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Orthopaedic Specialties

Anterior Cruciate Ligament (ACL) Injury

An ACL injury can be either a tear or sprain of the anterior cruciate ligament (ACL). It is one of the four key ligaments in your knee joint. The ACL helps maintain the knee’s rotational stability and prevents the shinbone (tibia) from slipping in front of the thighbone (femur).

ACL injuries frequently occur during sports activities that involve sudden stops or changes in direction, jumping, and landing, such as basketball, soccer, football, tennis, or even pickleball. Approximately 85% of ACL tears occur in non-contact-sudden deceleration or change in direction injuries. For this reason, people who participate in these sports have an especially high risk of ACL tears.

A torn ACL is a well-known injury in athletes of all levels. Surgery is required to repair an ACL tear. When an ACL is torn, it cannot regrow or heal on its own.
Individuals of all ages, physical conditions, and skills can tear an ACL. Active women suffer a higher incidence of ACL injuries than men since their biomechanics are more likely to produce stress on their knees and factors like anatomy, muscle imbalances, and hormones.

Many people report hearing a popping in their knee when an ACL injury occurs. The injured knee may swell, become unstable feeling and hurt too much to bear weight.
Treatment may include rest and rehab exercises depending on the severity of your ACL injury. If the ACL is torn, surgery will probably be required. Afterward, Physical Therapy to help regain strength and motion.

Torn Anterior Cruciate Ligament ACL

ACL injuries in Children

Frequently children get ACL injuries, especially in youth sports where competition has become very intense. In the past, ACL treatments for children and teens were almost totally nonsurgical. Historically, there were concerns that ACL surgery techniques could cause children who had not reached skeletal maturity to develop a growth deformity in their legs. However, newer surgical techniques have made surgical repair an option for many children.
In the medical community today, the more recent understanding is that playing sports on a damaged and non-repaired ACL can do significant and possibly permanent damage to a child’s knee within a few months, even if they are wearing a leg brace.

When Surgery is Necessary

If you have an ACL tear, you may wonder if surgery is required; some factors to be considered include how unstable the injured knee is and your activity level.
Occasionally this type of injury necessitates a complete surgical reconstruction utilizing a tendon from the patella (kneecap) or hamstring. Donor tissue is also an option.
ACL injuries, like other types of ligament injuries, are classified by the following grading system:

  • Grade I — A minor injury that produces only microscopic tears in the ACL. Even though these very small tears may stretch the ligament out of shape, they do not affect the knee joint’s ability to support your weight. A stable ACL tear indicates that although there is a tear, the muscles and other ligaments are able to stabilize the knee during everyday activities.
  • Grade II — A moderate injury wherein the ACL is partially torn. Frequently, the knee can be fairly unstable and can give way sporadically when you walk or stand.
  • Grade III — If the injury is a Grade III, it means that it severe and the ACL is completely torn through, and the knee feels very unstable.

The majority of ACL injuries are Grade IIIs, with only 10% – 28% being either Grade I or Grade II. In general, between 100,000 and 200,000 ACL injuries happen each year in the US, affecting nearly one out of every 3,500 people. Most of these injuries are associated with athletic activities, especially contact sports. About 75% occur without any direct contact from another participant.

If your knee is frequently buckling, your knee has become unstable. This is an indicator that surgery may be necessary to stabilize the knee. Your activity level can also be a determining factor for surgery.

Sports that require sudden changes in direction, for example football, basketball, soccer, or tennis, would be hard to participate in with an ACL tear. Some people are able to do so with proper strengthening and use of an ACL functional knee brace.

Running with an ACL tear

It is possible to run with an ACL tear if the knee is stable and the muscle around the knee has been strengthened properly to support the knee. When you run, wear a knee brace and run on level surfaces to decrease further injury risk. Running on irregular surfaces such as grass or sand may cause unexpected twists resulting in increased stress to the knee or could cause a fall.

Playing Sports after ACL Reconstruction

Reconstructive surgeries typically have good outcomes by improving the pain and providing more knee stability and leg strength. Arthritis is always a potential risk to the knee; depending on whether the individual returns to active sports, it may worsen if surgery is not performed. Unfortunately, ACL reconstruction surgery does not guarantee you will return to sports activities at your pre-injury level. After surgery, you may require up to six months of physical therapy to recover your full leg strength and range of motion. The first part of recovery usually focuses on regaining range of motion in the knee and improving quad strength.

The Physical Therapist will help you determine which activities are suitable and how to safely increase your strengthening exercises.
A broad timeline for recovery following ACL reconstruction surgery is as follows:

    • At three months after surgery, you may start a walking program.
    • At four to six months, you may add agility training and running.
    • Returning to sports activities can occur at the earliest eight months after surgery but more likely will occur between months ten and twelve.

When returning to a sports activity, your physician may initially recommend using a knee brace to prevent re-injury. This will allow more stability as the knee adapts to the increased activity.
Recovery will vary from person to person. Factors may include:

    • How well the body heals itself.
    • Response to therapy.
    • Your overall strength.
    • Your compliance with a home exercise program.

These are a few of the reasons why it is essential to work with a Physical Therapist and orthopedic physician to ensure a safe return to your lifestyle.