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strength training of the quads, hamstrings, and glutes can help stabilize the knee

it may be difficult for athletes to build muscle if they do not have access to proper training

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Neuromuscular control is the coordinated response of the nervous and muscular systems to maintain joint stability.

Deficits may causes weakness, delayed activation, or imbalance of muscle contraction.

If this coordination fails, the ACL is vulnerable to rupture.

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Knee pain is a very common and almost guaranteed symptom of an ACL injury

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ACL injuries are most commonly caused by different sports-related movements. These include sudden stops, pivots or twists. These movements put too much stress on the ACL which causes injury.

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We chose to examine ACL Injuries because of the severtity of the injuries in the world. ACL tears specifically are relatively common as there are as many cases as hundreds of thousands throughout the year.

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Women are more prone to ACL injuries due to anatomical, hormonal, and neuromuscular factors.

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If you hear a pop or click in the knee area, which is then followed by pain, discomfort, or instability, there is a chance of ACL injury.

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Swelling in the area, a few hours after the initial event of the injury could be due to an ACL injury.

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Athletes are also at risk for ACL injuries because sports that involve quick stopping and directional changes lead to high stress on the knee

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Some kind of impact to the knee can cause the knee to move too far and hyperextend the ACL. This can cause damage or strain to the ACL. Hyper extension can be caused by an impact to the knee or landing improperly after jumping.

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Initially, ACL injuries are assessed through a physical examination, as well as through an MRI. Doctors will evaluate the range of motion in the knee area, along with the extent of the tear.

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MRIs specifically use radio waves and a magnetic field to create images of the tissue, both soft and hard, of the body. They show any signs of damage to other vital tissues in the knee.

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ACL injuries are set off by copious amounts of mechanical processes that can lead to chronic inflammation. Without a functional ACL, the tibia can shift uncontrollably forward to the femur. This shift leads to knee movements feeling "wobbly" and allows the feeling of the knee "giving out" to occur.

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Anterior cruciate ligament, tibia and femur

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Anterior cruciate ligament, tibia and femur

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The ACL connects the anterior part of the tibia to the medial part of the femur.

The ACL is responsible for making sure that the tibia does not move too far forward from the femur, this is called anterior tibial translation.

The ACL also provides stability to not allow the tibia to rotate on the femur.

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Because the ACL is what stabilizes the tibia (shin), and femur (thigh), a tear in the ligament can give a feeling of instability in the leg during activity.

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One type of non-surgical treatment for ACL injuries is rehabilitative therapy. A physical therapist assists with various exercises performed under close supervision. The goal of rehabilitation is to reduce pain and swelling in order to strengthen the knee's muscles.

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With an ACL injury, difficulty in bending or straightening the knee fully will occur.

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One surgical treatment is an ACL reconstruction. During this, the surgeon will remove the damaged ligaments and replace them with a tendon, in order to connect the bone and the muscle; this is named a graft. After a successful surgery, the patient will need physical therapy in order to restore stability and function in the knee.

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The pain and swelling can cause the quadriceps muscle to shut down, this can also lead to a loss in stability and hinders muscle control.

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After an injury or tear to the ACL people can end up having long term knee instability. This can lead to always feeling like the knee is buckling or "giving way" under weight. This can make it very difficult for people to do physical exercise since their knee keeps giving out underneath them. Patients may end up needing to use a brace while exercising, going to physical therapy to build strength in the surrounding muscles or needing additional surgery to fix it. They may also need to modify their workout routines to lessen the stress on the knee or use canes/crutches.

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This is a kind of osteoarthritis that develops after some kind of traumatic injury to a joint, like an ACL injury.

A patient may feel like their knee is creaking or crunching during movement, limited mobility, stiffness and swelling in the knee.

Most of the time doctors will have a patient do conservative treatments like modifying activities, icing the area, physical therapy, medications and the use of braces or splints.

If the osteoarthritis is severe then it may require surgery to remove the inflamed tissue or loose cartilage, or to do a joint fusion/replacement of the joint.

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Despite going through surgery and rehab, those participating in high impact activities still remain the chance of injuring their ACL, either the same, or opposite leg.

This is occurs usually when those with previous ACL tears rush back into competition or do not properly complete the rehabbing process.

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Arthrofibrosis, more commonly known as scar tissue, restricts movement in the knee joint. A long term build up of excessive scar tissue will increase stiffness, increase pain, and reduce mobility.

Long term management of scar tissue includes physical therapy to help minimize buildup, improve mobility, and restore strength.

In severe cases scar tissue can be removed through surgical intervention. Overall, managing scar tissue involves patience, monitoring, and proper rehabilitation to ensure effective healing.

