ACL Injuries

ACL injuries are one of the most common knee injuries, especially for athletes who dominate high-demand sports, including soccer, tennis, football, or snowboarding. If you believe you have an ACL injury, you may require ACL reconstruction surgery to regain full function of your knee before returning to physical activities. However, there are non-surgical treatments for elderly or non-active individuals that may alleviate their painful symptoms.

Knee anatomy

The bones that meet and form your knee, including your kneecap (patella), thighbone (femur), and shinbone (tibia), are all connected by four primary ligaments. These ligaments are like strong ropes that hold everything together. The anterior cruciate ligament, or ACL, stretches diagonally in the middle of the knee, which allows rotational stability and prevents the tibia from sliding in front of the femur.

When the ACL is injured, orthopaedic surgeons classify it as a “sprain” and grade it on a severity scale to determine the best treatment course. Most cases of ACL injuries result in complete or near complete tears, and partial tears are generally rare.

ACL injury symptoms

If you have an ACL injury, you may experience one or several of the following symptoms:

• “Popping” noise of the knee
• Weakness or looseness of the knee
• Knee giving out from under you
• Pain and swelling
• Reduced full range of motion
• Tenderness along the joint line

Treatment for ACL injuries

Depending on the severity of your ACL injury and your age and lifestyle, treatment options will vary. If you are an athlete that is desperate to return to training, you will most likely require surgery to recover safely and efficiently in the shortest time possible.

Nonsurgical treatment

Completely torn ACLs generally are unable to heal without surgery. However, non-surgical treatments may be helpful for individuals with low activity levels or elderly patients. Non-surgical options may include bracing to stabilize the knee and physical therapy. The rehabilitation program will focus on restoring knee strength.

It is necessary for the muscles around the knee, specifically the hamstring muscles, to be strengthened after an ACL injury. Then the reinforced muscles can take some support off the injured ACL’s duties of stabilizing the knee. In any case of non-surgical ACL recoveries, an ACL brace will be administered to decrease the chance of knee instability. Patients who opt for non-surgical treatments are at more risk for a recurrent injury, or other injuries including meniscus tears.

Surgical treatment

ACL reconstruction is usually not performed right away unless it is a treatment for a combined ligament injury. Waiting for ACL reconstruction provides time for inflammation to subside, quadriceps muscles to function, and allows a restoration of motion before surgery. Delaying the surgery can significantly reduce the risk of arthrofibrosis, or scar forming in the joint, which may lead to loss of knee motion.

ACL reconstruction surgery

Rebuilding the ligament

Since the ACL is unable to be sutured, or stitched back together, the ligament needs to be surgically removed and replaced with another soft tissue to allow proper knee function. During ACL reconstruction, Dr. Hackett utilizes a tissue graft to act as the new ACL ligament. There are many areas where grafts can be taken from autogenous (from the patient), including the patellar tendon, hamstring tendons, or in some cases, quadriceps tendons. However, the patellar tendon is most popular among surgeons because it is large and strong and has bone fragments at each end, which are attached to the femur and tibia. This allows for bone-to-bone healing.
For all graft sources there are pros and cons, and a consultation with Dr. Hackett is necessary to determine which graft choice would be optimal for your recovery. Since regrowth takes time, it may take six months or longer before patients can return to strenuous activities.

The procedure

ACL reconstruction surgery is generally performed with an arthroscope, or a tiny endoscopic camera through minimalistic incisions, which is a less invasive surgical method. This technique provides benefits such as less pain and a quicker recovery time. During the procedure, the torn ACL is removed, and the graft is attached through holes made in the thighbone and shinbone. After the graft is put in place, it is held by screws or other devices to allow proper growth and healing. Then the incisions of your surgery are closed.

Physical therapy

In any case of treatment, rehabilitation and physical therapy play a critical role in helping you return to your daily activities. Physical therapy programs help restore knee strength and motion. In the case of ACL reconstruction, physical therapy focuses on returning movement to the surrounding muscles and knee, which is followed by a strengthening treatment to maintain and protect the new ligament. Finally, in the last step of rehabilitation the methods are customized for a safe return to the athlete’s sport.