Author: Dr. Vikram Chauhan

Abstract

Running and regular leg exercises are very much necessary for maintaining the good health of the knee joint, but over-performing these exercises for a longer time or on a repeated basis, or some other underlying trauma leads to the tear in the anterior cruciate ligament which is one of the most common knee injuries. The athletes who play sports like basketball, soccer, football, etc. are at higher risk of ACL tears. In this article we are going to discuss about the ACL tear along with its causes, clinical features, diagnosis, complications and the best Ayurvedic line of management of this deformity.

Introduction

Anterior cruciate ligament is one of the four key ligaments of the knee which holds the bones of the knee (thigh bone-femur and shinbone- tibia) and has a prime function in stabilizing the knee joint. The ACL tear occurs mainly with the pop sound following the severe pain in the knee. After this, inflammation of the knee starts and because of the swelling and ligament tear, it becomes very difficult for the person to straighten the knee.

Sign and Symptoms

The clinical features of anterior cruciate ligament tears may depend upon the extent of damage to the ligament, manifestations may differ from person to person. Few common features of the tear are the hearing of pop sound on breaking of the ligament, inflammation of the affected knee, and there is generally straightening of the knee because of this swelling, which results in the decrease in the range of motion of the knee and it becomes limited. Due to the intense pain, the knee is unable to bear its own body weight.

Stages of ACL Tear

There are three main stages of ACL tear depending upon its severity and manifestations. These are-

• Stage-1: The knee is stable with mild or absence of tears but it is marked by stretching in the ligament fibers, which results in mild swelling and tenderness.
• Stage-2: When the ligament fibers suffer from a greater tear which is  near to complete tear with hemorrhage, and greater swelling, pain and little tenderness, few loss in functioning of the knee. This stage may be presented with an unstable affected knee.
• Stage-3: This stage is presented with the complete ruptured fibers of the ligament into two parts. This condition is marked by complete loss of stability, absence of knee movements but the pain and swelling may vary in the different patients.

Causes

The causes behind the anterior cruciate ligament tear can be due to the sudden trauma or jerk to the ligament that may be resulted due to instant reducing speed while running, suddenly stopping, incorrect landing on feet from a jump, rapid move around, direct hit from a hard object such as football cricket ball, hockey ball or any other thing that may cause tear in the ACL.

Moreover the various risk factors of ACL Tear include the regular participation in certain sports or athletics such as football, long or high jumping, gymnastics, cricket etc, and females are more prone for this deformity due to less physical, hormonal, muscular strength. Other risk factors include wearing unfit footwears or using unforgettable sports equipment.

Ayurvedic View

In Ayurveda, this disease can be considered as Abhighatjanya janusandhigata vata. Here, the abhighatjanya means due to traumatic origin or injuries, janu means knee. Acharya Charka had given the features of sandhigata vata as

(Reference- Charka Samhita Chikitsa Sthana 28/37)

The sandhigata vata is characterised by heaviness in the joints, shotha-inflammation in the joints i.e. here affected knee joint, prasaranakunchnayo- pain during the extension and flexion of the affected joint, crepitation during walking or movements of joints, deformity in the joint.

Diagnosis

The diagnosis of this tear of the knee is based on clinical symptoms and physical examinations of the joint for inflammation and tenderness. Further supporting evidence can be elicited by doing radiological examinations such as X-ray to rule out any boy injury or osteoporotic changes. For making the final diagnosis and to evaluate the extent of tear MRI Scan is done.

Complications

ACL tears, if neglected, can directly affect the knee and can lead difficulty in the movement such as jumping, walking, etc. Few complications which may arise due to anterior cruciate ligament tear include the obstruction in the motion of the affected leg, limiting its range. The affected person is at high risk for damaging the joint cartilages, developing osteoporosis etc. The limping effects may be seen in the walking of the affected person.

Does it Need Surgery?

The requirement of the surgery depends upon the extent of the tear or the stage of the ACL tear. Uncomplicated stage-1, stage-2 and stage-3 tears in the early stage can be managed by the conservative and medicinal management. But the complicated stage-3, in which the ACL is completely broken into two pieces, then anterior cruciate ligament requires reconstructive surgery. Further, there are many post-surgical consequences, such as infections, knee stiffness, patellar fracture, tunnel malposition etc.

