Orthopaedic and Sports Medicine Center
What is an ACL tear and how can it be repaired?
Ligaments are tough bands of tissue that connect bones in the body. Two of the most important ligaments in the knee are the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL). These ligaments connect the femur and the tibia and are vital to the stability of the knee during athletic activities.
The ACL limits excessive forward movement of the tibia in relation to the femur and limits rotational movements of the knee. ACL tears most commonly result during athletic events in which an individual experiences an injury due to a sudden stop and twisting motion in the knee, or a force or “blow” to the front of the knee. This is often accompanied by a “pop” and painful swelling and instability in the knee. Unfortunately return to sporting activities is most often not possible and not advised with a torn ACL due to risk of further injury to the knee and recurrent symptoms of “giving out” in the knee.
Not all ACL tears will require surgery. Ultimately the decision for treatment is based on a particular individual’s level of activities and willingness to limit or avoid activities that require an intact ACL. These activities include basketball, football, baseball, softball, racquetball and tennis, snow skiing and other sporting events that require frequent pivoting or direction changes.
If athletics are an important part of your life, or if your job requires nonsedentary work, your surgeon may recommend surgical reconstruction of the ACL. There are several viable options for an ACL reconstruction which involve using a “graft” or substitute tissue to reconstruct the ACL. Unfortunately, attempting to simply “suture” the torn ACL together has historically led to failure and this technique has been universally abandoned.
In general, surgery is done arthoscopically using very small incisions, specialized instruments and a fiberoptic, high definition camera. This is usually done as an outpatient surgery, and takes between one and two hours to complete.
There are three common graft choices used when reconstructing the ACL:
- Patellar tendon
- Hamstring tendons
- Allograft tendons
Each of these techniques have proven to be very effective at restoring normal function to the knee and allowing return to full, unrestricted athletic participation.
After surgery the physical therapist becomes an integral part of the rehabilitation process. Rehab begins within a few days of surgery, and most patients are allowed to bear full weight on the operative knee as soon as 1-2 weeks post op. Additionally, your surgeon may elect to use an ACL rehabilitation brace in the post operative period. Initial physical therapy involves regaining full range of motion in the knee, and this progresses over time to emphasizing balance, coordination and return of muscle strength and agility.
Return to work and sporting activities depends on a patient’s ability to successfully complete an appropriate rehabilitation protocol. Most patients can expect to return to light jogging at four months post op, bicycling at four to five months, straight line running at five months, and ability to perform agility drills and light cutting activities by six months post op. Successful return to full and unrestricted sporting activities can be expected at 7-9 months after surgery.
For most individuals who undergo reconstruction of the ACL, they can expect to achieve a reliable and stable knee that will allow them to return to preinjury sporting and work activities without limitations.
