The anterior cruciate ligament (ACL) is a very important ligament to knee function and is one of the most common structures injured in the knee. While athletes participating in high demand sports such as football, basketball, and soccer are more likely to tear the ACL, these injuries can occur in anyone. This article will give some basic information on ACL injuries and treatment options available. At Raleigh Orthopaedic walk in Clinic our team of sports medicine surgeons see ACL injuries every day and can help you make the best decision for treatment going forward.
What is the anterior cruciate ligament?
The anterior cruciate ligament (ACL) is an important stabilizing structure of the knee. The basic role of the ACL is to keep the shin bone (tibia) from moving too far forward on your thigh bone (femur). It also has an important role in preventing the knee from turning to far inward during twisting and pivoting motions. The ACL lives in the knee joint and its blood supply is normally injured when it is torn. The combination of these factors keeps the ACL from being able to heal or regrow itself.
How does an ACL tear happen?
The ACL is injured when too much stress is placed across the ligament causing it to tear. There are multiple ways this can happen including stopping suddenly, landing from a jump incorrectly, changing direction rapidly, or direct contact or collision like with soccer and football tackles. Studies have shown that female athletes are more like to injure the ACL than males in certain sports. There are multiple proposed reasons for this including differences in neuromuscular control, differences in pelvic and leg alignment, and the effects of hormones on the body.
What are symptoms of an ACL tear?
Common symptoms of an ACL tear include hearing a popping sound or feeling of a popping sensation in the knee. This is usually followed by the knee giving out from under you. Patients who suffer ACL injuries typically experience significant knee swelling which can occur within hours. Additionally, pain behind the knee and continued feelings of knee instability are common. If you have any of these symptoms it is important to be seen by a physician, as continuing to “play through” or use a knee after an ACL tear can cause additional permanent damage.
What will happen when I see a sports medicine doctor?
It is recommended that anytime a serious knee injury occurs that the injured person should be seen by a doctor as soon as possible, ideally a sports medicine orthopaedic specialist. Your physician will then do a physical examination and may obtain x-rays. Normally the physical examination will confirm an ACL tear. Usually, an MRI will be ordered to verify the tear, and to see if there has been any other damage to the knee. A brace and/or crutches may be provided if the doctor is concerned about falling or further damage to any of the knee structures.
What are the treatment options for an ACL tear?
Treatment for an ACL tear will depend upon the patient’s individual needs. The ACL does not heal itself due to its poor blood supply, and so the decision becomes whether or not to have surgery to place a new ACL in the knee. This procedure is called an “ACL reconstruction”.
Non-surgical treatment for ACL injuries is usually reserved for less active, older individuals, who desire a more sedentary lifestyle. Physical therapy can be used to regain most of the knee function and ice and medications can usually get the swelling to stop. Patients can often return to non-pivoting, linear activities such as jogging, cycling, and walking. If there is a desire to do activities that involve pivoting, cutting, jumping, or contact, non-surgical treatment is not recommended.
Surgical treatment consists of performing an arthroscopic ACL reconstruction. This is a procedure where small instruments are used to remove the torn ACL and replace it. This procedure is done arthroscopically, to minimalize soft-tissue damage and improve recovery time. There are two major options for reconstructing the ACL, one option is to use a tendon from your own body (autograft). The other option is to use a tendon from a donor (allograft). Normally for younger athletes autograft ACL reconstructions are performed and for older patients allograft tissue is used. Your surgeon will talk to you about what treatment option is best for you.
What should I expect after surgery?
The surgery is normally done at an outpatient surgical facility such as Raleigh Orthopaedic Surgery Center. The surgery typically takes 1-2 hours and you will be able to go home the same day. Often a brace and crutches are used for the first several weeks. Physical therapy is usually started right away and is a very important part of the recovery process. Physical therapy will work on getting full range of motion and strength back in the knee. Your surgeon will see you at regular intervals throughout the recovery process and will work with your physical therapist to determine the ideal time to allow you to progress through the various stages of recovery. Most patients are able to get back performing all the sports and activities they did prior to the injury once fully recovered. For more information on ACL tears or to schedule an appointment, give us a call at Raleigh Orthopaedic today.
About the Author
This articles was written by Joseph Barker, M.D. Dr. Barker is a fellowship trained orthopaedic surgeon in Sports Medicine and is a team physician for the Carolina Hurricanes, NC State University, and Broughton High School. His areas of expertise include sports medicine, shoulder, hip and knee arthroscopy, and cartilage restoration. Read more about Dr. Joseph Barker.