ACL Injuries, Surgery, and Rehabilitation
The knee is a complex joint, made up of many different structures that help produce motion and stability when you move, work, or play sports. The knee joint is made up of the femur, the tibia and the patella, and the ACL is one of four main ligaments that connect the femur to the tibia. It runs diagonally through the middle of the knee and provides rotational stability in the knee while working to prevent the tibia from sliding in front of the femur.
The ACL (anterior cruciate ligament) is one of the most commonly injured ligaments in the knee. Injuries are most often associated with non-contact events during sports like basketball, skiing, football, volleyball, and soccer. Injuries usually occur when you stop quickly, change direction suddenly, pivot, or side step. Jumping and awkward landings can also cause ACL injuries. There is a growing body of evidence of more injuries in female athletes, perhaps due to differences in body type or hormonal effects on the ligaments. Use of improper footwear and a lack of physical training for sports can also lead to injury.
Symptoms that may indicate an acute ACL injury include:
- A loud “popping” sensation in the knee that you and others can hear
- Instability when you attempt to put weight on the joint
- Pain when you try to stand
- Inability to continue playing or doing the things you normally do
- Difficulty when you try to extend or straighten the knee
- Swelling of the knee after the injury
- Loss of a range of motion
If you have an injury where you experience these symptoms, you should contact your doctor immediately. The sooner you address the injury, the more likely you will be able to rehabilitate fully and return to normal activity.
Treatment for ACL injuries varies depending on the nature of the injury. Surgery is generally recommended for those with complete tears, damage to other parts of the knee due to the ACL injury, and those who wish to continue to play high risk sports. The key determinant in choosing surgery should be your activity level, not your age. Even older patients with active lifestyles should consider surgery to prevent knee instability and related injury.
Partial tears can sometimes be rehabilitated without surgery, although this may require the patient to stop participating in high risk sports and activities. Patients with partial tears and no symptoms of instability, those with sedentary lifestyles, and children with open growth plates may avoid surgery. There is a risk that without surgical treatment, the joint will show instability over time, making it crucial to perform physical therapy and strengthening exercises.
Surgery to treat ACL injuries usually replaces the ligament with a graft. Sewing the ACL in place has proven to be largely unsuccessful, with a greater chance of failure post-surgically. Instead, a graft is used to create a new ACL that will replace the torn ligament. The two most common types of graft are autografts, in which a tendon is harvested from another part of your body to replace the ligament, and allografts, which utilize a tendon provided by a donor. You will want to discuss these options with your doctor to determine which suits you best.
Most ACL surgeries are performed arthroscopically – surgeons make a small incision and insert a camera to perform the procedure. Small tunnels are drilled into the tibia and the femur to place an ACL graft in nearly the same position as the original torn ACL. Sutures then secure the graft in place and are reinforced with screws, posts, staples, or other devices to keep it in place and under tension. These devices are usually left in place and not removed.
The speed and effectiveness of rehabilitation often depends largely on the patient. Exercises done both pre-surgically and post-operatively will help to restore strength and range of motion. Patients who do these exercises faithfully will recover more quickly and be more likely to be able to return to the activities they performed before surgery. You should discuss any exercise program with your doctor or physical therapist.
You can work on avoiding ACL injuries by strengthening your body before an injury can occur. Strengthening your core, hips, and quadriceps can help to reduce stress on your knees and improve your balance so that your ACL is not stressed or injured during activity. Retraining your jumping and landing mechanics has been shown to be particularly beneficial in preventing ACL injury. An emphasis on lower extremity proprioceptive training with specific coordination drills has proven effective at reducing ACL injury risks. Our Sports Performance program can help you improve your movement mechanics and avoid the type of movement that may lead to injury. If you have already experienced an ACL injury, we can help you return to normal activity sooner. Contact our office at (434) 817-0980 to schedule an appointment and learn more!