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Athletic Training

ACL mild partial tear

06/06/2007

Question:

from 2 monthes , i dropped on my right knee while playing football,swelling and pain i did mri , the result was mild partial tear in acl and pcl my knee never loose stability .but i feel that the knee are not strong like before ,i dont know may be it is just feeling the doctor said to me it is something not big and in 3 weeks i will play football again he gave me some exercises to strengh my quad , but honestly i wasnt doing the exercise regularly it is now 2 monthes and i feel pain while bending my knee very hardly, put i can jog , walk, i tried to sprint but i felt a little pain i wanna to know what is best rehabilitation program to do, and i could return to normal again , playing football, in the gym can i squat or deadlift,another doctor saw me and said it was partial tear but grade 2 and i wont be normal again like before i told u my knee never unstable , i can jump high and drop on my feet without loosing stability could u please help me?

Answer:

First, I'll give you the stock disclaimer that I can't give specific medical advice over this website.  I haven't examined you and don't have enough information to give you specific care recommendations.  With that said, I do have a few thoughts about your situation...

The cruciate ligaments (ACL & PCL) are tremendously important structures in the knee.  They are the most important structural stabilizers of this joint and they have some vital functions including:

1) controlling anterior-posterior (front - back) sliding movements of your tibia (shin bone) on your femur (thigh bone)

2) rotation of your tibia

3) controlling the amount of space between the tibia and femur.

Even more importantly, they do all of these dynamically.  That is, they keep you stable while your knee is flexing and extending, particularly while you bear weight on it.  It is not surprising that an injury to them, even a partial injury, is affecting your level of function and pain. 

When these ligaments are injured, it changes the mechanics of the knee.  It changes the forces, angles, and movements of the bones as well as the way your knee feels while you move it. It also changes the proprioception of the joint.  Proprioception is not something you can "feel" directly, but it includes all the information about position, force, and movement of the joint that your body unconsciously uses to control your movements and coordinate them. With changes in all of these things, you don't move the same way and this changes both your performance and how it feels while you do activities.

Another thing that happens when you injure these ligaments is that your knee swells.  Sometimes this swelling is very noticeable, sometimes it is very subtle.  In any case, the presence of extra fluid in the joint causes the joint capsule to stretch, sort of like the way a balloon stretches when you inflate it.  We have learned in recent years that this stretch has neurological consequences that reduce your ability to coordinate and forcefully contract the muscles that surround the joint.  We call this "arthogenic (means: originating from a joint) muscle inhibition".  This inhibition means that your quads, hamstrings, gastrocs, etc do not function the way they normally do.  This also changes the mechanics of the joint.

To make a long story short, your knee is NOT the same as it used to be.  Basically, there are two ways to deal with this.  The first is to surgically repair the damage.  Most orthopedic surgeons I've worked with don't usually do this with a partial tear unless what's left of the ligament is too small to function.  The second way (conservative treatment) is to try to restore the function and improve the mechanics of the knee so that it begins to function more normally.  To be honest, this is also part of the surgical intervention as well... so it's not really an "either-or" decision, it's more of a "one or both" decision.

Conservative treatment is what it sounds like has been recommended for you.  It's important to understand how it works so you can help it work for you.  The goal is to reduce the swelling and pain, overcome the inhibition, and then gradually improve the strength and coordination of the muscles surrounding the joint so that it can come closer to normal function.  In many (most?) cases, it can come close enough to normal function that you can return to just about anything that you used to do before the injury(provided that the tear is not too large). 

To make this happen, you need to do exercises that restore these functions AND the key to these is working your way up through them.  Just like you don't become a top level sports performer on your first try, you can't go from injured to high-level function without first going through the developmental steps.  You can't just go to gym and do a few lifts and be ready to go.  You have to first control the inflammation, then re-train your muscles (especially your quads and hamstrings) to control the sliding and rotating motions of the knee during weightbearing, and then you start to restore the strength needed for sports activities. 

You will have setbacks along the way as well. You can't skip a step, and you can't make it happen overnight.  This is where working with a professional makes the difference.  A rehab professional like an athletic trainer or physical therapist can work with you to develop a program that addresses your specific limitations and needs and they will be there to modify and advance the program as you go.  There is no quick fix or home ready that can adequately substitute for professional care in trying to get your knee to act like it should. It takes time and expertise to do it right.  Time alone will make it not hurt as much or as often, but just time alone and no rehab does not correct the mechanics.  You will continue to get flare-ups when you do try to do anything more than just walking. 

My first and best advice is to get your physician to refer you to a rehab professional who can evaluate you, determine where you are in the process and where you want to go, and then design a program to help you get there.

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Response by:

Mark  A Merrick, PhD, ATC Mark A Merrick, PhD, ATC
Associate Professor at the School of Allied Medical Professions
College of Medicine
The Ohio State University