ACL Tear and Repair

One of the most common knee injuries is an anterior cruciate ligament (ACL) sprain or tear, according to the American Academy of Orthopaedic Surgeons. Participating in high demand sports such as soccer, football, hockey and basketball can increase the changes an ACL injury will occur.

An ACL injury can be painful and can limit a person’s mobility. Depending on the severity of the injury, surgery will likely be necessary for a patient to make a full recovery.

What is an ACL Injury?

The ACL is one of four ligaments in the knee that provides stabilization. It is connected to the bottom of the thighbone and the front of the shinbone.

An ACL injury occurs when a knee is locked and then there is a sudden change in direction or pivot. It can also occur when there is a direct blow to the knee, forcing the knee into an abnormal position. Women are significantly more likely to have an ACL tear than men participating in the same sports, according to the Mayo Clinic.

When an ACL injury occurs, symptoms may include:

  • A loud “pop” sound
  • Severe pain
  • Inability to continue activity
  • Knee swelling that usually worsens for hours
  • Discomfort when walking or inability to sustain weight on injured leg

If you think you have an ACL injury, you should consult your physician. To determine if you have an ACL sprain or ACL tear, your doctor will likely run tests that may include X-rays, magnetic resonance imaging (MRI) or ultrasounds.

What are the Treatments for an ACL Injury?

If the ACL is torn, it will not heal without surgery. For patients who are less active and do not participate in activities that include running and jumping, they may work with their physician to create a stability plan. This will likely include nonsurgical treatments such as physical therapy and bracing.

For those who need surgery, the ACL ligament will be replaced entirely. The ligament is replaced with a tendon, which then acts as a graft. The graft will mature over time and become a new, living ligament.

The surgery is performed by having small incisions made over the front of the knee cap. The ligaments needed for the graft are then removed. The incision is closed and the remainder of the surgery is performed through small incisions on the side of the knee. From there, a fiber-optic viewing scope is used to assist the surgeon and guide the ACL graft into place.

While the knee is bent, the damaged ACL is cleared away. A pin is then inserted and will act as a guide to recreate the ACL. Holes are then drilled into the tibia and femur. The graft is attached to the guide pin and it’s pulled through the drill holes into place. Once complete, special screws or other fixation devices are used to secure the ends of the graft to the femur and tibia. The knee is then flexed to test the new joint.

What to Expect After ACL Repair Surgery

After ACL repair surgery, a patient will participate in rehabilitation, including physical therapy. Rehabilitating after ACL repair surgery can be hard work and takes time. The first step of physical therapy will focus on returning motion to the joint and surrounding muscle. This will likely be followed by a strengthening program that will gradually increase the range of motion and stress that’s able to be applied to the knee.

Results of an ACL Repair

Depending on the surgery, it may be up to nine months before a patient can return to sports. ACL surgeries are usually successful with more than 90 percent of patients being able to return to sports and workplace activities without symptoms of knee instability, according to the American Orthopaedic Society for Sports Medicine.

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