The knee joint is protected by a very powerful capsular-ligamentous and neuromuscular system. Major ligaments include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL).
- LCA: It is a robust, fibrous ligament made of collagen. It is located in the center of the knee joint, providing the strength and flexibility necessary to withstand stress during movement. The main function of the anterior cruciate ligament is to provide stability to the knee. It prevents the tibia from moving forward relative to the femur and controls the rotation of the knee.
- LCP: Prevents the tibia from moving backwards in relation to the femur and contributes to rotational stability.
- LCM or LLI: Provides stability to the internal compartment of the knee, preventing it from opening excessively (valgus).
- LCL or LLE: Provides stability to the external compartment of the knee, preventing it from opening excessively (varus).
- Joint capsule: Fibrous structure that covers the knee joint. It offers support and containment to the internal components.
The mechanism of injury to the anterior cruciate ligament is due to actions that subject it to excessive tension, taking it beyond its capacity to support said load. ACL injury is usually more common when there is no direct contact with the knee (70% of the cases) such as in jumping, landing, changes of direction, hyperextensions, etc. In these cases, there is an internal rotation of the femur on the tibia and a valgus of the knee (excessive opening of the medial compartment).
When playing sports such as football, rugby, tennis or paddle tennis, it is very common to find an anterior cruciate ligament injury due to sudden braking and a change of direction, where the tibia moves forward in relation to the femur.
Finally, direct ACL injury occurs from contact with the lateral or anterior side of the knee, which is less common (30% cases).
Below we show a video of the professional padel player Exe Mou, where the protagonist talks to us about his experience after having suffered this injury:
At these Olympic Games we have been able to see how our candidate for the Badminton gold medal, Carolina Marín, injured her anterior cruciate ligament and ends up retiring from the match which would take him to the final of this championship, after landing with poor support on the ground.
LCA, is it more common in men or women?
Anterior cruciate ligament injury is more common in women, and specifically at an early age, due to a combination of anatomical, hormonal and biomechanical factors.
- Anatomical factors: Women have wider hips than men, affecting the angle of the femur relative to the tibia (Q angle). This increased Q angle predisposes to knee valgus, increasing stress on the ACL. In addition, women tend to be more lax and have less muscle mass, which can reduce knee stability.
- Hormonal factors: Fluctuations in progesterone and estrogen levels can affect ligament laxity. During menstruation, they can become looser and therefore susceptible to injury.
- Biomechanical factors: When landing after a jump, women tend to do so in extension and with the knee falling into valgus. In addition, they tend to use the quadriceps more than the hamstrings, increasing the load on the ACL.
- Age and development: It is more common in girls during growth. The accelerated development of bones compared to muscles and ligaments generates greater tension on the anterior cruciate ligament.
ACL-related injuries
The anterior cruciate ligament is often not torn in isolation, due to its interconnections with other tissues in the knee joint. Some of the most common are:
Meniscus injuries
These shock absorbers located between the femur and tibia can be affected by the compressive and rotational forces of the injury mechanism.
Ligament injuries
These structures, which provide lateral stability to the knee, can be affected, with the most common injury to the medial collateral ligament due to its proximity and the valgus caused by the injury. Injuries to the posterior cruciate ligament associated with the anterior cruciate ligament are rare and usually occur in high-impact traumas such as car accidents or major falls.
Articular cartilage injuries
This tissue covers the bony surfaces of the knee and facilitates smooth, fluid movement of the joint. Impacts and the resulting instability can lead to fragmentation or damage to the cartilage.
Does anterior cruciate ligament injury require surgery? Surgical or conservative treatment?
The final decision on whether a cruciate ligament should be operated on or not will depend on several factors such as the severity of the injury, whether there is associated damage, the age and activity level of the patient and the subject's functional expectations.
In young and athletic patients with instability, surgery is necessary (external link), while in older people or those with a more sedentary lifestyle, physiotherapy can be considered as an option.
An intensive physical therapy program containing muscle strengthening, proprioceptive and lower limb stability exercises can help compensate for ACL function.
Is it possible to prevent an ACL injury? Preventive approach and strategies.
Anterior cruciate ligament injury cannot be completely prevented. It occurs in a fraction of a millisecond following unpredictable, high-intensity movements such as jumping, landing or turning. Reactive muscle activation is insufficient to prevent injury. There is an intrinsic delay between the stimulus (change of direction) and the muscular response due to the time it takes for the receptors to detect the movement, transmit the signal to the brain and develop a neuromuscular avoidance response.
In addition, the biomechanical, anatomical and genetic predisposition of certain individuals or the playing conditions (condition of the field, climate, etc.) can favor the injury.
However, Although there is no absolute way to prevent ACL injuries, we can establish a series of strategies to reduce the risks and severity of this injury. An individualized program of strengthening and neuromuscular training that includes gestures to avoid the injury mechanism is highly recommended for amateur and professional athletes.
Role of physiotherapy in the recovery of anterior cruciate ligament injury.
Anterior cruciate ligament injury is one of the most challenging and worrying injuries in the world of sport (football) and physical activity.
Physiotherapy plays a very important role in the rehabilitation and re-adaptation of this pathology. Through adequate treatment and a structured program, it is possible not only to achieve complete recovery, but also to reach the optimal state to return to activity stronger than ever.
Physiotherapy is not an option but a necessity for patients who have suffered an anterior cruciate ligament injury.
To ensure a successful recovery and minimize the risk of relapse, it is important to start rehabilitation early with a physiotherapist expert in this anterior cruciate ligament injuryThis early care will prevent joint stiffness, improve blood circulation facilitating tissue healing, reduce inflammation and pain, improve scarring and avoid adhesions, as well as other postoperative complications (deep vein thrombosis).
In the case of conservative treatment, which avoids surgery, or a preoperative procedure, physiotherapy is again the best choice for the patient.
Clinics specializing in anterior cruciate ligament injuries in Alcalá de Henares.
Our Evolution physiotherapy clinic, in the town of Alcalá de Henares, is a benchmark when it comes to treating patients who, after having suffered an anterior cruciate ligament injury, have undergone surgery.
We are specialists in sports injuries and we will accompany you in the rehabilitation and readaptation process until you are fully recovered. We offer fully personalized and individualized care. Our physiotherapists, with advanced knowledge in health and previous experience in post-surgical injuries, will help you in the process. Every day, professional athletes and people who practice sports come through our hands and want to recover their best form to return to their activity safely.
Don't wait any longer to start your rehabilitation. Schedule your appointment with our physiotherapists.
Your path to a strong, healthy knee starts today!
