Diagnosis and Treatment of an ACL Tear

Are you a former competitive athlete? 

Those of us who competed in high level sports when we were younger are often left with a bit of a void in adulthood. There’s running, cycling, intramurals or even CrossFit. But whatever activity you choose, there are often disconnects between what our minds tell us we can do and what our bodies actually can. Because let’s face it, no working adult has time to train like a young athlete! This disconnect can contribute to an ACL injury or “anterior cruciate ligament tears”. 

Young sport man with strong athletic legs holding knee with his hands in pain after suffering ligament injury isolated on white.

ACL injury is highly researched for youth athletes, but what happens when you sustain an ACL tear as an adult?

Take our client Brian, for example. Brian played Division I Soccer in the U.S. on a full-ride scholarship. He made it through his prime soccer years relatively injury-free and is now 40 years old and works as an Accountant at E&Y. Brian has three kids, 12, 9, and 4. He stays active with regular running and cycling. He also plays in the Guelph Men’s Recreational League on the weekend to fill the athletic void from his “former” life. However, in February of last year he sprinted for a challenge, planted to turn, and felt the “pop” that every athlete fears might be an ACL tear.

We got Brian in the next day for a Physiotherapy Assessment. Physiotherapy is a good place to start after a knee injury. A good orthopedic physiotherapist can perform tests for knee ligaments, including ACL tears. These tests are highly accurate at diagnosing. 

Here’s what Brian told us that made us think it might be an ACL tear:

  • He felt and heard a “pop” at the time of injury
  • He had rapid, diffuse swelling around the knee 
  • He felt unable to continue playing and felt the knee was “unstable”

Here’s what we saw and found:

  • Brian came in on crutches, and could not walk without limping 
  • He had puffy, diffuse swelling around the whole knee joint
  • He had lost a lot of range of motion at the knee; it was painful to straighten and to bend
  • The test used for ACL Tear diagnosis, “Lachman’s Test”, showed clear increased movement, indicating that the ACL ligament was likely ruptured 

Brian was devastated that he had experienced an ACL tear, after being in the clear for so long. The mental side of injury can be just as difficult as the physical components, which is something we understand. Like we did with Brian, let’s start with returning to the physiology of the knee and what an ACL tear really means. 

What is the ACL and why is it important? 

The “anterior cruciate ligament” or “ACL” is a ligament that connects your upper leg to your lower leg. The way that it runs (front to back, on an angle), provides your knee with rotational stability as well as prevents the lower leg from “sliding forward” on the upper leg. 

In addition to providing stability, the ACL contains “mechanoreceptors”, which affects the ability of the knee to “detect motion” and to fire it’s muscles with appropriate timing. Both of these result in less control of the leg. 

Here’s how we helped treat Brian’s ACL injury on day one:

  • EDUCATION: this injury often presents a lot of fear. We were able to reassure Brian that if his ACL was torn as we suspected, that he was starting on the path to improving his outcome: surgery or not. 
  • REDUCE SWELLING: by instructing him in range of motion exercises, plus some manual therapy, we were able to set Brian up to decrease the swelling around the knee. This is important for getting the muscles around the knee to work properly, and for reducing pain.
  • IMPROVE RANGE: most acute knee injuries avoid both ends of the spectrum, straightening and bending. We were able to help Brian to start these motions, so he didn’t wind up worse off weeks later.
  • ACTIVATE MUSCLES: we instructed Brian on ways to “wake up” his muscular system to start supporting his knee
  • CORRECT GAIT: we encouraged Brian to use his crutches properly and how to return to a normal walking pattern as soon as possible 
  • COMMUNICATION with MD: we sent a report to Brian’s doctor that outlined our testing, asking that he be referred for an MRI to confirm our findings. An MRI is the imaging of choice for confirming an ACL tear. 

What was the long-term plan for Brian’s ACL injury? 

Stay tuned for Part II of Brian’s case, where we will discuss his options for this injury. 

Do you have a knee injury? Are you wondering if you have an ACL tear? 

Contact us and we can arrange for a Free Consultation with one of our Physiotherapists to speak with you about your individual case.

FAQ:

  • We are able to help individuals of all ages and at all activity levels (recreational to competitive). 
  • We offer direct billing to most major insurance companies for the convenience of our clients.
  • We have appointments as early as 7am and as late as 7:30pm to accommodate busy lifestyles.

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