What are the symptoms of an ACL tear. How is an ACL injury diagnosed. What treatment options are available for ACL injuries. Can an ACL tear heal on its own. How long does it take to recover from ACL surgery. What exercises help prevent ACL injuries.

Understanding the Anatomy of the Knee

The knee joint is a complex structure where three bones meet: the femur (thighbone), tibia (shinbone), and patella (kneecap). These bones are connected by ligaments, which act as strong ropes to maintain stability and control movement. There are four primary ligaments in the knee:

• Medial collateral ligament (MCL)
• Lateral collateral ligament (LCL)
• Anterior cruciate ligament (ACL)
• Posterior cruciate ligament (PCL)

The ACL, which runs diagonally in the middle of the knee, plays a crucial role in preventing the tibia from sliding out in front of the femur and providing rotational stability. Understanding this anatomy is essential for comprehending the impact of an ACL injury.

ACL Injuries: Types and Severity

ACL injuries are typically classified as sprains and graded based on their severity:

• Grade 1 Sprain: Mild damage with slight stretching of the ligament
• Grade 2 Sprain: Partial tear of the ligament, resulting in looseness
• Grade 3 Sprain: Complete tear or separation of the ligament from the bone

It’s worth noting that partial tears of the ACL are relatively rare. Most ACL injuries are complete or near-complete tears, which can significantly impact knee stability and function.

Common Causes of ACL Injuries

ACL injuries often occur during sports or physical activities. Some common mechanisms of injury include:

• Rapid changes in direction
• Sudden stops or deceleration while running
• Incorrect landing from a jump
• Direct contact or collision, such as a football tackle

Interestingly, studies have shown that female athletes have a higher incidence of ACL injuries compared to their male counterparts in certain sports. This difference may be attributed to factors such as physical conditioning, muscular strength, neuromuscular control, pelvic and lower extremity alignment, ligament laxity, and hormonal influences.

Recognizing the Symptoms of an ACL Tear

Identifying the symptoms of an ACL tear is crucial for prompt diagnosis and treatment. What are the telltale signs of an ACL injury? The most common symptoms include:

• A popping sound at the time of injury
• A feeling of the knee “giving out”
• Pain and swelling within 24 hours of the injury
• Loss of full range of motion
• Tenderness along the joint line
• Discomfort while walking

It’s important to note that if left untreated, the swelling and pain may subside on their own. However, attempting to return to sports or strenuous activities without proper treatment can lead to knee instability and potentially cause further damage to the knee’s cartilage.

Diagnosing ACL Injuries: From Physical Examination to Imaging

How do medical professionals diagnose an ACL tear? The diagnostic process typically involves a combination of methods:

Physical Examination and Patient History

During the initial visit, a doctor will:

• Discuss the patient’s symptoms and medical history
• Perform a thorough examination of the injured knee, comparing it to the uninjured knee
• Assess the stability and structure of the knee joint

In many cases, a skilled physician can diagnose most ligament injuries through a comprehensive physical examination alone.

Imaging Tests for ACL Injuries

To confirm the diagnosis and assess the extent of the injury, doctors may employ various imaging techniques:

• X-rays: While they don’t show ligament damage directly, X-rays can reveal if there are any associated bone fractures.
• Magnetic Resonance Imaging (MRI): This non-invasive test provides detailed images of soft tissues, including ligaments, making it particularly useful for diagnosing ACL tears and assessing the severity of the injury.

These imaging tests, combined with the physical examination, allow for a comprehensive evaluation of the ACL injury and help guide treatment decisions.

Treatment Options for ACL Injuries: Conservative vs. Surgical Approaches

What treatment options are available for ACL injuries? The approach to treating an ACL tear depends on several factors, including the severity of the injury, the patient’s activity level, and their overall health. Treatment options generally fall into two categories: conservative management and surgical intervention.

Conservative Treatment for ACL Injuries

For less severe ACL injuries or in cases where the patient’s lifestyle doesn’t demand high levels of knee stability, conservative treatment may be appropriate. This approach typically includes:

• RICE protocol (Rest, Ice, Compression, Elevation)
• Physical therapy to improve strength and stability
• Bracing to provide additional support
• Modification of activities to avoid high-risk movements

Can an ACL tear heal on its own? While complete ACL tears generally do not heal without surgical intervention, partial tears may heal with conservative treatment. However, the knee may remain less stable than before the injury.

