Injury

ACL injuries frequently occur during sports, often during non-contact activities like cutting or pivoting. However, contact injuries, such as a direct blow to the knee, can also cause an ACL rupture. Athletes often report a feeling of their knee "giving way" or buckling, sometimes accompanied by a popping sensation. The knee typically swells rapidly due to bleeding from the torn ligament. ACL tears can occur in isolation, but often involve concomitant injuries to the meniscus, cartilage, or other ligaments (like the medial collateral ligament).

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Diagnosis

A clinician will suspect an ACL tear based on the mechanism of injury and a physical examination. X-rays, while not able to directly visualize the ACL, help rule out fractures. Occasionally, a Segond fracture is visible on X-ray, which is highly suggestive of an ACL tear. MRI is the gold standard for confirming an ACL rupture and assessing any associated injuries.

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What to Expect

Following an ACL injury, a thorough history and physical examination are performed, followed by X-rays. If an ACL tear is suspected, an MRI is ordered. Patients begin physical therapy to regain range of motion and quadriceps strength. This pre-operative rehabilitation helps prevent post-operative stiffness and muscle atrophy. Patients are typically weight-bearing as tolerated. In cases of multi-ligament injuries or meniscus tears that limit motion, surgery may be expedited.

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Surgical Considerations

• Timing: Except in rare cases, surgery is often delayed to allow swelling to subside and range of motion to improve. While ACL reconstruction is an elective procedure, it should ideally be performed within 6 months of injury to minimize the risk of further damage.

• Graft Selection: ACL repair is uncommon; reconstruction is the standard procedure. This requires a graft to replace the torn ACL. Options include autografts (tissue from the patient's own body) or allografts (tissue from a cadaver). Autografts are generally preferred, with common sources including the hamstring tendon, quadriceps tendon, and patellar tendon. Allografts may be considered for less active or older individuals.

• Psychological Impact: An ACL injury can be psychologically traumatic. Fear of re-injury, concerns about returning to sport, and other anxieties are common. Support groups and mental health resources are available.

 

Downtime and Recovery

Recovery time varies depending on individual factors and the extent of the injury. Return to sport may be possible in 6 months, but 9 months is often recommended. Patients typically begin weight-bearing as tolerated with crutches after surgery. Crutches and a hinged knee brace are used for support. Most patients walk comfortably by 6 weeks, return to school within 1-2 weeks, and sedentary work within 4-6 weeks. Low-impact exercise starts around 3 months, with progression to higher-impact activities around 4 months.

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Our Practice

Our practice has extensive experience managing ACL injuries, including complex cases with multiple ligament or cartilage damage. We prioritize meniscus preservation and offer a range of cartilage restoration techniques. We perform ACL reconstructions using both autografts and allografts, with the quadriceps tendon being our preferred autograft choice. Our minimally invasive techniques and use of internal bracing aim to reduce re-tear rates. We also offer ACL repair and the BEAR procedure (using a collagen bovine graft) for suitable candidates.

Our approach is constantly evolving to reflect the latest research and techniques. Contact us for an evaluation or MRI review. We are dedicated to providing personalized care that addresses your individual needs and goals.