Anterior Cruciate Ligament (ACL) injuries affect more than 250,000 Americans every year. Since the knee joint is put at a higher risk during most physical activities, tears are very common between ages 15-45. This ligament is one of four major ligaments of the knee joint and connects the femur to the tibia. It provides 90% of stability in the knee joint.
70% of ACL injuries occur while playing sports (most commonly basketball, soccer, skiing, and football). 70% are from non-contact while 30% are from direct blows. They most commonly occur when decelerating, suddenly stopping/change of direction, twisting or jumping. Females are in fact 2-8x more likely to receive an ACL injury while playing sports. Both partial and complete tears are repaired surgically and are confirmed using an MRI. 50% of anterior cruciate ligament tears are also accompanied by injures to other particles in the knee (ex. meniscus, medial collateral ligament, articular cartilage).
Signs & Symptoms
- Loud, popping noise/sensation in the knee
- Severe pain
- Swelling several hours after injury occurs
- Loss of range of motion
- Inability to change direction quickly
- Instability with weight bearing
Depending on the extent of injury, the ACL is either surgically reconstructed or fully repaired. For reconstruction, the surgeon typically uses a graft to replace the ligament. It is generally taken from the patellar, hamstring, or quadriceps tendon. Most orthopedic surgeons utilize anthroscopic surgery (scope) for these injuries.
After the surgery, your knee will be swollen. Swelling is also common around the shin and ankle. The skin from your knee to your foot can turn black and blue. The leg will also typically experience some sort of stiffness. Physical therapy can take 6-12 months depending on the patient.
- Rehab is unique to each patient, however OrthoNeuro has surgeon directed protocols for rehab
- Day After Surgery: change dressing & assess incision, stretching, range of motion, leg lift, stem (usually quads), ice
- Post Surgery goals stem from full leg extension (0-2 weeks) all the way to jogging (12 weeks)
Full repair surgery is specifically used in the case of an avulsion fraction (separation of the ligament and a piece of the bone from the rest of the bone). The bone fragment connected to the ligament is then reattached to the bone.
Though uncommon, non-operative treatment is sometimes an option if the tear is small enough and they are willing to modify their activity. The patient should follow the common RICE guidelines (rest, ice, compression, and elevation). The patient should work on getting full range of motion, especially extension. Typically, within 1-3 weeks the swelling will have decreased dramatically and full range of motion will return. This is followed by an aggressive physical therapy program.
Click the button below to watch an annimation of the surgery.
Professional Athletes who have torn their ACLs and made full recoveries: Tom Brady, Derrick Rose, and Lindsey Vonn.