“Navigating ACL Injuries: Choosing Between Physiotherapy and Medicinal Approaches”
Introduction:
Anterior cruciate ligament (ACL) injuries, one of the four main ligaments in the knee, are frequently caused by the Anterior cruciate ligament (ACL) being ripped or stretched above its normal range of motion. The thighbone (femur) and shinbone (tibia) are joined by the Anterior cruciate ligament (ACL), a powerful band of tissue that aids in stabilizing the knee joint. Research in the Journal of Biomedical engineering found that sports involving cutting, pivoting, and jumping actions are the ones most likely to cause Anterior cruciate ligament (ACL) injuries. ACL injuries are more common among athletes who play sports like football, basketball, and soccer (McLean, Mallet, & Arruda, 2015).
The severity of an Anterior cruciate ligament (ACL) injury can range from a minor stretch or tear to the ligament being completely ruptured. An Anterior cruciate ligament (ACL) injury presents with immediate pain, swelling, and a popping sound, as well as difficulties bearing weight on the injured knee, instability, and a sense that the knee is giving way (McLean, Mallet, & Arruda, 2015). A physical examination, imaging tests like an MRI, and a battery of tests to gauge the stability and range of motion of the knee are frequently used to diagnose an ACL injury.
ACL injuries can be treated with physical therapy, bracing, and surgery. People who are less active or have less serious injuries may benefit from non-surgical treatment options like physical therapy. In contrast, athletes or others who are more physically active and want to return to sports are frequently advised to consider surgical treatments like ACL repair, which includes replacing the damaged ligament with new tissue (Diermeier, et al., 2020). All things considered, ACL tears are frequent and potentially catastrophic knee injuries that can affect both athletes and physically active people. Early detection of the damage and adequate treatment, such as surgery or physical therapy, can increase the likelihood of a full recovery and lessen its long-term repercussions (Post, et al., 2017).
Injuries to the anterior cruciate ligament (ACL) are frequent among student-athletes, especially in activities requiring cutting, pivoting, and jumping. ACL injuries are 2 to 8 times more common in female athletes than in male competitors. The disparity between males’ and girls’ neuromuscular control and muscle strength may be one factor contributing to this greater risk. According to research in The American Journal of Sports Medicine, compared to male sports, female athletes had weaker hip muscles and less effective neuromuscular control, which can put more strain on the ACL (Stevenson, Beattie, Schwartz, & Busconi, 2015).
Another factor contributing to student athletes’ high rate of ACL injuries is the increased emphasis on year-round, specialized training and the pressure to perform well. According to research in the American Journal of Sports Medicine, players who specialize in one activity and engage in it year-round are more likely to get an ACL injury than those who participate in many sports (Post, et al., 2017).
ACL injuries are also more likely when sufficient conditioning and training are lacking. According to research in the Journal, student-athletes who don’t perform the right warm-up, cool-down, and strength training activities are more likely to have an anterior cruciate ligament injury. ACL injuries are a common injury among student-athletes and are influenced by a combination of factors such as gender, muscle strength, neuromuscular control, specialized training, and proper conditioning. Physiotherapy is much more effective in the case of ACL injuries as compared to medications (Post, et al., 2017).
Physiotherapy helps avoid surgery for ACL injuries:
Knee instability is frequently brought on by anterior cruciate ligament (ACL) injuries, which frequently call for surgery to regain stability and function. However, in some situations of Anterior cruciate ligament (ACL) injury, physical treatment can be quite helpful in preventing surgery.
According to one study, people with Anterior cruciate ligament (ACL) injuries who are not candidates for surgery can get positive results through a thorough physical therapy program that includes exercises to increase muscular strength and control. This study was published in the Journal of Orthopedic & Sports Physical Therapy. 60 individuals with ACL injuries were enrolled in the trial and split into two groups; one group received physiotherapy while the other group received no care. Compared to the group that received no treatment, the physiotherapy group had considerably better knee stability and function as well as a reduction in discomfort after 12 weeks. The study revealed that physiotherapy can be useful in assisting those with Anterior cruciate ligament (ACL) injuries to return to sports. This study was published in the Journal of Bone and Joint Surgery. 131 patients with Anterior cruciate ligament (ACL) injuries who received physiotherapy and rehabilitation were included in the research. 89% of the patients had reached their pre-injury level of sports involvement after an average of 8.5 months (Donald, 2016).