Treatment

Ayurveda being the oldest Science of medicine and healing has the ability to successfully manage this tear without any surgical interventions, that too neither affecting the condition adversely nor increasing the risk of complications. Ayurvedic herbal formulations have the strength to even treat the stage-2 and uncomplicated stage-3 level of ACL tear.

Planet ayurveda is the leading brand of herbal manufacturers that formulates the herbal or herbomineral preparations based on strict adherence with the ayurvedic texts or principles. These products that are made here are being obtained from 100% natural sources. These formulations are being prepared under the guidance of our expert team ayurvedic doctors with ancient time tested formulas and methodologies.

Herbal remedies for the treatment of Anterior Cruciate Ligament Tear as suggested by Planet Ayurveda’s experts are as-

1. Boswellia Curcumin
2. Coral Calcium Complex
3. Joint Aid Plus Capsule
4. Yograj Guggul
5. Orthovita Oil

Product Description

1. Boswellia Curcumin

These capsules are the effective herbal formulation made by Planet Ayurveda with the best active ingredients of two herbs i.e. Shallaki (Boswellia serrata) and Haridra (Curcuma longa). These both herbs are having analgesic and anti-inflammatory properties and thus this formulation aids in reducing the pain, swelling and stiffness in the affected joint associated with ACL tear and leading to the enhancement of mobility and flexibility.

Dosage– 2 capsules twice daily, with water after meals.

2. Coral Calcium Complex

This poly herbomineral preparation is the mixture of detoxified clax of minerals such as Akik Pishti, Praval pishti,Mukta Pishti, Jawar Mohra Pishti, along with Kamdudha Ras (an Ayurvedic mineral based preparation) and Guduchi (Tinospora cordifolia). These all minerals are rich sources of calcium, thus helping in improving and maintaining the calcium levels inside the body, which as a result help in the strengthening of muscles, bones and nerves. Also the guduchi promotes the immunity that reduces the risk for various other associated infections with the condition.

Dosage– 1 capsule twice daily, after meals with water.

3. Joint Aid Plus Capsule

These capsules have the exact same function as the name of this product suggests. This Planet Ayurveda’s polyherbal formulation helps in relieving joints related disorders. The use of most effective herbs having analgesic & anti-inflammatory herbs are used for the manufacturing of these capsules that helps in relieving the pain and swelling associated with the anterior cruciate ligament tear. The vata shamak properties of its ingredients helps in pacifying the excessive vitiation of vata. The ingredients of these capsules are Guggul (Commiphora mukul), Nirgundi (Vitex negundo), Ashwagandha (Withania somnifera) Shallaki (Boswellia serrata), and Sunthi (Zingiber officinale). These capsules not only reduce the symptoms but also strengthen the ligaments and muscles of the knee and whole body to prevent further tears.

Dosage– 1 capsule twice daily, after meals with water.

4. Yograj Guggul

Yograj Guggul are the classical Ayurvedic tablet formulations used since ages for the various joint’s disorders. This tablet formulation helps in reducing the numbness, stiffness, and tingling sensations in the joints and muscles. These tablets also aid in reducing the joint pain, inflammation and damages. The contents of this tablet include Guggul along with Pippali (Piper longum), Amalaki (Emblica officinalis), Jeeraka (Cuminum cyminum), Haritaki (Terminalia chebula), Shunthi like herbs for providing multiple health benefits in the joint affected with ACL tear, and strengthening the associated structures to prevent complications.

Dosage– 2 tablets twice daily, with water after meals.

5. Orthovita Oil

This is the oil based herbal preparation made by Planet Ayurveda for the external local application on the affected part. The ingredients of this oil preparation include herbs such as Prasarini oil (Paederia foetida), Camphor, Gandhapura oil (Gaultheria) etc. that reduces the stiffness of the joint. It also helps in maintaining the good health of bones and muscles and reducing joint pain & inflammation associated with various joint disorders. It is the best local application for ACL Tear.

Method of application– Take 5-10 mL of oil in a bowl and heat it to make it lukewarm, massage the oil gently over the affected area, then wrap the joint with a cloth for 3-4 hours.

Conclusion

There is no exact treatment method of this deformity with modern medicine, they just rely on symptomatic treatment and finally depend on the reconstructive surgery of the ligament, as discussed earlier there are numerous post -operative complications. So, the best method of healing this deformity is with Ayurvedic medicines and procedures. Ayurveda uses herbal medications which are relatively very much effective and have lesser side effects for the management of ACL tears.