Treatment of Anterior Cruciate Ligament (ACL) Injuries

Yiyang Geng

Rehabilitation Physical Therapy, Capital Medical University, Beijing, China

Keywords: Anterior Cruciate Ligament (ACL) Rehabilitation, Digital Physical Therapy, Surgical and Non-Surgical

Treatment.

Abstract: Anterior cruciate ligament (ACL) injuries are prevalent among athletes, necessitating abound of effective

rehabilitation strategies for optimal recovery and return to play. This paper explains ACL anatomy,

epidemiology, diagnostic methods, treatment options, and emerging rehabilitation technologies. Diagnosis

relies on physical examinations and imaging techniques such as MRI, X-rays, and CT scans. Treatment

options include surgical reconstruction for severe cases and non-surgical management for less active

individuals. Innovative rehabilitation methods such as telehealth, wearable technology, enhance patient

engagement and adherence to recovery plans. Psychological factors such as fear of re-injury also impact

rehabilitation outcomes. Future strategies should integrate digital tools for personalized rehab.

1 INTRODUCTION

Anterior cruciate ligament is one of the most

important knee-stabilizing ligaments, which helps to

maintain dynamic-static stability as well as knee joint

coordination (Al-Khalifa et al, 2014). The ubiquity of

ACL injuries within athletic contexts necessitates an

advanced understanding of rehabilitation processes to

ensure efficacious treatment plans that guarantee

return-to-play capabilities. As sports continue to

evolve in competitiveness and intensity, the

prevalence of ACL injuries has obligated the sports

medicine field to pursue continuous improvements in

rehabilitation strategies. This sentiment is echoed by

Esfahiani and Thompson, who highlight the utility of

adopting innovative rehabilitation protocols

(Esfahlani & Thomposon, 2021). Physical therapy

thus emerges as a pivotal strategy within this domain,

supported by empirical evidence that underscore its

benefits in the comprehensive recovery landscape.

Empiric inquiry reflects a sex deviation in the

happening of ACL injuries, with females have a

higher non-contact ACL injuries proportion and

exhibited higher injury-related patterns (Chia et

al,2022; Brunetti et al, 2024). This phenomenon

proposes underlying sex-associated differences in

biomechanical or anatomic factors that could work

hurt susceptibly. Particularly, adolescents and

immature adults have a higher incidence of ACL

injuries (Chia et al,2022). During growth spurts,

adolescents experience rapid changes in height,

weight, and bone length, which can affect

coordination and balance, increasing the risk of ACL

injuries (Prince, Laor & Bean, 2005). Individuals who

sustained non-contact ACL injuries had markedly

increased their participation in activities such as

running, jumping, cutting, pivoting, and decelerating

in the six months leading up to the injury (Grodman,

Beaulieu & Ashton-Miler, 2023). There’s no

sufficient research of how these factors interact to

impact ACL hurt rates, foregrounding an important

spread in our comprehensive apprehension of ACL

injuries mechanism and reclamation needs.

2 EPIDEMIOLOGICAL

INVESTIGATION

ACL is a significant ligament, and its injuries are

unusually mutual among athletes, which stresses the

grandness of effectual reclamation. Understanding

the anatomic construction of the ACL, together with

preponderance information and expert penetrations,

and the function of forcible therapy in the reclamation

of ACL injuries is of cardinal grandness.

The prior cruciate ligament is a cardinal

construction in the knee articulation, its chief intent

being to brace the knee by associating the thighbone

to the tibia (Duthon et al, 2006). The ACL consists of

two parts: the anteromedial bundle (AMB) and the

posterolateral bundle (PLB). These bundles do not

312

Geng, Y.

Treatment of Anterior Cruciate Ligament (ACL) Injuries.

DOI: 10.5220/0014487600004933

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 1st International Conference on Biomedical Engineering and Food Science (BEFS 2025), pages 312-318

ISBN: 978-989-758-789-4

maintain a constant length, as the AMB elongates

while the PLB shortens when the knee bends (Duthon

et al, 2006). The apprehension of the anatomic

features of this ligament is cardinal to understanding

the deductions of the injuries and the appropriate

reclamation. This functionality is indispensable

during motions such as disconnected cuts, turns, and

changes in way, which often happen in sports.

Moreover, the complex structure of the ACL makes it

hard to plan an effectual reclamation scheme. The

staleness of the genu depends on the ACL, and it is

significant for the knee’s mobility and overall

wellness (Evans & Mabrouk, 2023).

The dynamical function of the ACL in

guaranteeing knee staleness foregrounds the

grandness of tailoring forcible therapy interventions.

Therefore, it is significant to realize and speak the

ACL’s complex construction in ordering to evolve

effectual and individualized reclamation programs.

Such a program is vital for guaranteeing full

functionality and reducing the hazard of re-hurt.

