ACL injury An ACL injury is the tearing of the anterior cruciate (KROO-she-ate) ligament in your knee. An ACL injury may make your knee feel unstable or loose, and your knee may "give way" if you return to your sport too quickly. Although an active lifestyle benefits your overall health, exercise isn't always easy on your knees. The anterior cruciate ligament is especially susceptible to the demands of certain sports, such as volleyball, gymnastics, basketball, soccer and football. Treatment of an ACL injury may include surgery to replace the torn ligament, along with an intense rehabilitation program. As for prevention, if your favorite sport involves pivoting or jumping, a proper training program can help you avoid an ACL injury. Symptoms At the time of an ACL injury, signs and symptoms may include: A loud "pop" sound Severe pain Knee swelling that usually worsens for hours after the injury occurs A feeling of instability or "giving way" with weight bearing Once the swelling subsides, your knee may still feel unstable. It may feel as if it's going to "give way" during twisting or pivoting movements. When to see a doctor If you experience any of the signs and symptoms of ACL injury — a popping sound, severe knee pain, a swollen knee or a feeling that your knee is giving out — see a doctor. Also see your doctor if your knee feels loose or unable to support your weight. In general, the longer you wait to start treatment, the longer it will take to get better. Ligaments are strong bands of tissue that attach one bone to another. The ACL, one of two ligaments that cross in the middle of the knee, connects your thighbone (femur) to your shinbone (tibia) and helps stabilize your knee joint. Most ACL injuries happen during sports and fitness activities. The ligament may tear when you slow down suddenly to change direction or pivot with your foot firmly planted, twisting or overextending your knee. Sports that involve running, turning sharply, pivoting and jumping — especially basketball, soccer and gymnastics — put your knee at risk. The ACL can also tear when the tibia is pushed forward below the femur, such as during a fall in downhill skiing. A football tackle or motor vehicle accident also can cause an ACL injury. However, most ACL injuries occur without such contact. Risk factors ACL injuries are most common among: Athletes. If you engage in certain sports, such as those that rely on cut-and-run techniques (basketball, soccer, football) you're more at risk of an ACL injury. Women. Women are significantly more likely to have an ACL tear than are men participating in the same sports. Women tend to have imbalanced thigh muscles, with stronger muscles at the front of the thigh (quadriceps), compared with those at the back of the thigh (hamstrings). The hamstrings help protect the shinbone from sliding too far forward. When landing from a jump, some women may land in a position that increases stress on the ACL. Complications In the short term, you'll have to stop doing the activities that cause pain until your injured ligament has healed. You may have to take time off work, school and sports. Other complications may include: Torn meniscus. In many cases, an ACL injury also results in a tear of the meniscus — the cartilage in your knee between the thighbone and shinbone. A cartilage tear increases the risk of future joint problems. Arthritis. A common long-term complication is the early onset of knee osteoarthritis, in which joint cartilage deteriorates and its smooth surface roughens. About half the people with an ACL tear develop osteoarthritis in the involved joint 10 to 20 years later. Arthritis may occur even if you have surgery to reconstruct the ligament. Treatments and drugs Initial treatment for an ACL injury aims to reduce pain and swelling in your knee, regain normal joint movement and strengthen the muscles around your knee. You and your doctor will then decide if you need surgery plus rehabilitation or intense rehabilitation alone. Surgery A torn ACL can't be sewn back together. The ligament is reconstructed by taking a piece of tendon from another part of your leg and connecting it to the thighbone and shinbone (autograft). If your own tendons don't provide the best replacement for the injured ligament, your doctor may recommend using a tendon from a cadaver (allograft). The cadavers used for allografts have been carefully screened and tested for diseases. ACL reconstruction surgery is an outpatient procedure using arthroscopic techniques. The surgeon inserts a thin instrument (arthroscope) with a light and a small camera into one or two small incisions. This allows your surgeon to see the inside of your knee joint and make the repairs. After surgery you'll go through a rehabilitation program. In addition to working with a physical therapist, you may wear a knee brace and you'll need to avoid activities that put undue stress on your knee. Most people can return to their sports about six months after surgery. About nine in 10 people who undergo ACL reconstruction report good to excellent results and satisfactory knee stability, according to the American Academy of Orthopaedic Surgeons. Prevention To reduce your chance of an ACL injury, follow these tips: Improve your conditioning. Training programs that have been shown to be effective in helping to prevent ACL injuries typically include stretching and strengthening exercises, aerobic conditioning, plyometric exercises, "jump training" and risk-awareness training. Exercises that improve balance also can help when done in conjunction with other training exercises. Strengthen your hamstrings (women). Women athletes should take care to strengthen and stretch their hamstring muscles as well as their quadriceps. Keep fit year-round. If you're on a seasonal sports team, stay conditioned all year. This will help with your balance, strength and coordination when the next season starts. Use proper techniques when playing sports or exercising. If your sport involves jumping, learn how to land safely. Learn to do cutting maneuvers in a crouched posture with a slight bend at the knee and hip. Check your gear. In downhill skiing, make sure your ski bindings are adjusted correctly by a trained professional so that your skis will release when you fall. Using a knee brace during sports doesn't reduce your risk of injury - and may provide a false sense of security.
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