Anterior Cruciate Ligament Tears
There are four ligaments in the knee that help hold the bones of the knee joint in position and prevent it from moving in an undesired direction. The collateral ligaments support the knee medially and laterally. The cruciate ligaments stabilize the knee anteriorly and posteriorly. The anterior cruciate ligament (ACL) prevents the knee from gliding anteriorly. The ACL also stabilizes the knee in cutting and pivoting activities by providing proprioceptive signals to the brain that in turn fire supporting musculature to fire and further assist to stabilize the knee.
The ACL is one of the most commonly injured structures in the knee. A rupture or strain typically occurs during high impact activities such as soccer, football, skiing, or basketball. The injury often involves an impact from the front or side, a sudden change in direction, a plant and twist type of motion, or an awkward landing. Most patients feel a “pop” in their knee as the ACL tears. Pain, swelling and a sense of the knee wanting to “give out” are other common symptoms.
The diagnosis can usually be made by taking a good history and performing pertinent physical examination maneuvers. X-rays can rule out any bone injury. An MRI is often obtained to confirm the diagnosis and to visualize any additional damage to the knee. Initial home care includes rest, ice, compression and elevation (R.I.C.E.).
Nonsurgical treatment includes physical therapy and bracing and is reserved for those who do not have any additional damage to their knee and those who do not engage in higher impact activities that involve cutting, twisting, and jumping.
Surgery is usually recommended if you are an athlete or participate in activities that involve the motions mentioned above. It is also recommended for those who experience persistent instability and those who have additional damage to their knee.
Surgical options include ACL reconstruction using an autograft (your own tissue) or an allograft (donor tissue). There are many graft options and techniques available to reconstruct the ACL. You and your physician can decide which would be the best options for you depending on your age, activity level, preference and overall condition of your knee.
Physical therapy is necessary after reconstruction to help reduce swelling, regain strength and range of motion and facilitate your return to normal activity. Return to normal unrestricted activity usually takes 9-12 months.
If you believe you have knee pain from an ACL tear, consult with an orthopedic surgeon.