3 DIAGNOSIS

ACL is considered the most commonly injured

ligament of the knee. Physical examinations, such as

the anterior drawer, Lachman, and pivot-shift tests,

can help most experienced clinicians accurately

diagnose ACL injury (Tanaka et al, 2022). However,

in the case of acute injury and a swollen knee, these

tests may be challenging to perform due to the knee

pain. Consequently, Magnetic Resonance Imaging

(MRI) plays a vital role in supporting the clinical

suspicion (AI Mohammad & Gharaibeh, 2024).

3.1 MRI in ACL Diagnosis

In some cases of acute complete ACL tear, direct

signs including failure to visualize the ACL fibers on

images taken in ant plane or discontinuity of the

ligament. Moreover, the ACL have the presence of an

abnormal morphology characterized by an irregular

or wavy contour of the ACL. As such, ACL fibers are

not parallel to the intercondylar notch roof or running

more parallel to the tibial plateau (Brandser, Riley,

Berbaum, EI-Khoury & Bennett, 1996; Tung, Davis,

Wiggins & Fadale, 1993).

Chronic ACL tears exhibit more variable

characteristics on MRI, which can sometimes make

them harder to identify. This is likely due to the

reduction of certain indicators that were prominent

during the acute phase, such as edema and thickening

of ACL fibers, by the time of imaging. In cases of a

chronic complete ACL tear, the ligament may be

absent, showing an “empty notch sign” where fluid

has replaced the ACL (Chen, Shih, Tu, Chen & Shau,

2002). Occasionally, a chronic tear is substituted by

fibrous scar tissue that mimics a normal ligament,

appearing as a hypointense signal spanning the

expected origin and insertion of the ACL. In some

instances, the proximal fibers of the torn ACL may

attach to the Posterior Cruciate Ligament (PCL),

resulting in abnormal angulation (Kam, Chee & Phe,

2010; Vahey, Broome, Kayes & Shelbourne, 1991).

3.2 X-Ray and CT Applications

In the diagnosing of prior cruciate ligament injuries,

the function of computed imaging and X-rays is of

cardinal grandness despite sure restrictions of each.

X-rays are typically the first imaging studies

performed when an ACL injury is suspected.

Although X-rays cannot visualize the ACL itself, they

are essential for identifying associated bone injuries

(Gruenewald et al, 2024). Computed Tomography

(CT) scans proffer exceptionally elaborate images of

bone structures compared to standard X-rays and are

particularly useful in characterizing avulsion

fractures and complex fractures: In cases where

multiple fractures are present, CT provides a

comprehensive view, aiding in surgical planning (Ng

et al, 2011).

4 TREATMENT

The intervention of ACL injuries involves both

operative and non-operative procedures. Operative

intercession is often recommended for consummate

ruptures of the ACL, which stabilizes the knee

articulation and restores knee functions. Non-

operative intervention is mostly preferred for those

normally involves forcible therapy to reduce hurting,

puffiness and redness, and can better mobility and

posture in the knee. Surgical reconstruction is the

gold standard treatment for younger and more active

patients, while nonoperative treatment is mainly

reserved for older and less active patients (Krause et

al, 2018).

Integrated technical guarantees a more

individualized reclamation tract, enabling

practitioners to accommodate the reclamation

exercises established on existent-clip information

collected from the patient’s execution and

advancement (Yusof & Lin, 2022). For illustration,

telehealth services and wearable engineering are

progressively used to heighten reclamation results by

Treatment of Anterior Cruciate Ligament (ACL) Injuries

313

enabling distant monitoring and ongoing

reinforcement, which stay polar to both patient

conformity and advancement (Vaghasiya, Mayorga-

Martinez & Pumera, 2023; Bandawar et al, 2024).

There is outstanding potentiality for optimizing

patient results and attachment to ACL reclamation

protocols.

4.1 Surgical Treatments

Operative intervention for ACL injuries stays a

cardinal focusing in both clinical pattern and

scientific inquiry (Brophy & Lowry, 2023). This

character of intercession is recommended for patients

with temperate to terrible symptoms or those involved

in demanding acrobatic activities, where knee

staleness is of overring grandness. These procedures

mostly dwell in the reconstruction of the ligament

with grafts taken from the patient's own tissue or from

a giver (Petit et al, 2023). There is a continuing

demand to analyze these schemes in a circumstance

that reflects the diverse patient universe they are

intended to function.

The increasing usage of automatic and minimally

incursive or techniques presents extra questions

referring patient refuge and convalescences results.

So even if operative interventions like ACL

reconstruction show the hypothesis of effectual

convalescence, the practical must cautiously choose

the patients and consider the hazards and the benefits.

A retrospective survey of the usage of automatic aid

in operative procedures bespeaks that, although it

may increase preciseness, it may also take to

anticipated complications, such as malfunctioning of

the tool (Alemzadeh, Raman, Leveson, Kalbarczyk &

lyer, 2016). Below is an overview of recommended

exercises during various stages of ACL rehabilitation.

