The severity of an ACL injury [2] can vary, from mild strains to complete tears, and the appropriate treatment path depends on factors like age, activity level, and injury extent. ACL injuries are classified based on the severity of the damage to the ligament. The most common classification includes three grades:

• Grade I (Mild Sprain): This involves slight stretching or minor tearing of the ACL fibres, leading to some pain and swelling but minimal impact on knee stability.
• Grade II (Moderate Tear): In this case, there is a partial tear of the ligament, causing more pronounced instability and difficulty with movement.
• Grade III (Complete Rupture): This is a full tear of the ACL, resulting in significant knee instability and requiring surgical intervention for proper recovery.

Understanding these classifications helps guide appropriate treatment and rehabilitation strategies.

Common causes include: 

• Sports-related activities: High-impact sports like football and basketball involve frequent stopping, pivoting, and jumping that put stress on the ACL. Winter sports such as snowboarding may also cause ACL tears due to sudden twists and awkward landings. 
• Mechanisms of injury: Sudden deceleration, landing incorrectly from a jump, or a direct collision or impact can lead to ACL tears.
• Contributing factors: Gender, body structure, and muscle strength all play a role in ACL injury risk, with anatomical differences making women particularly susceptible [4].

Symptoms include: 

• Popping: Often, a loud popping sound or sensation is heard or felt at the time of injury.
• Severe pain: Sharp and intense pain in the knee, especially during movement.
• Rapid swelling: Swelling and inflammation usually develops within a few hours of the injury.
• Instability: The knee may feel unstable or give out when attempting to stand or walk.
• Limited range of motion: Difficulty fully extending or bending the knee due to pain and swelling.

• Physical Examination: Tests such as the Lachman test and pivot shift test to assess ligament stability.
• Patient history: Your doctor may inquire about the injury's circumstances and initial symptoms.
• MRI (Magnetic Resonance Imaging): Provides detailed images to identify ligament tears and additional knee damage.
• X-rays: Used to rule out bone fractures that might accompany an ACL injury.

Non-surgical Treatments

• RICE Method:
  • Rest: Avoid putting weight on the injured knee to prevent further damage.
  • Ice: Apply ice packs for 15-20 minutes several times a day to reduce swelling and numb pain.
  • Compression: Use a bandage to limit swelling and provide support to the knee.
  • Elevation: Keep the leg elevated above heart level to help decrease fluid buildup.
• Physical therapy: Engaging in strengthening exercises to improve knee support and stability.

Surgical Treatments

• Surgical Reconstruction:some text
  • Keyhole Surgery (Arthroscopy): A minimally invasive procedure where small incisions and a camera are used to guide the surgeon.
  • Graft Replacement: The torn ACL is replaced with a graft, either from the patient's tissue or a donor.

Recovery and Rehabilitation

• Post-surgery Rehabilitation: Following a structured program of targeted exercises to rebuild strength and mobility over several months for safe return to activities. This will take about 6 months to a year. 

Prevention strategies for ACL Injuries include:

• Strength training: Focus on exercises that strengthen the legs, hips, and core to support the knee joint.
• Flexibility: Incorporate stretching routines to maintain muscle elasticity and joint mobility.
• Proper techniques: Emphasise safe landing and cutting techniques in sports to minimise undue stress on the ACL.
• Warm-up routines: Engage in dynamic warm-ups before physical activity to prepare the muscles and joints.
• Supportive equipment: Use appropriate footwear and consider knee braces for additional support during high-risk activities.

Consider factors like board certification, years of experience, and patient testimonials when selecting a doctor. Some specialists also offer advanced diagnostic and minimally invasive surgical techniques, which can lead to faster recovery and improved outcomes. A reputable clinic with a strong rehabilitation program can further aid in restoring knee strength and mobility post-treatment, providing a well-rounded approach to managing ACL injuries.

Some specialists in Singapore offer advanced diagnostic and treatment options; for example, Artisan Orthopaedics provides comprehensive ACL care, from consultation to post-surgery rehabilitation. The clinic is led by Dr. Puah Ken Lee, an experienced orthopaedic surgeon specialising in sports medicine and joint reconstruction at Artisan Orthopaedics. His experience of almost 20 years has led him to become the  Medical Director of Basketball Association Singapore (BAS) and Trainer for AO Orthopaedic Surgery, among others. 

With a strong focus on knee injuries, particularly ACL tears, Dr Puah employs advanced surgical techniques and personalised rehabilitation plans to help patients achieve optimal recovery. His expertise extends to treating various musculoskeletal conditions, ensuring that patients receive comprehensive care tailored to their individual needs. Contact us today to book an appointment.