The anterior cruciate ligament (ACL) is one of the four main ligaments of the knee. It is the primary restraint that provides rotational stability to the joint. It is often injured during cutting, twisting, jumping, change of direction or pivoting-type maneuvers. In addition, it is often associated with meniscal or articular cartilage injuries in greater than 50% of patients. Females are up to 3-6 times more likely to be injured than males, given the same athletic performance. Once the ACL tears, it is not able to heal itself. Repair of the torn ends does not work either. Anterior cruciate ligament reconstruction is one of the most common operations performed in orthopaedic sports medicine with more than 200,000 reconstructions performed in the U.S. annually.
Treatment options consist of either conservative (non-surgical) or surgical treatment. Conservative treatment involves modification of those activities that involve cutting, twisting, jumping, or pivoting. In-line activities can typically be resumed once pain and swelling subsides. A physician may prescribe anti-inflammatory medication and physical therapy to regain normal knee motion and strength. Bracing may also be prescribed for certain at-risk activities. Some patients may be willing to reduce or eliminate those activities that may cause instability episodes.
Surgical treatment consists of reconstruction of the ligament as its direct repair is not feasible due to the inability of the torn ligament to heal. This surgery involves the placement of a reconstructive graft taken from the patient’s knee’s patellar tendon (the tendon located beneath the knee cap) or from the hamstring tendons. Alternatively, your surgeon may choose to use a donor graft, known as an allograft, to reconstruct the ACL. The surgery itself takes approximately one hour and is performed on an out-patient basis with less than 1% percent risk of complications. Allograft reconstruction is not advised for younger, active patients.
Extensive physical therapy is required for a successful recovery from ACL reconstructive surgery. It is necessary following the surgery in order to regain full knee motion and strength, and to return to athletic activity. Most patients are able to return to play following ACL reconstruction approximately 6 months postoperatively. The overall success rate of ACL reconstruction using present-day surgical techniques is well over 90%.
Future posts will give additional detail regarding the treatment and outcome of these injuries.
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