Surgical Treatment for ACL Injuries

For more severe ACL tears or for patients who wish to return to high-demand sports or activities, surgical reconstruction is often recommended. ACL reconstruction typically involves:

• Removing the torn ACL
• Replacing it with a graft (often taken from the patient’s own tissue or from a donor)
• Securing the graft to create a new ACL

How long does it take to recover from ACL surgery? The recovery process can take several months to a year, depending on various factors. It typically involves a structured rehabilitation program to restore strength, stability, and function to the knee.

Rehabilitation and Recovery After ACL Injury

Regardless of whether a patient undergoes surgery or opts for conservative treatment, rehabilitation plays a crucial role in recovery from an ACL injury. The rehabilitation process typically focuses on:

• Restoring range of motion
• Strengthening the muscles supporting the knee
• Improving balance and proprioception
• Gradually returning to sport-specific activities

What exercises help in ACL injury recovery? Some beneficial exercises include:

• Quad sets and straight leg raises
• Hamstring curls
• Stationary cycling
• Balance and proprioception exercises
• Controlled lunges and squats

It’s important to note that rehabilitation should be guided by a physical therapist or sports medicine professional to ensure safe and effective recovery.

Preventing ACL Injuries: Strategies for Athletes and Active Individuals

While not all ACL injuries can be prevented, there are strategies that can help reduce the risk, especially for athletes and active individuals. What measures can be taken to prevent ACL injuries?

Neuromuscular Training Programs

These programs focus on improving balance, agility, and body awareness. They typically include:

• Plyometric exercises
• Balance training
• Agility drills
• Strength training, particularly for the core and lower body

Proper Technique and Body Mechanics

Learning and practicing proper techniques for activities such as jumping, landing, and changing direction can significantly reduce the risk of ACL injuries. This includes:

• Maintaining proper alignment of the hips, knees, and ankles
• Landing softly with bent knees
• Avoiding excessive side-to-side movement of the knees

Equipment and Playing Surface Considerations

Proper equipment and suitable playing surfaces can also play a role in preventing ACL injuries:

• Wearing appropriate footwear for the specific sport or activity
• Ensuring playing surfaces are well-maintained and not excessively slippery or sticky
• Using proper protective gear, especially in contact sports

By implementing these preventive strategies, athletes and active individuals can reduce their risk of ACL injuries and maintain healthy, stable knees.

Long-Term Outlook and Considerations for ACL Injuries

Understanding the long-term implications of an ACL injury is crucial for patients and healthcare providers alike. What can individuals expect in the years following an ACL injury or reconstruction?

Return to Sport and Activity

Many patients who undergo ACL reconstruction can return to their previous level of activity, including competitive sports. However, the timeline for return varies and typically ranges from 6 to 12 months post-surgery. Factors influencing return to sport include:

• The patient’s dedication to rehabilitation
• The specific demands of their sport or activity
• Individual healing rates
• The guidance of their healthcare team

Risk of Re-injury and Contralateral Injury

Unfortunately, individuals who have experienced an ACL injury are at an increased risk of:

• Re-injuring the reconstructed ACL
• Injuring the ACL in the opposite knee

This underscores the importance of ongoing preventive measures and careful attention to proper biomechanics even after successful rehabilitation.

Long-Term Joint Health

ACL injuries, particularly those involving additional damage to other knee structures, may increase the risk of developing osteoarthritis in the future. To promote long-term joint health, patients are often advised to:

• Maintain a healthy body weight
• Engage in low-impact exercises to keep the joint mobile
• Continue strength training to support the knee joint
• Be mindful of high-impact activities that may stress the knee

Psychological Considerations

The impact of an ACL injury extends beyond the physical realm. Many patients experience psychological challenges, including:

• Fear of re-injury
• Anxiety about returning to sports or activities
• Frustration with the lengthy recovery process

Addressing these psychological aspects is an important part of the overall recovery process and may involve support from mental health professionals specializing in sports psychology.

Emerging Trends and Future Directions in ACL Injury Management

The field of ACL injury treatment and prevention is continually evolving. What are some of the emerging trends and future directions in ACL injury management?

