Ligaments are tough, nonstretchable fibers that hold your bones together. A tear to the anterior cruciate ligament (ACL) of your knee joint is among the most common sport-related injuries. The ACL connects the thighbone (the femur) to the shinbone (the tibia) and acts to prevent your thighbone from moving too far forward over the knee joint. This ligament also helps stabilize the shinbone from rotating out of the knee joint.

Cause & Symptoms

The ACL can tear when it’s stretched beyond its normal range. This typically happens by sudden twisting movements, slowing down from running, or landing from a jump. Injury to the ACL can result from a direct blow to the knee, or from non-contact injuries such as making a sudden stop or landing on an extended leg. At the time of injury, you may hear an audible popping sound, and the knee will give way. Shortly after the injury, the knee will become swollen and walking will be very difficult. The swelling and pain will subside after the first few days.

A different injury to the knee to be aware of is a Meniscus Tear. A meniscal tear can also occur simultaneously with injury to other ligaments of the knee (in particular, the anterior cruciate ligament which helps to connect the upper and lower leg bones).

Repair for an ACL tear

Immobilize the knee

Following the acute injury you should use a knee immobilizer and crutches until you regain good muscular control of the leg. Extended use of the knee immobilizer should be limited to avoid quadriceps atrophy. You are encouraged to bear as much weight on the leg as is comfortable.

Control Pain and Swelling

Crushed ice or an Aircast knee Cryocuff along with nonsteroidal anti-inflammatory medications such as Advil, Nuprin, Motrin, Ibuprofen, Aleve (2 tablets twice a day) are used to help control pain and swelling. The nonsteroidal anti-inflammatory medications are continued for 7 – 10 days following the acute injury.

Consult a Specialist

In most cases, your ProSports physician will be able to diagnose and ACL injury with direct examination. In the likelihood that there may be additional injury to the joint, or if the swelling makes diagnosis difficult, your physician may conduct an MRI or arthroscope the fully evaluate the injury to the knee.

Because the ACL is not capable of healing itself (ligaments, unlike muscles, do not have their own blood supply), it can only be reconstructed (that is, replaced) surgically — it cannot simply be repaired. Less active people may choose to treat a torn ligament nonsurgically with a rehabilitation program focusing on muscle strengthening and lifestyle changes. Surgical reconstruction, however, may help many people recover full function after an ACL tear. Your doctor can discuss these different options with you and help choose what is right for you.

The decision whether or not to surgically repair the ACL depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee, and the “laxity,” or looseness, of the joint.

For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.

Recovery

After ACL reconstruction, performing rehabilitative exercises may gradually return full flexibility and stability to your knee. Building strength in your thigh and calf muscles to support the reconstructed knee is a primary goal of rehabilitation. You may also need to use a knee brace for a short time, and it is important not to return to full activity too soon to prevent reinjury.

ACL rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.

If you have undergone surgery for an ACL tear, the ACL protocol contains instructions and exercises to help you recover.

Arthroscopic Surgery to Reconstruct an ACL

The ACL, or Anterior Cruciate Ligament, connects the front of the tibia (shinbone) to the back of the femur (thighbone). The ACL serves to prevent the shinbone from moving forward in the knee joint. Injury to the ACL can result from a direct blow to the knee, or from non-contact injuries such as making a sudden stop or landing on an extended leg.

Symptoms

Frequently a tear in the ACL will result in an audible popping sound, and the knee will give way. Shortly after the injury, the knee will become swollen and walking will be very difficult. The swelling and pain will subside after the first few days.

Diagnosis

In most cases, your ProSports physician will be able to diagnose and ACL injury with direct examination. In the likelihood that there may be additional injury to the joint, or if the swelling makes diagnosis difficult, your physician may conduct an MRI or arthroscopy to fully evaluate the injury to the knee.

Surgery or not?

The decision whether or not to surgically repair the ACL depends on several factors, including the extent of the injury and the expectations of the patient. Your ProSports physician will determine the degree of the injury or injuries to the knee, and the “laxity,” or looseness, of the joint.