In the Immediate Post-Surgery Phase (Weeks 0–

2), the primary focus is on reducing swelling and

inflammation while restoring knee extension (Jenkins

et al, 2022). Recommended exercises include ankle

pumps, quadriceps sets, and heel slides (Jenkins et al,

2022).

During the Early Rehabilitation Phase (Weeks 2–

6), the goal is to increase the range of motion and

begin weight-bearing activities while enhancing

muscle strength (Pamboris et al, 2024). Suggested

exercises include closed kinetic chain exercises,

stationary cycling, and balance training (Pamboris et

al, 2024).

The Intermediate Rehabilitation Phase (Weeks 6–

12) aims to restore full range of motion, increase

muscle strength and endurance, and improve

neuromuscular control (Pamboris et al, 2024).

Recommended exercises include open kinetic chain

exercises and core stabilization exercises (Saki et al,

2023).

Finally, the Advanced Rehabilitation Phase

(Months 3–6) focuses on achieving near-normal

muscle strength, enhancing agility and functional

movements, and preparing for a return to sports or

daily activities (Eitzen et al, 2010). Exercises such as

plyometric drills, sport-specific drills, and continued

strength training are recommended for this stage

(Eitzen et al, 2010).

4.2 Non-Operative Management

Non-surgical intervention of ACL injuries is

indispensable for those who desire to debar operative

procedures. The peak of intervention is chiefly

determined by the strength of the patient's activities

and the badness of the hurt. Non-surgical intervention

chiefly includes a physiotherapy plan, particular

exercises and veritable checks planned to heighten

knee staleness and usable execution. Post operative

exercises are also recommended for patients who are

not willing to receive an invasive therapy.

4.3 Innovative Treatment Methods

The evolution of effectual reclamation protocols for

ACL injuries has become indispensable in bettering

convalescence results for patients. The modishness

progress has mostly concentrated on uniting

engineering and forcible therapy to increase

attachment to reclamation plans (Vaghsdiya et al,

2023; Bandawar et al, 2024). Notably, this has

included the usage of smartphone applications and

wearable devices for distant monitoring. This attack

has two benefits. It promotes attachment to the

therapy and lets therapists to utilize existent-clip

patient information to orient single reclamation

programs, thereby bettering the overall effectivity of

intervention.

5 DIGITAL PHYSICAL

THERAPY REHABILITATION

For illustration, telemedicine has been shown to

better communicating between patients and therapists

importantly, thereby facilitating reclamation

procedures (Lu et al, 2020). However, the

variableness of these digital tools means that

comprehensive and individualized appraisals are

indispensable.

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Telemedicne has emerged as a polar component

in the schemes of digital reclamation. It not only

betters patient gratification but reduces costs and

increase method to attention in distant areas (Alanazi

& AI Hader, 2022). The eminent degree of patient

assurance and motive for the forcible therapy

exercises facilitated uninterrupted advancement

monitoring.

These inventions jointly back a circumstance-

specific reclamation process, guaranteeing that

therapy is both approachable and adaptable. Wearable

engineering further supports patients through

immediate feedback, monitoring forcible action and

informing therapists about patient’s performance.

5.1 Telehealth and Remote Monitoring

The debut of telehealth and distant monitoring

systems has outstanding potentiality for bettering

forcible therapy for ACL injuries. These advanced

services let patients to have reclamation from home,

which is particularly advantageous to people who are

not willing to receive treatment by visiting hospital

frequently. The devices will supply greater

flexibleness and handiness for patients, letting them

to retrieve in more commodious and price-effectual

ways (Lee, Davenport & Randall, 2018).

Research comparing telerehabilitation to

traditional rehabilitation following total knee

arthroplasty revealed similar clinical and patient-

reported outcomes between the two methods,

suggesting that while telerehabilitation is effective, it

is not necessarily superior to conventional approaches

(LeBrun et al, 2022).

5.2 App-Based Programs

It is well established that the evolution of app-

established programs in forcible therapy can help the

reclamation of ACL injuries. For illustration,

applications such as TRAK supply patients with a

tailored exercising plan with videos of tight

proficiency to steer then through the reclamation

exercises (Park et al, 2023). The development of app-

established plans can be seen as an important measure

forwards in the direction of ACL injuries (Park et al,

2023). However, it is significant to observe that the

effectivity of these applications may change

depending on the degree of proficient literacy and

single motive, which may decrease their possible

benefits (Park et al, 2023).

