Understanding a major knee injury
There anterior cruciate ligament rupture, better known by its abbreviation LCAThis is one of the most common and debilitating knee injuries. It is particularly feared by athletes, as it often leads to a prolonged interruption of physical activity and often requires surgery followed by a lengthy rehabilitation. However, this injury doesn't only affect elite athletes: it can also occur during amateur sports activities, or even in certain everyday situations. It is essential to adapt the treatment, optimize recovery, and limit the risk of long-term consequences.
What is the anterior cruciate ligament?
The knee is a complex joint that allows for flexion, extension, and slight rotational movements. This stability relies largely on a set of strong ligaments, including the anterior cruciate ligament (ACL). Located in the center of the joint, the ACL connects the femur to the tibia diagonally and prevents the tibia from sliding excessively forward.
Beyond its role as a mechanical "brake," the anterior cruciate ligament actively participates in controlling the rotational movements of the knee. It is particularly involved during changes of direction, pivots, and deceleration phases. When intact, it allows the knee to remain stable even during complex athletic movements. Conversely, when it ruptures, this stability is severely compromised, which explains the sensation of the knee "giving way" frequently reported by patients.
A common injury, especially in certain activities
Anterior cruciate ligament rupture is particularly common in sports that place intense stress on the lower limbs. It is frequently observed in disciplines involving jumping, landing, or rapid pivots.
It is found in particular in:
- football and rugby,
- basketball and handball,
- alpine skiing,
- certain combat sports or dance.
What is an ACL rupture?
ACL rupture usually occurs during a Indirect trauma.
- a sudden change of direction,
- an unbalanced landing from a jump
- a sudden deceleration.
These various factors can be enough to rupture the ligament if the stresses exerted exceed its resistance capacity. In these situations, the knee is subjected to significant torsional forces while slightly flexed, a position particularly vulnerable to the anterior cruciate ligament.
Less commonly, a direct blow to the knee, particularly during a tackle or violent contact, can cause the rupture. Whatever the cause, the injury often occurs suddenly and unexpectedly.
The symptoms: often telling signs
The symptoms of an anterior cruciate ligament (ACL) rupture typically appear suddenly. At the time of the injury, many patients describe a popping sensation or hear a clicking sound inside the knee. This sensation is frequently followed by sharp pain, forcing them to immediately stop the activity.
In the hours that follow, several signs may appear:
- rapid swelling of the knee, linked to hemarthrosis,
- a decrease in mobility,
- difficulty putting weight on the affected leg.
After the acute phase, the pain may lessen, but a feeling of instability persists. The knee may feel like it is "giving way," especially when walking briskly, going down stairs, or making twisting movements. In the case of partial tears, the symptoms may be more subtle, which explains some delays in diagnosis.
How to make the diagnosis?
The diagnosis is based on a combination of clinical findings and additional tests. The clinical examination assesses knee stability using specific tests, such as the Lachman test or the anterior drawer test. These maneuvers can reveal abnormal tibial displacement.
However, imaging is often essential to confirm the suspicion. MRI is now the gold standard. It allows not only visualization of the anterior cruciate ligament rupture, but also detection of any associated injuries, such as meniscal or cartilage damage, which can influence the treatment strategy.
What are the treatment options?
The treatment of an ACL rupture depends on several parameters: age, activity level, the patient's functional goals, and the degree of knee instability. Two main approaches exist.
Conservative treatment
In some cases, non-surgical treatment may be considered. This is primarily intended for people who are not very active or whose knee remains stable in their daily life. This treatment is based on:
- an initial phase of rest and inflammation management,
- a thorough rehabilitation program aimed at strengthening the stabilizing muscles,
- Proprioceptive exercises to improve knee control.
It is important to clarify that this approach does not repair the torn ligament, but aims to compensate for its absence through good muscle control.
Surgical treatment
Surgery is often recommended for young, active, or athletic patients, as well as those suffering from persistent instability. The procedure involves reconstructing the ligament using a tendon graft. It is performed arthroscopically and followed by rigorous rehabilitation.
Rehabilitation: a crucial step
Rehabilitation is a fundamental pillar of recovery, whether or not surgery has been performed. It extends over several months and follows a structured progression, including:
- the recovery of joint range of motion,
- progressive muscle strengthening,
- balance and coordination work,
- the supervised resumption of sporting activities.
Resuming sports activities generally takes between six and twelve months, depending on the type of activity and the quality of recovery.
Long-term risks
Without proper treatment, an anterior cruciate ligament rupture can lead to complications. Chronic instability promotes repeated meniscal tears and cartilage wear, thus increasing the risk of knee osteoarthritis in the medium to long term.
Preventing ACL rupture
Prevention plays a major role, especially for athletes. Specific programs integrating muscle strengthening, jump technique work, and proprioceptive exercises have proven effective in significantly reducing the risk of injury.
Conclusion
An anterior cruciate ligament (ACL) rupture is a serious injury, but one that is now well understood and effectively managed. Thanks to accurate diagnosis, an appropriate treatment strategy, and rigorous rehabilitation, the majority of patients can return to a satisfactory active life. The key lies in early and personalized care, which allows for the long-term preservation of knee health.