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After tearing the ACL, surgery is most likely needed to reconstruct the ACL. This reconstruction surgery costs about $20,000- $50,000. On a scale from 1 to 5 the likelihood of insurance fully covering this treatment is about a 1.

Choosing not to have ACL reconstruction surgery will result in chronic knee instability, knee osteoarthritis, and an increased risk of developing further knee injuries.

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One treatment available for ACL Injuries is attending physical therapy and expected cost is between $75-$350 per session.

On a scale of 1-5 the likelihood of this treatment being fully covered is about 1, most insurances will cover a portion of the cost but will not cover all of it.

The consequences of not going to physical therapy can be: chronic knee instability, increased pain, further damage to cartilage and meniscus, or potentially the early onset of osteoarthritis.

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CBT is structured therapy sessions that focus on identifying and helping emotional difficulties. This treats both the short and long term psychological effects such as depression, anxiety, and low self-esteem. CBT helps rephrase negative thoughts like "I'll never play again" into "It will take time, but I will return stronger".

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Kinesiophobia is the phobia of re-injury. Those who suffered a major injury (like an ACL tear/injury) are likely to get it. The treatment typically is a combination of physical therapy and psychological therapy (like CBT).

Physical therapy is used to expose the patient to movements that scare them and help desensitize them to the movement. Psychological therapy is then used to help with the thoughts of the fear to help the patient work through those.

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For more minor ACL injuries, one way to treat them is through conservative methods, this is RICE.

Rest - avoid putting any weight on the leg to prevent any further injury

Ice - use ice packs on the knee for about 15-20 minutes at a time and multiple times a day to help with swelling and pain

Compression - wrap the knee in some kind of bandaging to reduce swelling and avoid movements that may hurt the knee more

Elevate - keep the knee raised up to help with swelling and to promote blood flow to the area

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CBT can assist patients with identifying and changing negative thoughts and behaviors, such as thoughts of reinjury. CBT also allows patients to learn to cope with pain, which leads to better engagement with physical therapy and faster functional recovery.

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MRI scans of patients who had ACL reconstruction surgery showed that the corticospinal tract was smaller than it should have been, by about 15%. So patients who have a reconstruction have less information going from the brain to the muscles.

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Pretty much all patients with an ACL injury will go to physical therapy to help restore the normal function of the knee, get strength back in the muscles and minimize any risk of re-injury. Especially if the patient had a full tear and had to get a surgery, they have to regain the movement and strength in the knee. A physical therapist would be the one creating the patients' treatment plan and bringing them through the exercises.

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Creating a balanced diet is important to support the rehabilitation of an ACL tear.

protein: helps rebuild muscle and tissues

vitamin C: promotes collagen production for ligaments

antioxidants : reduce inflammation

Contact a dietitian or sports nutritionalist to receive guidance for a personalized meal plan.

Difficulty level: 5

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Women are 2-8 times more likely to sustain ACL injuries due to biochemical, hormonal and neuromuscular changes. Women often have wider pelvis’s, leading to a narrower intercondylar notch in the femur and a smaller ACL tissue, which can result in stress in the ligament. A few challenges include, specialized neuromuscular training, diagnostic biases that could lead to underestimation of injury severity, and treatment modification to account for same-sex anatomical structures.

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After an ACL injury, a patient will have a limited range of motion and will need to modify daily activities to reduce the risk of further injury. A physical therapist or physician would be able to figure out what the patient can and can't do

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Seniors may have a higher risk of ACL injury due to:

low joint stability

high fall risk

It may become challenging to pay for proper treatment if government funded programs are all they have to rely on.

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Adolescent athletes are at the highest risk of ACL injuries because of the high exposure of body movement at younger ages.

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It's important to incorporate dynamic movements and stretches for your hips, hamstrings, and calves into your warm-ups and cool-downs.

Performing exercises like single-leg stands and reactive balance drills can improve your body's awareness of its position in space.

Focusing on improving the connection between your brain and muscles will lead to optimizing lower extremity movement patterns.

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Magnetic Resonance Imaging (MRI) is used for the diagnoses of an ACL tear.

An MRI, of the knee, will provide an image of all the knee's ligaments which allows doctors to properly diagnose the correct severity of an ACL tear.

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A specific kind of cleat was made for soccer players that has the front spikes shaped in a circle. This is meant to help the cleats not get stuck in turf or grass so that players are less likely to injure their ACL.

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NMT programs designed to improve coordination, balance, strength, and correct risky movement patterns (like inward knee collapse) during athletic activities.

A few training programs include Strength Training, Plyometrics, Balance and Agility Training, and Flexability.

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Education and awareness campaigns to teach athletes, parents and coaches about the risk of ACL injuries. This also can educate them on proper techniques, risk factors that they may have and resources they have access to help reduce the risk of injury.