Anterior Cruciate Ligament (ACL) Tears
Dr. M. Brett Raynor, gives a brief overview of ACL (Anterior Cruciate Ligament) tears. They are a common knee injury in athletes of all ages and a source of instability. Not all need surgery, but many require a reconstruction.
What is the ACL?
The Anterior Cruciate Ligament (ACL) is a ligament inside the knee that plays an import role in knee stability, especially rotational stability during cutting, pivoting, and twisting activities.
How do acl injuries happeN?
Most are non-contact injuries, but they can occur with any number of mechanisms
WHat are the symptoms of an ACL Tear?
Patients often report a “pop” followed by pain and swelling with the injury
The initial pain from an ACL injury will typically subside eventually. However, patients with a symptomatic ACL tear will report ongoing symptoms of instability which can include the following:
The knee shifts or pivots
The knee just feels unstable or "wobbly"
Cannot trust the knee
Persistent pain associated with the instability
how do we treat acl tears?
Here is an animation of an ACL reconstruction that is performed in somewhat similar fashion to how Dr. Raynor currently performs the operation. Some parts of the technique and the location of the scars may vary.
Nonoperative Treatment (Sometimes)
Not all ACL tears require surgery. Some people can have a stable knee without an operation, and strengthening up the hamstrings and quadriceps muscles can help improve knee stability. However, most ACL injuries in athletic individuals will require an operation to have a knee that one can trust for cutting, pivoting, and twisting activities.
Operative Treatment
Repair (Rare)
In some very specific circumstances and tear patterns, the ACL can be saved and repaired back. This is how ACL tears were treated years ago when we first learned that it was an important ligament. The early results of this had unacceptably high failure rates, so we evolved to doing a reconstruction where we take out the torn ligament and create a new one. The concept of ACL repair has been revisited recently with the advent of newer technology, and this is something we will entertain in very select circumstances. The vast majority of ACL tears treated surgically will need a reconstruction.
Reconstruction (Most of the Time)
As stated above, the ACL has a difficult time healing on its own, and repairing it is only an option for very selective cases. Therefore, most ACL tears will need to be treated with an ACL reconstruction. This is when we remove the entire torn ligament and make a new one out of something. We have 4 main graft options that are outlined below that are available to make the new ligament out of. A camera is used to drill sockets in the bone where the original ACL was and the new ligament is fixed in the sockets. The body then grows into the graft to make it into the new ACL.
When? / Timing of Surgery?
The ACL does not have to be operated on right away in most situations. If other ligaments are injured, or if there is a displaced meniscus tear, we might discuss a more urgent time course for surgery. Usually, we will send our patients to some physical therapy, or "pre-hab", for about 3 weeks prior to surgery to get motion and strength back, swelling down, and to allow the knee to calm down.
what are the Graft Options for Reconstructing a Torn ACL?
Click on the image above to enlarge it for easier viewing.