post injury management and care include the RICE technique (rest, application of ice, compression and elevating the injured extremity). The joint is assessed and evaluated for fracture of the bone as well as any other associated injury to the supporting structures of the joint. Joint effusion and hemarthrosis require joint aspiration and wrapping with compression elastic dressing to help minimize the swelling and relieve the individual of the discomfort and pain.
Surgical intervention of ACL tear
Treatment usually depends on the severity of the ACL tear and the effects of the injury as well as the impact on the person on his activities of daily living. Early supporting treatment involves the application of a brace, physical therapy and avoidance of strenuous physical activities that would stress out the affected joint such as running and jumping. Surgical reconstruction of the anterior cruciate ligament can follow after near-normal joint function and range of motion is achieved which generally involves tendon repair and grafting. This is usually performed as an ambulatory arthroscopic surgery, a procedure in which the surgeon uses an arthroscope to visualize and repair the damage of the anterior cruciate ligament. The best surgical candidates for this type of procedure are younger more active patients however, older and less active patients may choose to undergo with this procedure as well.
Recovery from ACL tear
After surgery, the patient is normally prescribed with oral opiod analgesics, NSAIDs and cryotherapy (a cooling pad incorporated in the post operative dressing). The patient is taught on how to monitor his/her neurovascular status of the affected extremity, proper postoperative wound care and the immediate need to report and signs of complications. Exercises such as ankle pumps, quadriceps sets and hamstring sets are encouraged during early stages of the postoperative recovery period. The nurse should reinforce instructions and health care teaching regarding weight-bearing limitations, exercise restrictions and the use of a knee brace or immobilizing aid to allow for uninterrupted healing. Physical therapy is encouraged so that the patient can gradually gain back his/her full range of motion and weight bearing capabilities. Rehabilitation and recover after an ACL tear typically takes six months to an entire year.
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