ACL Tear

What is an ACL injury?

One of the most common problems involving the knee joint is an anterior cruciate ligament tear. The anterior cruciate ligament (also called the ACL) is one of four ligaments that are critical to the stability of the knee joint. A ligament is made of tough fibrous material and functions to control excessive motion by limiting joint mobility. Of the four major ligaments of the knee, the ACL injury is the most common knee ligament injury.

What is the normal function of the ACL?

The anterior cruciate ligament is the primary restraint to forward motion of the shin bone (tibia).

The ACL also contributes stability to other movements at the joint including the angulation and rotation at the knee joint.

What happens when there is an ACL injury?

When an ACL injury occurs, the knee becomes less stable. The ACL injury is a problem because this instability can make sudden, pivoting movements difficult, and it may make the knee more prone to developing arthritis and cartilage tears.

Athletes often have particular difficulty once they have sustained an ACL injury. Many sports require a functioning ACL to perform common maneuvers such as cutting, pivoting, and sudden turns. These high demand sports include, but are not limited to:

• Football
• Soccer
• Basketball
• Skiing
• Gymnastics
• Hockey (Ice and Field)
• Wrestling
• Lacrosse
• Rugby

Patients may be able to function in their normal daily activities without a normal ACL, but these high-demand sports may prove difficult. Therefore, athletes are often faced with the decision to undergo surgery in order to return to their previous level of competition.

What are the symptoms of an ACL tear?

An ACL tear most often occurs during sporting activities when an athlete suddenly pivots causing excessive rotational forces on the ligament. Other mechanisms that can cause an ACL tear include severe trauma and work injuries. Individuals who experience ACL tears usually describe a feeling of the joint giving out, or buckling--patients also often say they hear a "pop."

What should I do if I think I have an ACL tear?

Patients who think they have an ACL tear should be evaluated by their doctor. An ACL tear may be difficult to diagnose immediately after the injury because of associated pain and swelling. There may also be muscle spasm that contributes to making the knee difficult to examine. Therefore, it may not be possible to conclusively determine the presence of an ACL tear soon after the injury. If an ACL tear is suspected, you will return for follow-up evaluation with your orthopedic surgeon.

What other tests are needed to diagnose an ACL tear?

A complete examination of the knee is also necessary to determine if other injuries may have occurred that could be causing your symptoms.

Your physician will also evaluate x-rays of the knee to assess for any possible fractures, and a MRI may be ordered to evaluate for ligament or cartilage damage.

Can the ACL be repaired?

ACL reconstruction surgery is commonly, and improperly, referred to as an ACL repair. Unfortunately, a torn ACL cannot be "repaired." Rather, the torn ligament must be entirely removed, and a new ACL must be reconstructed using other, healthy tissue. It is not possible to repair the torn ACL by simply reconnecting the torn ends.

How is the ACL reconstruction done?

The surgical procedure for an ACL reconstruction is variable, but commonly involves using a segment of another larger ligament or tendon to replace the damaged ACL.

Once the graft is chosen, what is next in the ACL reconstruction?

Once the decision is made to perform ACL reconstruction surgery, the procedure will be scheduled. The procedure can be done as an in-and-out (same day) surgery. The anesthesia may be either general or regional anesthesia; you can discuss these options both with your surgeon and anesthesiologist.

The ACL reconstruction surgery lasts about 1 1/2 to 2 hours, depending on the graft choice and any other work that may need to be done in the knee joint. Following the procedure, you will be given crutches and a knee brace.

What is the timeline for return to activities after ACL reconstruction?

Initially following ACL reconstruction, patients can expect to be using crutches from one to three weeks. Early in rehabilitation, emphasis is placed on control of swelling, flexibility of the joint, and return of strength. As range of motion improves, an increased emphasis is placed on recovering strength.

ACL reconstruction

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