For younger patients with moderate to several injuries and laxity, who want to continue with a broad range of physical activities, surgery will most likely be necessary. For older patients and others with less severe injuries, who anticipate less vigorous physical activity, a rehabilitation program will be prescribed.

Preparing for Surgery

Before proceeding with surgery the acutely injured knee should be in a quiescent state with little or no swelling, have a full range of motion, and the patient should have a normal or near normal gait pattern. One of the most common complications following ACL reconstruction is loss of motion, especially loss of extension. Studies have demonstrated that the timing of ACL surgery has a significant influence on the development of postoperative knee stiffness.

The highest incidence of knee stiffness occurs if ACL surgery is performed when the knee is swollen, painful, and has a limited range of motion.

The risk of developing a stiff knee after surgery can be significantly reduced if the surgery is delayed until the acute inflammatory phase has passed, the swelling has subsided, a normal or near normal range of motion (especially extension) has been obtained, and a normal gait pattern has been reestablished.

More important than a predetermined time before performing surgery is the condition of the knee at the time of surgery.

Control Pain and Swelling

Crushed ice or an Aircast knee Cryocuff along with nonsteroidal anti-inflammatory medications such as Advil, Nuprin, Motrin, Ibuprofen, Aleve (2 tablets twice a day) are used to help control pain and swelling. The nonsteroidal anti-inflammatory medications are continued for 7 – 10 days following the acute injury.

Restore Normal Range of Motion

You should attempt to achieve full range of motion as quickly as possible. Quadriceps isometrics exercises, straight leg raises, and range of motion exercises should be started immediately.

Development Muscle Strength

Once 100 degrees of flexion (bending) has been achieved you may begin to work on muscular strength: Mentally Prepare

• Understand what to realistically expect of the surgery
• Make arrangements with a physical therapist for post-operative rehabilitation
• Make arrangements with your place of employment.
• Make arrangements with family and/or friends to help during the post-operative rehabilitation
• Read and understand the rehabilitation phases after surgery

The Surgery

Before Surgery

Prior to beginning the operation and at the conclusion of the operation, a solution containing morphine or Demerol and a long acting local anesthetic Marcaine will be injected into your knee. This solution will block the pain nerve fibers and local pain receptors in your knee. Recent studies have shown that this is a safe and effective way to control pain after knee surgery. In many cases the injection will last 12 ormore hours after surgery and significantly reduce the amount of pain medication that you will have to take.

During Surgery

At the time of surgery a plastic drainage tube which is connected to a vacuum container is placed in the subcutaneous tissues around your knee and into the knee joint to prevent blood from collecting.

After Surgery

Prior to leaving the operating room a Cryocuff and a knee immobilizer will be applied to your knee.

• The Cryocuff will provide cold and compression, reducing pain and swelling. This unit should be used continuously for the first 3 – 4 days after your surgery. After this time period the Cryocuff can be used as needed for comfort.
• The knee immobilizer is to be worn while walking and sleeping, otherwise it can be removed.
• After surgery, your leg will be wrapped in soft cotton bandage and a white elastic TED stocking will be applied over the cotton dressing from your toes to your groin.
• The purpose of the elastic stocking is control swelling in the leg. The TED stocking should be worn full time for the first 12 – 14 days after surgery.
• The drainage tubes are still attached to prevent blood from collecting. The drainage tubes will be removed before you leave the hospital.

After the anesthesia has worn off, your vital signs are stable and your pain is under control you will be discharged from thehospital.

You will not be allowed to drive a car. Prior to your discharge arrange for transportation.

Recovering from ACL Surgery

ACL rehabilitation includes exercises to restore the full range of motion to the knee, followed by a program of strengthening exercises. These programs continue until the leg strength and flexibility are nearly back to normal.

If you have undergone surgery for an ACL tear, the ACL protocol contains instructions and exercises to help you recover.