One of the most common injuries in the knee is the rupture of the anterior cruciate ligament. This injury is most prevalent in sports such as soccer, football, and skiing. Injury to this ligament in most cases requires surgical repair.
The ACL is a ligament in the middle of the knee that prevents excessive rotation and prevents your tibia (shin bone) from sliding forward on your femur (thigh bone). This ligament is susceptible to injury during activities such as: changing direction rapidly, stopping suddenly, landing from a jump incorrectly, and direct contact to the knee.
There are many typical symptoms of an ACL injury. One major symptom of an ACL injury is a feeling of instability (like your knee is going to buckle). Some people hear a “pop” when the tear their ACL but it does not happen with all tears. A loss of motion is common as well especially with a lack of extending the knee fully. Increased pain and swelling occurs but is not severe. Discomfort with walking especially going up and down
stairs is another symptom associated with ACL injury.
Upon seeing an orthopedic doctor, an MRI will be ordered to confirm the ACL injury and to check if there is any damage to the meniscus or articular cartilage. The usual recommendation is surgical reconstruction of the ligament. In patients over 40 who are not active in sports that require side to side motion, surgery is not always necessary. However, one risk associated with not repairing the ACL is that arthritis in the knee might progress faster than normal.
In patients who want to return to their prior level of function, ACL reconstruction is the primary option. The surgery requires taking out the old ACL and replacing it with a new graft. There are 3 choices of grafts; patella tendon, hamstring tendon, and a cadaver tendon. The patella tendon graft is the most common and considered to be the gold standard. All graft choices have been shown to be successful. The best option for your individual knee will be decided after discussing options with your surgeon.
Following surgery, Physical Therapy is vital to recovery. You will be referred to therapy within a week of your operation. If your surgeon performed a meniscal repair or repaired any articular cartilage, you will be in a brace locked in extension for ambulation for 1 month. If you had part of your meniscus removed or had no meniscal or cartilage damage, you will be in the brace locked for usually 1-2 weeks depending on quadriceps control.
Physical Therapy will initially focus on getting your knee completely straight, as well as minimizing inflammation and initiating quadriceps muscle re-education. At 3 months from surgery light jogging is started and return to sport is anywhere from 6-9 months depending on the patient and surgeon.