General Surgery

ACL Tear Treatment—Surgical Reconstruction

Surgical tools and materials sit on a table in preparation for a procedure. Common in athletes and active youngsters, torn ligaments often involve the knee joint. The ACL (anterior cruciate ligament) is a common site of athletic sprains. When the ACL tears, either partially or completely, it causes significant pain and impairs mobility.

The most common treatment for a torn ACL is surgery. The ligament will not heal on its own. Depending on the patient, non-surgical interventions might be appropriate. For anyone who is active, however, surgery is a must to get back to full strength.

About ACL Tears

The ACL provides important stability in the knee. ACL tears can be mild or severe, resulting in an inability to put weight on the joint.

What is the ACL?

The posterior and anterior cruciate ligaments in the knee cross back to front in the joint, making an X shape. The ACL runs from the front of the tibia (shinbone) to the femur (thighbone). It keeps the tibia from moving too far ahead of the femur. It also stabilizes the knee joint during rotational movements.

ACL Injuries

A sprain occurs when a ligament stretches or tears. The ACL can be overstretched in accidents and injuries. It can also tear, partially or completely through, severing the ligament entirely. The latter is known as a grade 3 sprain and leaves the knee joint unstable.

Causes of ACL Tears

An ACL tear is a fairly common injury, especially among active young people and athletes. Any movement that requires a sudden stop or change in direction can twist and tear it. Contact sports and other types of trauma, like car accidents, can also tear the ACL.

Who Needs ACL Tear Treatment?

Only minor sprains will heal without intervention. A tear requires at least nonsurgical treatment, but most people need surgery to correct the tear and be restored to full mobility and activity level. You will likely know if you’ve torn a ligament in the knee if you have these symptoms:

  • Pain and swelling immediately or in the first 24 hours after an injury
  • Pain and discomfort when walking
  • Difficulty putting weight on your knee joint
  • Inability to use the full range of motion in your knee

In some cases, nonsurgical treatment is more appropriate, at least as a first step. For instance, a younger child or teen might suffer a growth plate injury after ACL surgery, necessitating a delay.

Surgery for ACL Tears

Torn knee ligament treatment is not as simple as stitching the tissue back together. A surgeon must reconstruct the ligament using additional tissue. There are a few different ways to do this:

  • Patellar tendon autograft. The surgeon can take part of the kneecap (patellar) tendon and a small amount of bone from the shin to reconstruct a torn ACL. This is used most often for very active individuals but can cause more pain behind the kneecap later.
  • Hamstring tendon autograft. A surgeon might also take tissue from the tendon inside the knee. This requires a smaller incision and causes less kneecap pain, but the reconstructed ACL might be more susceptible to overstretching.
  • Quadriceps tendon autograft. Surgeons reserve the use of tissue from the quadriceps tendon to patients who have a failed ACL reconstruction. It requires a larger incision but can provide more tissue for patients who are taller or heavier.
  • Allograft. A final option is to take tissue from a cadaver for the reconstruction. The patient benefits from not losing tissue from another area of the body. Risks include infection and possibly a higher rate of stretching and failure.

Your surgeon will discuss the best type of ACL surgery for you or your child considering your symptoms, lifestyle, and the results of imaging scans of the injury. Preparation for the procedure often involves going through some physical therapy and bracing for initial healing.

In the days leading up to the surgery, you should follow your surgeon’s instructions in terms of medications to stop taking and when to stop eating. Prepare your home so you can get around easily and have the essentials in one place where you can rest and recover.

Recovery and Rehab After ACL Surgery

You should have someone available to take you to the procedure and drive you home. ACL reconstruction is usually an outpatient surgery, so be ready to go home the same day. You will be able to walk on crutches very soon after, but you will still need someone at home to help you with tasks.

The surgeon will send you home with a prescription for pain medication and a plan for recovery. You might need to wear a brace, and icing will help reduce swelling in the joint. You will need to rest, but your surgeon will likely recommend working on straightening the knee, establishing more range of motion, and putting some weight on it.

Rehab for an ACL tear is essential for full recovery. Your surgeon will recommend a course of physical therapy and rehabilitation to strengthen the joint, muscles, and connective tissue. The more effort you put into rehab and PT, the sooner you will be back to full strength. It can take several months to resume your normal activities.

Contact us today to request an appointment with one of our orthopedic and sports medicine specialists who can discuss ACL surgery with you.

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