An anterior cruciate ligament (ACL) occurs at a higher rate in people who are highly involved in sporting activities. Females are considered to be at a higher risk of developing the Anterior cruciate ligament (ACL) as compared to men because the tensile strain increases on the Anterior cruciate ligament (ACL) due to the activation of the quadriceps in females rather than the hamstrings. Anterior cruciate ligament (ACL) injuries can be prevented by closed kinetic chain exercises, these physical exercises help and encourage the movement of both the major muscles the quadriceps and the hamstrings, and can help isolate the muscles to make them stronger. Open-chained kinetics exercises can also be beneficial in suppressing Anterior cruciate ligament (ACL) injuries. According to the research in the International Journal of Sports Physical Therapy, the sufficient ratio for the co-activation of the hamstring and quadriceps to decrease the chance of injury and force on the ACL is approximately 42–72 degrees of knee flexion.(1) The moment arm of the hamstring is the highest between 50–90 degrees of knee flexion and the moment arm of the quadriceps is between 20–60 degrees of knee flexion. (1) During the early stages of rehabilitation of muscle injuries exercises that produce a poor hamstring-to-quadricep ratio should be avoided.
Younger athletes who develop an Anterior cruciate ligament (ACL) and are getting physiotherapy for it may recover from Anterior cruciate ligament (ACL) but if they get back to their previous level of activity such as sports activities they might get a second Anterior cruciate ligament (ACL) injury because the first one is not completely recovered and it is important to decide whether to treat it surgically or non surgically. If the patient is suffering from functional instability it is recommended that ACLR surgical treatment is given to that person however it is still unknown what is the best practice for treating Anterior cruciate ligament (ACL) either surgical or non-surgical. If the person decides to take non-surgical treatment then rehabilitation is provided to that person for about five months and that person is recommended to stay away from any type of physical activity. Another option other than surgical and non-surgical treatment for the athletes is to adjust sports participation which might reduce the risks of Anterior cruciate ligament (ACL) injury. Different physical therapy exercises are provided to these individuals progressively to help prevent Anterior cruciate ligament (ACL). Physiotherapists have to consider the choices and the wishes of the patients as it might help in better decision-making and better outcome of the results
Medicinal Capacities to cure injuries:
Anterior cruciate ligament (ACL) injuries are frequent and can be extremely detrimental. An important ligament in the knee, the Anterior cruciate ligament (ACL), aids in stabilizing the joint and limiting excessive motion. The prevalent belief that an Anterior cruciate ligament (ACL) injury cannot heal has been disproved by new research, which suggests that anterior cruciate ligament (ACL) ruptures can mend without surgery and that this may be important for improving patient outcomes. Numerous factors, such as sports-related activities, falls, and automobile accidents, can result in Anterior cruciate ligament (ACL) injuries. An anterior cruciate ligament (ACL) is a common issue in football players and can lead to different problems too if left untreated it can be cured with physical therapy but sometimes becomes difficult to cure so surgery is the best option. Some players when they return to the field after the surgery continue to have knee problems and may require another surgery. the ACL injury rate in male football players is increasing continuously different studies have shown that Anterior cruciate ligament (ACL) injuries can be prevented by neuromuscular training programs are programs that aim at attaining stabilization in the joints by performing different exercises i.e. physical therapy of the nerves and the muscles can be trained
