Acute Treatment Of Anterior Cruciate Ligament Injury
The first 48 to 72 hours after injury is referred to as the acute phase. This is the time when the inflammation may be increasing, swelling occurring and the pain being a significant factor.
During the acute phase the knee is difficult to diagnose as the pain and swelling prevents the stress testing that the surgeon needs to do to find out which structures have been injured or ruptured.
The initial aims of treatment are to reduce the pain and inflammation, restore the range of motion of the joint and restore the muscle power and stability of the knee.
Cryotherapy, Cold Therapy, Ice Therapy
The first line of therapy is to reduce inflammation and for this cold therapy is a useful treatment. Ice packs can be used, with crushed or cubed ice or a packet of frozen peas. It is important not to put the cold directly on the skin as this can cause an ice burn, a kind of local frostbite or tissue death.
Wet a small towel or tea towel completely and then wring it out, wrapping the ice or frozen vegetables in this before applying to the knee. Monitor your knee after 10 minutes to check the skin condition. A gently pink colour is good, if you notice very white spots you should stop the treatment and get advice.
Once you know the ice will not harm you, use the treatment for up to 20 minutes at a time several times a day.
Ice is useful but compression of the knee to prevent/reduce swelling may be even more important. One device which successfully combines these two therapy techniques is the Aircast Cryocuff. We find this very useful in the management of post-operative pain and swelling after ACL reconstruction.
Diagnosis Of The Knee
Once the acute phase has settled with treatment, the surgeon may be able to examine the knee and check for the laxity in any of the knee ligaments. An MRI scan may be used if there is some doubt about the degree of ligament damage. This scan gives detailed images of the soft tissues within the knee and can provide a very accurate picture of the internal status of the joint. This allows a clear diagnosis and treatment plan.
Treatment of an ACL injury depends on the amount and type of damage found, the level of difficulty the patient has with functional activities and their age and sporting requirements.
Knee Bracing For Anterior Cruciate Ligament Tears
Partial tears of the ACL are common and if the knee has only limited stability problems, a knee brace may be useful and can be a long-term option for less active individuals. Physiotherapy to strengthen the knee and restore the joint position sense is necessary along with knee bracing if the result is to be good.
In more sporting individuals it may not be possible to leave the knee with the degree of instability as this will prevent any medium or high level sport. Anterior cruciate ligament reconstruction will then be necessary. During the pre-operative period a brace such as made by Donjoy can give effective stability to the knee for normal and moderate activity.
Modern ACL braces prevent the abnormal movement of the shin bone under the knee bone and restore some degree of joint stability. This stops the feeling that the knee is going to give way under stressful conditions such as weight bearing on the knee and turning. These braces can be used during rehabilitation and to some extent in various sporting activities.