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Knee

Pediatric ACL Injuries

There are three bones that make up the knee joint – the femur (thigh bone), the tibia (shin bone), and the patella (kneecap). There are two cruciate ligaments—Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL)—inside the knee joint that cross to form an X. The ACL sits in the front of the knee joint, while the PCL sits in the back of the knee joint. Together, they help control the front-to-back motion of the knee, as well as rotation.

The ACL is one of two cruciate ligaments in the knee joint that cross to form an X. It is a vital structure that helps stabilize the knee and control its movement. The primary function of the ACL is to prevent excessive forward movement of the tibia relative to the femur, as well as controlling rotational movements of the knee. It works in conjunction with other ligaments and structures in the knee to provide stability and support during activities like walking, running, jumping, and pivoting.

 

The purpose of the ACL ligament is to prevent the tibia from sliding in front of the femur. The ACL also acts to stabilize the knee during rotation. The ACL runs diagonally from the back of the femur to the front of the tibia in order to provide this stability. The ACL ligament contains important nerve fibers that tell your brain where your knee is positioned, as well as vessels that help with the overall nutrition of the ACL.

Traumatic injury to the ACL occurs in athletes who participate in high-risk sports such as skiing, soccer, football, and basketball. The majority of ACL injuries result from a sharp twisting of the knee; sudden deceleration while cutting, pivoting, or performing sidestepping movements; an abrupt stop when running, or an awkward landing from a jump. Other, less common, causes include direct contact, a fall, or a traumatic accident. Women who participate in college sports, such as soccer, basketball, softball, lacrosse, or rugby are four times more likely than men to rupture their ACL.

When you injure your ACL, you may hear or feel a “pop” at the time of injury coupled with buckling of the knee. There will be immediate and intense knee pain, swelling, inflammation, redness, and bruising. The pain may resolve, but the knee will likely remain unstable, especially when attempting to quickly pivot or change direction. Additionally, you may experience a loss of knee range of motion following an ACL injury. Finally, symptoms such as tenderness along the knee joint or locking of the knee if there is an associated meniscus tear may occur. Continuing regular activities with a deficiency in your ACL may lead to additional instability episodes, which can cause more damage to other structures such as the meniscus and cartilage. If you feel that you may have suffered an injury to your ACL, it is important to have it evaluated by an orthopedic specialist as soon as possible.

The combination of a detailed history, comprehensive physical examination, x-rays, and an MRI (magnetic resonance imaging) is the key to a successful diagnosis of an ACL injury.  Dr. Jorge Chahla and his team use stability tests as part of his physical exam, including the Lachman and Anterior Drawer tests, to properly diagnose an ACL Injury. Because almost half of all ACL injuries occur in combination with other knee injuries, imaging studies such as an MRI are important to evaluate the full extent of your injuries.

ACL injuries can be classified into different types based on the severity and extent of the damage to the ACL fibers. The grading of severity is based on the amount of ligament disruption and the extent of knee instability present following an injury. It is important to accurately diagnose the extent of an ACL injury, as the appropriate treatment plan can vary based off the type of ACL injury that an individual has suffered.

Grade 1: ACL Sprain

An ACL injury that stretches the fibers of the ligament but does not lead to a full thickness tear of the fibers is called an ACL Sprain. This is the least severe injury to the ACL, and often, these injuries can heal on their own with conservative treatment including rest, ice, compression, elevation, oral anti-inflammatory medications, and physical therapy.

Grade 2: Partial ACL Tear

An ACL injury that tears some of the ligament fibers is called a “partial tear” of the ACL. When partial tearing of the ACL occurs, patients may experience some episodes of mild instability or pain. However, the severity can vary depending on the extent of the partial tear. In some cases, a partial tear of the ACL may heal with conservative treatment including rest, ice, compression, elevation, oral anti-inflammatory medications, physical therapy, and possibly the need of a specialty brace called a functional ACL brace. However, when instability persists despite conservative treatment, it is reasonable to consider surgical intervention. The decision to perform surgery to fix a partial tear depends on the severity of instability of the knee and patient’s desire to return to sport. When discussing surgery for a partial ACL tear, Dr. Chahla and his team may discuss both the option of an ACL repair and an ACL reconstruction. The options available to you for surgery will depend on the location and extent of your partial ACL tear. Please see treatment options below for further information.

Grade 3: Complete ACL Tear

A complete tear of the ACL describes an injury in which the ligament is non-functional and will require surgery to fix it. Professional athletes and most recreational athletes will likely require surgery to return to play, especially if their desired sport includes pivoting, cutting, and lateral movements.

At a Glance

Dr. Jorge Chahla

  • Triple fellowship-trained sports medicine surgeon
  • Performs over 700 surgeries per year
  • Assistant professor of orthopedic surgery at Rush University
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