The ACL Deficient Knee

Pain & Injury on January 11th, 2011 No Comments

kneeThe Anterior Cruciate Ligament (ACL) of knee is a commonly injured structure and is not as strong as the Posterior Cruciate Ligament (PCL). This ligament attaches the femur to the tibia at the midline of the joint from the intercondylar area of the tibia to the lateral condyle of the femur. The important role that this ligament plays is to restrict excessive movement of the tibia in an anterior movement or translation, as well as posterior movement of the femur and medial rotation of the tibia.
My clinical and personal observation is that the Gastrocnemius and Popliteus are recruited to compensate and stabilize against the anterior shear forces of the (ACL) deficient knee. This translation without ligamentous restriction requires these muscles to play a different role, a paradox between prime movers to stabilizers of the knee joint. Palpation of these muscles would therefore lead the practitioner to probably identify these muscles as hypertonic and fibrotic. The typical approach would then be to try and loosen up these dense tight muscles. Caution should be taken, too much reduction in the muscles tonicity may result in additional translation of the tibia, increasing friction within the joint and  leading to greater inflammation. As we all known inflammation leads to swelling causing decreased range of motion at the largest synovial joint in the body and once again a loss of communication between the joint and surrounding musculature. Would love to hear other practitioners thoughts and observation of this common problem.

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