There are four main stabilising ligaments in the knee that connect the thighbone (femur) to the shin bone (tibia). They are:

• Anterior cruciate ligament (ACL)
• Posterior cruciate ligament (PCL)
• Medial collateral ligament (MCL)
• Lateral collateral ligament (LCL)

The anterior cruciate ligament is located in the centre of the knee. It controls rotation and forward movement of the shin bone (tibia).

An anterior cruciate ligament injury is more commonly known as an ACL tear. ACL tears usually happen without warning, especially when there is an abrupt stop or change of direction, or when someone lands awkwardly.

What are the symptoms of Anterior Cruciate Ligament (ACL) injury?

The symptoms onset for an ACL injury is usually sudden. They include:

• Sharp pain immediately after an injury
• Swelling of the impacted knee
• A popping sound when the ligament ruptures
• Difficulty with knee movement – restricted / reduced range of knee motion
• Feeling of instability – a feeling of the knee ‘giving way’ during daily activities
• Inability to bear weight – limping, difficulty walking

What are the risk factors of Anterior Cruciate Ligament (ACL) injury?

Following are factors that can increase the risk of getting ACL injuries:

• Gender: Women are at a higher risk, possibly due to different muscle conditioning compared to men.
• Certain sports: ACL injuries are more common among people who are active in sports activities that involve frequent start-stop movements, pivoting or sudden changes in direction which causes the knee to twist or turn. The sudden change in momentum or direction makes it more likely for the ACL to stretch or tear. These sports include football, basketball, netball, tennis, gymnastics, among others.
• Previous ACL injury: ACL injuries can also occur due to trauma, for example, in a car accident, falling off the stairs, etc.

How is Anterior Cruciate Ligament (ACL) injury diagnosed?

Diagnosis is made based on various investigations. Your doctor will first evaluate your medical history and symptoms before conducting a physical examination.

In order to assess your knee function, your doctor ask you to move your knee in different directions. Imaging tests such as X-ray, MRI or ultrasound may also be done.

How is Anterior Cruciate Ligament (ACL) injury treated?

If left untreated, an ACL injury can significantly impact a person’s level of activity and performance. Symptoms such as pain, swelling, and instability could restrict participation in sports.

Treatment for ACL tears include non-surgical and surgical options, depending on the extent of injury.

Non-surgical treatments

The initial non-surgical treatment for ACL injury is the R.I.C.E therapy to reduce knee pain and swelling.

• R: Rest
• I: Ice
• C: Compression
• E: Elevation

Physiotherapy is then done to help restore knee function and range of knee movement, increase leg muscle strength, and knee stability.

ACL reconstruction surgery

ACL reconstruction surgery may be needed for severe ACL tears. This surgery is a minimally invasive procedure known as arthroscopy (keyhole surgery) and it is performed under general anaesthesia.

In an ACL reconstruction surgery, the orthopaedic surgeon will make several small incisions, inserts a tiny camera, and uses surgical tools to remove the torn ligament. The surgeon will then replace it with a piece of tendon taken from another part of your knee or from a donor. The tendon is secured to surrounding bones to enable new ligament tissue to grow.

What to expect after surgery?

Generally, you can go home on the same day. You will be given medications and you can use ice packs and elevate your leg to relieve post-operative pain and swelling.

Post-operative rehabilitation is also recommended to help strengthen the muscles around the knee and improve flexibility.

Recovery may take around nine months. Athletes may require a longer recovery time before they can return to athletic activities.

Book an appointment at Pantai Hospitals

A dedicated and expert team of Orthopaedic specialists at Pantai Hospital is available for consultation to provide the best care and assistance.

Get in touch with us to book an appointment today if you have concerns or questions regarding Anterior Cruciate Ligament (ACL) injury. We assure you the best possible care tailored to your specific needs.

Pantai Hospital has been accredited by the Malaysian Society for Quality in Health (MSQH) for its commitment to patient safety and service quality.