Biologics and Regenerative Medicine

Researchers are exploring the use of biologics to enhance healing and potentially improve outcomes in ACL injuries. Some areas of interest include:

• Platelet-rich plasma (PRP) injections
• Stem cell therapies
• Growth factors to promote ligament healing

While these approaches show promise, more research is needed to fully understand their effectiveness and optimal use in ACL injury management.

Advanced Surgical Techniques

Surgeons continue to refine ACL reconstruction techniques to improve outcomes and reduce complications. Some areas of focus include:

• All-inside reconstruction techniques
• Preservation of the remnant ACL tissue
• Anatomic placement of grafts
• Use of alternative graft sources

Personalized Treatment Approaches

There is a growing recognition that ACL injury treatment should be tailored to the individual patient. Factors considered in personalized treatment plans may include:

• The patient’s age and skeletal maturity
• Activity level and goals
• Presence of associated injuries
• Genetic factors that may influence healing and recovery

Advanced Rehabilitation Protocols

Rehabilitation strategies continue to evolve, with new approaches focusing on:

• Earlier weight-bearing and range of motion exercises
• Integration of virtual reality and biofeedback in therapy
• Sport-specific rehabilitation programs
• Psychological preparation for return to sport

These emerging trends and future directions hold the potential to further improve outcomes for patients with ACL injuries, potentially leading to faster recovery times, reduced risk of re-injury, and better long-term joint health.

Anterior Cruciate Ligament (ACL) Injuries – OrthoInfo

The following article provides in-depth information about anterior cruciate ligament injuries. The article Anterior Cruciate Ligament (ACL) Injury: Does It Require Surgery? provides in-depth information about treatment for ACL injuries and is recommended as a follow-up to this article.

One of the most common knee injuries is an anterior cruciate ligament (ACL) sprain, or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their ACL.

If you have injured your ACL, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Three bones meet to form the knee joint: the femur (thighbone), tibia (shinbone), and patella (kneecap). The kneecap sits in front of the joint to provide some protection.

Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament (MCL) is on the inside, and the lateral collateral ligament (LCL) is on the outside. They control the side-to-side motion of your knee and brace it against unusual movement.

Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an X, with the anterior cruciate ligament (ACL) in front and the posterior cruciate ligament (PCL) in back. The cruciate ligaments control the front and back motion of your knee.

The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur and provides rotational stability to the knee.

The PCL keeps the shinbone from moving backward too far. It is stronger than the ACL and is injured far less often.  

Normal knee anatomy.  The knee is made up of four main things: bones, cartilage, ligaments, and tendons.

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.

Injured ligaments are considered sprains and are graded on a severity scale.

Injured ligaments are considered sprains and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 sprain. It has been slightly stretched but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been torn in half or pulled directly off the bone, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

The anterior cruciate ligament can be injured in several ways:

• Changing direction rapidly
• Stopping suddenly
• Slowing down while running
• Landing from a jump incorrectly
• Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of estrogen on ligament properties.

When you injure your anterior cruciate ligament, you might hear a popping noise and you may feel your knee give out from under you. Other typical symptoms include:

• Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may go away on its own. However, if you attempt to return to sports, your knee will probably be unstable, and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
• Loss of full range of motion
• Tenderness along the joint line
• Discomfort while walking

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Physical Examination and Patient History

During your first visit, your doctor will:

• Talk to you about your symptoms and medical history.
• Examine your knee, checking all the structures of your injured knee and comparing them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.

Imaging Tests

Other tests which may help your doctor confirm your diagnosis include:

X-rays. Although they will not show any injury to your anterior cruciate ligament, X-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan. An MRI creates better images than X-rays of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL. Obtaining an MRI will, however, allow your doctor to look for injuries to other soft tissue structures in the knee (e.g., meniscus, cartilage).

Treatment for an ACL tear will vary depending on the patient’s individual needs. For example, a young athlete involved in agility sports will most likely require surgery to safely return to sports. A less active older, individual may be able to return to a quieter lifestyle without surgery.

Continue to the next page: ACL Injury: Does It Require Surgery?

To assist doctors in the management of anterior cruciate (ACL) ligament injuries, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Plain Language Summary – Clinical Practice Guideline – Anterior Cruciate Ligament Injury – AAOS

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ACL Injury: Does It Require Surgery? – OrthoInfo

The following article provides in-depth information about treatment for anterior cruciate ligament injuries. It does not discuss knee anatomy, or the causes, symptoms, and diagnosis of ACL injuries. The article Anterior Cruciate Ligament (ACL) Injuries covers these topics and is recommended reading prior to this article.