Over time, medicine has made considerable strides in the treatment of Anterior cruciate ligament (ACL) injuries. The treatment of ACL has improved because of basic science and clinical studies and they continue to advance with time both surgical and non-surgical methods can be used. The most frequent form of treatment for ACL damage is surgery, which is quite effective in stabilizing the knee joint. Surgery is not without dangers and problems, though, and not all patients are suitable candidates for it (Grindem, 2014). In ACL reconstruction surgery is done to gain back the stability of the knee joint it is a process of removal of the torn ligament and replacement of it with the band of tissues. An anterior cruciate ligament (ACL) if left untreated can lead to several different problems related to osteoarthritis which is the breaking down of the cartilage within the joint and the changing of the bones. One of the most common orthopedic operations is considered to be ACL reconstruction. According to the National Centre for Health Statistics about 63000 ACL reconstructions were performed in the U.S. in 1991(3). Over 200 thousand surgeries costing over 3 billion dollars take place every year in the U.S. (4). Before the reconstruction surgery a pre-rehabilitation exercise program is provided for the maximum outcome of the rehabilitation process and also to successfully prepare the knee for the reconstruction process. this pre physiotherapy rehabilitation before the surgery will help increase the strength of the muscles and their functional ability. the risk of pivot shift episodes can also reduce which may help with the reconstruction after the surgery. Preoperative physiotherapy rehab helps with improving the outcomes of the Anterior cruciate ligament (ACL). The widespread use of anatomical ACL reconstruction procedures has been made possible by advances in our understanding of the anatomy and function of the natural Anterior cruciate ligament (ACL). For successful surgical or non-surgical treatment of the Anterior cruciate ligament (ACL), rehabilitation is an important factor that involves physical therapy which helps brace knee joints and successfully get back to sports.
Physical therapy is a crucial component of Anterior cruciate ligament (ACL) injury treatment. Physical therapy is the treatment of any kind of injury using different methods like exercises etc to help achieve desirable movements of the muscles and the joints. Physical treatment can assist to increase the damaged joint’s range of motion, strength, and flexibility, which can enhance overall function and lower the risk of additional injury.
Despite medical advancements, treating Anterior cruciate ligament (ACL) injuries can still be challenging. According to research, many patients still have pain and activity limits after surgery and physical treatment. It’s also important to note that recovery from surgery still presents significant challenges because it’s imperative for the patient to rebuild muscle strength, range of motion, and proprioception to avoid re-injury.
Even though medicine has made great progress in the treatment of Anterior cruciate ligament (ACL) injuries, there is still room for improvement. The knee joint can be successfully stabilized again with surgery, but there are risks and potential problems. Physical therapy is a crucial component of care, and medicine might not be sufficient to fully recover the function of the injured joint. As a result, it’s crucial to treat Anterior cruciate ligament (ACL) injuries using a multidisciplinary approach and to have reasonable expectations for the course of action.
References:
Arendt, E. and Dick, R. (1995). Knee Injury Patterns Among Men and Women in Collegiate Basketball and Soccer. The American Journal of Sports Medicine, 23(6), pp.694–701. doi:10.1177/036354659502300611.
Donald, K. (2016). Accelerated rehabilitation after anterior cruciate ligament reconstruction. [online] The American Journal of Sports Medicine. Available at: https://journals.sagepub.com/doi/abs/10.1177/036354659001800313?journalCode=ajsb.
Grindem, H., Eitzen, I., Engebretsen, L., Snyder-Mackler, L. and Risberg, M.A. (2014). Nonsurgical or Surgical Treatment of ACL Injuries. The Journal of Bone and Joint Surgery, [online] 96(15), pp.1233–1241. doi:10.2106/jbjs.m.01054.
LaBella, C.R., Hennrikus, W. and Hewett, T.E. (2014). Anterior Cruciate Ligament Injuries: Diagnosis, Treatment, and Prevention. PEDIATRICS, [online] 133(5), pp.e1437–e1450. doi:10.1542/peds.2014–0623.
Post, E.G. (2017). The Association of Sport Specialization and Training Volume With Injury History in Youth Athletes. [online] SAGE Journals. Available at: https://journals.sagepub.com/doi/abs/10.1177/0363546517690848?journalCode=ajsb.
Shea, K.G., Grimm, N.L., Ewing, C.K. and Aoki, S.K. (2011). Youth Sports Anterior Cruciate Ligament and Knee Injury Epidemiology: Who Is Getting Injured? In What Sports? When? Clinics in Sports Medicine, 30(4), pp.691–706. doi:10.1016/j.csm.2011.07.004.
