Anterior cruciate ligament (ACL) tear - advanced therapy program

Cruciate ligaments represent the most important passive stabilizers of the knee joint and the anterior cruciate ligament (ligamenta cruciata anterior - ACL) is seen as an especially important factor in knee joint stabilty. Cruciate ligaments, named that way due to the fact that they cross eachother diagonaly, connect the femur and the tibia and in that way, by following knee movements, they secure joint stability and ensure internal and structural knee joint congruity.

ACL prevents anterior or forward translation of the knee joint, ie. slidding or shifting of the lower leg forward in relation to the upper leg and the posterior cruciate ligament (ligamenta cruciata posterior – PCL) does the opposite and prevents the posterior or backward translation of the lower leg in realtion to the upper leg. The fact that these two ligaments are directly connected to two bones and that they do not have any other surrounding protection aside from their own strenght and the function of active knee joint stabilizers means that when a situation occurs during physical or sports activity where the force which is transferred onto the knee is too strong for the active stabilizers to handle or they do not have a proper and timely response for that force the knee joint gets overloaded and either one or in some cases both cruciate ligaments get injured, with the ACL being more commonly injured. The mere fact that timewise it takes cca. 6 months to completely rehabilitate and return to full activity after an ACL rupture/tear and the complexity of the rehabilitation and reconditioning process speak enough about the severity of an ACL injury.

Some of the factors that increase the risk of ACL injury are: unilateral or bilateral strenght disbalance between anterior and posterior upper leg muscles, ie. quadriceps muscle is much stronger than the hamstring muscle group, muscles that are morphologically big, but they do not have proper functionality, their role of active knee stabilizers is not performed on time or in the proper way, biomechanically incorrect performance of movements such as landing after a jump, cutting (changing direction), deceleration, sudden, explosive steps forward or diagonally, etc. When situations like the ones stated above happen the knee can collapse medialy, ie. knee valgus collapse occurs where the knee, the hip and the ankle are not aligned properly and by use of excessive force, which affects the body during performance of these movements, the risk of injury increases greatly. Gender is also seen as a possible risk factor for ACL injuries, women have a bigger Q angle (wider pelvis as a compensatory mechanism for the process of child birth) and their muscles have a lower capacity to generate force which leads to their risk of ACL injury being 2-8 times higher. All of the stated risk factors show the level of „threat“ for ACL during physical or sports activity if those risk factors are not dealt with and if their impact is not decreased properly with prevention programs.

Prevention: ACL injuries are still very frequent, especially with athletes, the way to prevent them from happening is to detect possible risk factors, which can be individual for every athlete, and to properly work on increasing and eliminating the impact of these factors through ACL injury preventive programs. Proper diagnostics, noticing the risk factors on time and implementing systematic injury prevention programs can be very effective in dealing with and decreasing possible ACL injuries. It is also very important to educate the coaches and especially athletes so that they themselves can recognise risk factors and work on decreasing or eliminating them.

Videoreha programs offer all of the prevention actions stated above and proper rehabilitation if an ACL injury did take place. Our video-rehabilitation programs function with the purpose of regaining proper range of motion, muscle strenght and functionality, stability function of muscles and ligaments (neuro-muscular connection) in not only the knee joint, but across the whole body in order to secure the knee joint and regain its full functionality. We offer specific exercises aimed to ensure the most effective return to full activity to every patient. Exercises that we use put the patient and the knee joint in situational conditions, menaning that we aim to progressively eliminate the impact of risk factors and recreate possible injury mechanisms and risk situations during which the knee or the ACL get injured, but we highlight and require proper biomechanical and functional performance of each and every exercise or movement we implement in the program as well as proper and timely muscle activation, ie. global neuro-muscular synergy which leads to knee joint stability and safe performance of all movements.