The Severity of Anterior Cruciate Ligament Injuries

Anterior cruciate ligament injuries are one of the most common knee injuries. An injury of this type can be very severe, due to the function of this ligament and the healing time it requires. The anterior cruciate ligament is located in the knee and is required for proper movement. Injury to this portion of the knee causes more instability in the knee than any other injured ligament. This makes injuries to the anterior cruciate ligament particularly concerning, especially in growing and active children. Injuring this ligament is one of the more serious and debilitating injuries to the knee; injuries can range in severity from sprains to small tears to being completely torn apart.

Causes
Sports are by far the most common cause of injury to this ligament. Anterior cruciate ligament injuries are common in the following sports:


• Alpine skiing
• Football
• Basketball
• Rugby
• Wrestling
• Martial arts
• Gymnastics
• Soccer

All of these sports have the potential to cause the knee to move in various ways that can put the anterior cruciate ligament in compromising positions, such as being straightened greater than 10 degrees past normal positioning. Injuries can occur when the leg is in a stable and standing position and is hit from the side. Sharp and sudden position changes and movements can also pose a risk. There are many other ways this delicate ligament can be torn or damaged. Women are more at risk for men for anterior cruciate ligament injuries due to bone structure, body alignment, posture, and hormones.

Symptoms
Generally, when a popping sound has been heard after an impact, an anterior cruciate ligament injury can be suspected. Other symptoms also include swelling, which may not be immediately evident, extreme pain when the knee is flexed, difficulty or pain while walking, loss of range of motion, and the knee being unable to support weight while standing still. Any of these symptoms should be investigated by a doctor. Not seeking medical attention after this type of injury can lead to increased risk for osteoarthritis later in life, severe cartilage damage to the area, and falls.

Treatments
Treatment for an injury to the anterior cruciate ligament will vary based on the patient, their age, the nature of the injury, and their activity level. Young athletes are more likely to require the use of surgery to return to the playing field than older, non-athlete patients are to return to normal activities of daily living. Anterior cruciate ligaments that are torn will not heal without surgery. However, for non-athletes with stable knees, doctors may recommend bracing or physical therapy over surgical intervention. Braces and crutches can help protect the knee and give it time to heal. Physical therapy can help function and strength to return to the area.

Surgical Treatment
Surgery cannot be performed until the swelling in the area has resolved and motion has returned. If surgery is performed too early in the healing process, it can cause scars on the knee joint and reduce motion in the knee. Tears to the anterior cruciate ligament cannot be stitched back together. This means that surgery involves reconstruction of the ligament by use of a tissue graft. Grafts allow an area for new ligament tissues to grow. Grafts can be taken from tendons in various portions of the leg and also from cadavers. There are pros and cons to different graft tissues and the surgeon should discuss them with you before a final decision is made. Ligament growth happens slowly. Due to this, many surgical patients may not be allowed to return to normal activity or sports for six months or more.

Prevention
Due to the nature and physical demands of many sports, anterior cruciate ligament injuries can be difficult to prevent. In general, wearing proper footwear and protective equipment for a sport can help prevent a variety of injuries. Training properly can also help, specifically participating in training that increases proprioception, balance, appropriate movement patterns, and muscle strength.

Injuries are a fact of life when it comes to active, energetic youth. If you think your child may have an injury, the Pediatric Orthopedic Associates of San Antonio can help. Give us a call today to schedule an appointment.

http://www.nlm.nih.gov/medlineplus/ency/article/001074.htm

http://orthoinfo.aaos.org/topic.cfm?topic=a00549