Many athletes suffer a tear in their knee’s Anterior Cruciate Ligament (ACL). Unlike many orthopedic injuries, the ACL cannot be stitched back together. McLeod Orthopedic Specialist Patrick Denton, MD, describes the treatments – nonsurgical and surgical:
Here are Dr. Denton’s major points:
The anterior cruciate ligament (ACL) is the primary stabilizer of the knee. The knee consists of four main ligaments — two ligaments that are outside the knee and two on the inside the knee, one of which is the ACL. The ACL stabilizes the lower leg bone (tibia) from shifting. Patients with an ACL rupture now have an unstable knee.
The most common causes of ACL tears are associated with a pivoting, twisting or rapid acceleration/deceleration of the knee. Some 70 percent of ACL tears occur with a non-contact injury. It’s not always that the football player or soccer player that gets the hit. But sometimes, when that football player or soccer player tries to quickly cut and turn a different direction, the ACL can tear.
The most common symptom of an ACL tear when it happens is the complaint of a “pop.” The patient experiences immediate pain and swelling in the knee. Most of the time, the patient is unable to continue with the endeavor or sport they were playing. The knee is quite swollen.
After a week or two, the swelling tends to subside. The patient can put weight on the knee and walk. However, they’ll complain that if they try to twist or cut, the knee gives way. Every time it gives way, more damage results.
The treatment options for ACL injuries are operative and non-operative. In the low-demand patient, who does not have frequent instability, we do some physical therapy and bracing. In a patient, who wants to continue an active lifestyle and has instability of the knee, we usually recommend ACL reconstruction.
Unfortunately, once the ACL is torn, it won’t grow or heal itself. We have to reconstruct it. The surgery itself is an outpatient surgery and is often performed arthroscopically through small incisions.
With ACL reconstruction, we have to replace the torn ACL with a graft. There are three options that we use for ACL grafts. One is a patellar tendon graft. We have to take part of the tendon that attaches the kneecap to the tibia bone and use that as a new ACL. We can take hamstrings. We take two of the three hamstrings that are on the side of the knee and rebuild a new ACL. The other option is that we can use what we call an allograft, which is a donor tissue graft, and reconstruct the ACL. After the surgery, the patient is able to put full weight bearing on the knee. Physical Therapy is started immediately. Expected recovery time is about six months with therapy. It takes that long for the graft to incorporate and be back to full strength.
The expected results after ACL reconstruction are that more than 90 percent of the patients will be able to return to full activity without restrictions.