What is the ACL?
The ACL (anterior cruciate ligament) is a major ligament in the knee that helps stabilize the knee. It is a strong ligament inside your knee that allows you to turn, cut, twist and pivot. There are four ligaments that connect the knee joint. The best known of these ligaments is the ACL. The ACL connects the tibia, a bone of the lower leg to the femur, the bone of the upper leg. It prevents the tibia from sliding (translating) too far forward from the femur. The ACL is especially crucial in sports where it provides stability during stop/go/pivot motions.
How do ACL Injuries Occur?
There are two common mechanisms in which an ACL gets torn: Contact and Non-contact. Contact ACL injuries involve a direct blow to the knee. Usually the foot is planted and the shin bone (tibia) is hyperextended. We see this injury pattern in collision sports and motor vehicle accidents. Most injuries to the ACL occur with a non-contact mechanism. Non-contact ACL injuries can are caused by a pivot, which is a sudden cut or turn and the foot stays planted on the ground or take place when landing improperly from a jump. It is estimated that 70% of ACL injuries are non-contact.
What are the Symptoms of ACL Injuries?
- Immediate swelling
- A “pop” is often heard
- Pain is noticed with walking and bending the knee
- Feeling unstable
ACL Treatment Options:
Non Surgical ACL Treatment
Complete tears of the ACL do not heal back together. In other areas of your body where you get a cut, your body has the ability to heal it with a scab or scar. Inside of your knee joint there is joint fluid. The joint fluid inhibits this healing process and does not allow the ACL to heal back together. A non-surgical treatment may be elected if the patient is not very active and does not participate in sports.
Your physician may recommend an ACL reconstruction after sustaining an injury. The reconstruction involves replacing the torn ACL with a new ACL graft. Since a repair (or suturing together) of torn ACL fibers is not effective, another piece of tissue (graft) is chosen by you and your doctor to place within your knee using the arthroscope. Autograft means your own tissue. These choices include two of your hamstring tendons or less commonly part of your patellar (the tendon from your kneecap to the bottom leg bone). Allograft tissues come from a donor. These tissues include either a patellar tendon or other soft tissue including most commonly the tibialis anterior and Achilles tendons. Reconstructing the ACL reestablishes the stability and can serve to protect the knee from future injuries.
Surgical Techniques in Patients with Open Growth Plates
ACL injuries often occur in younger children with open growth plates. The growth plates also called the physis, are the areas of the bone that allow it to grow in length. Treating this injury in children is challenging. Using adult surgical techniques to reconstruct the ACL in a child can cause damage to the growth plates and may lead to a shortened or an angled leg. To avoid damage to the growth plate, Dr. Gambacorta may recommend the use of a special surgical technique called physeal sparing ACL reconstruction. This is an accepted method for reconstructing the ACL in young children that minimizes the risk to the growth plate.
ACL Surgery Recovery:
After surgery you will be given written instruction sheets, pictures of your surgery, a prescription for therapy, and a copy of rehabilitation guidelines. This information will answer most of the questions you may have during your recovery.
You will be going to physical therapy (PT) the day after your surgery. At the initial evaluation you will meet with the physical therapist or athletic trainer (ATC) who will be responsible for your rehabilitation. During this visit, you will be instructed in Phase 1 exercises, wound care and how much weight you should place on your operated leg. In addition, your therapist will ask you to help set your goals for rehabilitation. If you have an ACL reconstruction with no meniscal repair, you will be partial weight bearing when you are able to feel your leg again after surgery. If you have a meniscal repair along with your ACL reconstruction, you will be on crutches from 4 to 6 weeks.
The entire rehabilitation process will take 5 to 6 months. During the early phase of your rehabilitation you will be closely monitored. As you progress, you will be able to do more exercises on your own. If you have any questions concerning your rehabilitation process, they should be directed to your rehabilitation team.
If you are unsure what type of pain you are experiencing and would like to schedule a consultation appointment with
contact us at (716) 636-1470.
For more information on this and other injuries see our website at www.northtownsorthopedics.com.
This information is intended for education of the reader about medical conditions and current treatments. It is not a substitute for examination, diagnosis, and care provided by your physician or a licensed healthcare provider. If you believe that you, your child, or someone you know has the condition described herein, please see your healthcare provider. Do not attempt to treat yourself or anyone else without proper medical attention.