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.