Many patients describe convinced experiences

with app-established acquisition when accompanied

by professional counsel. However, the usage of apps

raises questions about the proportion between human

interaction and technical aid in the curative

procedure, peculiarly for patients who may confront

troubles with digital literacy (Gell, Smith &

Wingood, 2024). As distant forcible therapy additions

land in reclamation practices, comparisons between

engineering-helped and face-to-face therapies

bespeak a noteworthy displacement in the landscape

of post-ACL reclamation (Gardner, Podbielski &

Dunphy, 2023).

5.3 Wearable Technology

Wearable devices are progressively acknowledge as

playing an important function in monitoring and

supporting reclamation after ACL injuries. The

effectivity of these devices often changes, indicating

to a possible mismatch between their proficient

capabilities and the specific reclamation needs of

patients. The answer lies in the integrating of these

fresh technologies in the circumstance of reclamation,

which necessitates exhaustive inquiry into the best

ways to accomplish a better apprehension of the

diverse demands of patient groups.

6 CONCLUSION

Psychological obstacles, such as fearfulness of re-hurt

and engagement, often perplex the reclamation

procedure. It is the undertaking of next schemes to

take these obstacles, by integrating digital tools that

increase patient motive and bond. Bond to

reclamation protocols is significant, since it can

importantly impact retentive-condition

convalescence and serviceability.

The outgrowth of telehealth platforms has shown

hope in increasing handiness and patient liberty,

which could finally better convalescence results.

Moreover, the usage of wearable engineering offers

immediate feedback and monitoring that can let

reclamation protocols to be adjusted in time, which

could assist to make the convalescence procedure

more antiphonal and effectual.

Important barriers to effectual reclamation are

psychological aspects such as emphasis and

anxiousness, which can impede advancement.

Accordingly, fostering curative environs that sees

psychological preparedness is necessary for holistic

reclamation.

Treatment of Anterior Cruciate Ligament (ACL) Injuries

315

6.1 Rehabilitation Outcomes

An integrated exercising plan markedly betters knee

structures and stabilizes muscles, which are

significant aspects in preventing re-hurt. This, in

bend, can trim anxiousness about the recluse

procedure itself and heighten attachment and results.

Conversely, psychological barriers, such as

fearfulness of reinjury, can trim these benefits. These

nuances specify the effectivity of reclamation in the

convalescence sense of the ACL.

6.2 Limitations and Barriers

The grandness of psychological preparedness for

successful reclamation results has been confirmed in

several surveys that bespeak that those who endure

from anxiousness or deficiency of assurance after the

hurt are less deposited to cling to reclamation

recommendations. The reclamation of an ACL hurt

embraces several restrictions and barriers that

importantly impede the convalescence. A prevailing

challenge is the psychological facet; fearfulness of re-

hurt is wide admitted as a major hinderance to the

reclamation. This ground foregrounds the

indispensable function of psychological

reinforcement in the circumstance of forcible therapy.

It uncovers a spread in clinical pattern where this

reinforcement is often undervalued.

Inquiry shows that these factors can importantly

detain convulsions and compromise joint structures.

Muscles wasting resulting from immobilizing may

also take a diminution in action, which further

complicates convalescence. Psychological barriers

such as mind, stiffness, scarring and other forcible

factors also led to the reclamation troubles. To stress

and speak these obstacles must be the nucleus of the

reclamation plan.

While improvements in intervention protocols

have been documented, the integrating of

comprehensive forcible therapy that addresses

psychological challenges stays under-researched.

Moreover, these restrictions foreground the demand

for a comprehensive reclamation plan that unites both

forcible and the psychological aspects. A

strengthened curative confederation between the

doctor and the patient is important to the successful

pilotage of these challenges and to the skill of better

consequences.

6.3 Future Strategies

Integrating psychological monitoring alongside

forcible appraisal could enrich reclamation models.

Leveraging digital tools for everyday monitoring

could also give a price-effectual manner to

comprehensively measure patient advancement. In

improver to supporting the forcible convalescence of

patients, it is also a psychological convalescence and

thus increases the overall effectivity of reclamation.

Given the quickly changing landscape of ACL

reclamation, developing advanced approaches is

important to bettering convalescence results. These

schemes can avoid the restrictions of traditional

approaches, facilitating ongoing reinforcement and

supplying contiguous feedback to patients, which

finally leads to a more occupied reclamation

procedure.

Indeed, the integrating of AI into reclamation

programs offers an outstanding trade of potentiality

for bettering ACL reclamation. In late surveys have

shown that the integrating of AI in reclamation

programs has the potentiality to accommodate

convalescence schemes to the single needs of each

jock, thus enhancing their execution and reducing the

hazard of re-hurt. However, a vital psychoanalysis of

these applications uncovers some challenges in

footings of dependability of information and

methodological cogency. This is why a balanced

attack uniting AI with human supervising is necessary

for the comprehensive answer of reclamation. For

next schemes, forcible reclamation of the ACL

injuries must be united with genial wellness

reinforcement to advance comprehensive reclamation

and to heighten the effectivity of reclamation.

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