The ACL or anterior cruciate ligament is one of four key knee ligaments. The ACL attaches the tibia to the femur, keeping the shin bone in place, and is critically important to knee movement and stability. An ACL strain or tear is one of the most common knee injuries and individuals who have suffered an ACL injury often complain that their knee "gives out" or buckles as the joint's overall stability has been compromised.
While there are many, many ways to tears one's ACL, the most common is high impact sports where the knee is forced to make sharp movements. High probability sports include football, skiing, rugby, and soccer. 80% of ACL tears occur in a non-contact situation where the knee is simply pushed beyond its capabilities. The other 20% result when there is a direct impact from another player or players. Research has also shown that women involved in sports are far more likely to sustain ACL tears than men. This is likely due to weight distribution and how the female hips situate the knees.
How Can I Tell if I Have Injured My ACL?
ACL injury's result is pain, swelling and knee instability. A physician or sports doctor can either conduct special tests or an MRI to decide the degree to which the ACL is injured and if other ligaments where torn as well. It is quite common for multiple ligaments to be injured simultaneously. An ACL injury can lead to significant long-term knee instability and for this reason, many seriously injured individuals opt for surgery. ACL Surgery is certainly not required, however. Torn ligaments, including the ACL, can heal on their own and some individuals prefer physical rehab rather than undergoing the knife.
Should I Have Surgery for My ACL Injury?
If you have a complete tear, it is very likely that surgery is your best option, but if you have a partial tear, you will need to evaluate your situation and decide whether or not surgery is right for you.
There are several things to consider when evaluating ACL surgery, including:
- What is the extent of your injury? Is it a small tear or something more substantial? The more extensive the injury, the longer non-surgical rehabilitation will take.
- How important is a healthy ACL to your lifestyle? Do you play high impact sports? Are there certain activities that are critical to your quality of life that you are not willing to give up, such as skiing or soccer?
- After several weeks of recuperation, does your knee feel "normal" or do you experience knee instability? Does it cause you pain or significant anxiety? Does it impede your ability to do important activities?
What to Expect with ACL Reconstruction
The surgery for an ACL tear is called ACL reconstruction. It is a procedure done under general anesthesia, meaning the patient is "asleep" for the operation. The surgery replaces the damaged ACL with healthy tissue from elsewhere in your body (autograpgh) or a donor (allograft), usually using tissue from the knee cap or hamstring tendons. The procedure is executed with a tiny knee arthoscopy camera which the surgeon will use to observe and treat the affected area. The new tissue is usually attached with screws or similar devices. After the surgery is complete, the patient will need to wear a post-surgical knee brace to support and stabilize the knee during rehabilitation.
ACL reconstruction surgery is fairly common and usually quite successful (90+%). There are, however, risks associated with any major medical operation. For ACL reconstruction the risks include infection, stiffness, the continuance of instability or pain, and difficulty performing certain tasks.
After surgery, the patient will undergo a rigorous rehabilitation period. Rehabilitation focuses on returning range of motion and building of muscles to support the knee and prevent future injury. It is recommended that the patient continue to strengthen their leg muscles as it will provide the best long-term knee stability. Many patients also choose to wear an ACL brace when they engage in at-risk activities -especial sports.
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