With football and soccer underway, and skiing and basketball seasons just around the corner, many individuals who injure a knee will hear the dreaded words, “You’ve torn your ACL.”
The anterior cruciate ligament is one of four major ligaments of the knee. It prevents the shin bone from moving forward in relation to the thigh bone. Active patients with an ACL tear usually develop a feeling of knee instability. That may limit an active lifestyle and cause injury to other knee structures.
An ACL tear usually results from a noncontact injury. The patient may hear a pop. The knee usually feels too painful to continue playing and swells within a few hours.
In most cases, a good history and thorough physical examination by an orthopedic surgeon, including X-rays, will establish the correct diagnosis.
When the examination is difficult or there is other suspected damage to the knee, a magnetic resonance imaging study may be helpful.
Initial treatment of an ACL injury typically consists of rest, ice, compression, elevation, anti-inflammatory medications, protected weight bearing, and range of motion and strengthening exercises.
The primary reason for surgical reconstruction of an ACL is the patient’s desire to return to a high level of activity. Age is of minor importance. Patients with an isolated ACL injury who are willing to modify their lifestyle or do not develop instability may avoid surgery and be treated with bracing and physical therapy.
ACL reconstruction is typically an outpatient surgery and is performed when the patient has regained pain-free range of motion and quadriceps muscle control. Operating on a stiff, inflamed knee increases the risk of post-operative stiffness.
The techniques for ACL reconstruction have evolved in recent years. Open surgeries using extensive incisions have been replaced by less invasive arthroscopic techniques. The majority of orthopedic surgeons reconstruct the ACL with the patient’s patellar tendon.
Post-operative rehabilitation is critical to a successful ACL reconstruction and is started right after surgery. It requires a significant commitment by the patient and is typically done with a physical therapist and at home. The patient’s ability to return to sports in a light functional knee brace depends on regaining range of motion, strength and confidence in the knee, which typically occurs six to nine months after surgery.
Dr. Boublik is a board-certified orthopedic surgeon with subspecialty training in sports medicine. He is a team physician for the Broncos. For more information, go to www.shcdenver.com.