The information that follows includes treatment options for ACL injuries along with a description of ACL surgical techniques and rehabilitation, potential complications, and outcomes.

This information is intended to assist the patient in making the best-informed decision possible regarding the management of ACL injury.

The ACL is one of the most commonly injured ligaments of the knee. 

Approximately half of ACL injuries occur along with damage to the meniscus, articular cartilage, or other ligaments.  

Injured ligaments are considered sprains and are graded on a severity scale.

Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 sprain. It has been slightly stretched but is still able to help keep the knee joint stable.

Grade 2 Sprains. A Grade 2 sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.

Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been torn in half or pulled directly off the bone, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries are complete or near complete tears.

(Left) Arthroscopic picture of the normal ACL. (Right) Arthroscopic picture of torn ACL [yellow star].

What happens naturally with an ACL injury without surgery varies from patient to patient and depends on the patient’s activity level, degree of injury, and instability symptoms.

Partial ACL Tears

The prognosis (outlook) for a partially torn ACL is often good, with the recovery and rehabilitation period usually lasting at least 3 months.

However, some patients with partial ACL tears may still have instability symptoms. Close clinical follow-up and a complete course of physical therapy help identify those patients with unstable knees due to partial ACL tears.

Complete ACL Tears

Complete ACL tears have a much less positive outcome without surgery.

After a complete ACL tear, some patients are unable to participate in cutting- or pivoting-type sports, while others have instability during even normal activities, such as walking. There are some rare individuals who can participate in sports without any symptoms of instability. This variability is related to the severity of the original knee injury, as well as the physical demands of the patient.

About half of ACL injuries occur in combination with damage to the meniscus, articular cartilage (the smooth cartilage that covers the ends of bones), or other ligaments.

Secondary (related) damage may occur in patients who have repeated episodes of instability due to ACL injury. With chronic instability, the majority of patients will have meniscus damage 10 or more years after the initial injury. Similarly, articular cartilage lesions are more common in patients who have a 10-year-old ACL deficiency.

Progressive physical therapy and rehabilitation can restore the knee to a condition close to its pre-injury state and teach the patient how to prevent instability. The doctor may also recommend wearing a hinged knee brace for added support. However, many people who choose not to have surgery suffer an injury to another part of the knee due to instability in the joint.

Surgical treatment is usually recommended for combined injuries (ACL tears that occur along with other injuries in the knee). However, deciding against surgery is reasonable for certain patients.

Nonsurgical management of isolated ACL tears is likely to be successful or may be recommended in patients:

• With partial tears and no instability symptoms
• With complete tears who don’t experience symptoms of knee instability during low-demand sports and are willing to give up high-demand sports
• Who do light manual work or live sedentary (inactive) lifestyles

There is increasing evidence that children with ACL tears are at high risk for future damage to the meniscus or cartilage with nonsurgical management. If your child or adolescent has open growth plates and an ACL tear, talk to the surgeon about the risks and benefits of surgery, as the growth plates can be avoided with certain surgical techniques.

ACL tears are not usually repaired using sutures (stitches) because repaired ACLs have generally been shown to fail over time.

Recent studies have focused on the repair of certain types of ACL tears (typically, an avulsion, or separation, of the ligament from where it attaches to the femur, or thighbone) with various techniques and the potential use of biologics to promote healing; however, long-term studies do not yet support widespread use.

Therefore, the torn ACL is generally replaced by a substitute graft made of tendon, including:

• Patellar, hamstring, or quadriceps tendon autograft (autografts come from the patient)
• Patellar tendon, Achilles tendon, semitendinosus, gracilis, or posterior tibialis tendon allograft (allografts come from a tissue donor)

Who Should Consider ACL Reconstruction Surgery?

• Active adult patients who are involved in sports or jobs that require pivoting, turning, or hard-cutting, or who perform heavy manual work are encouraged to consider surgical treatment. This includes older patients who have previously been excluded from consideration for ACL surgery. Activity level, not age, should determine whether surgery should be considered.
• In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. However, recent studies support early ACL reconstruction, as delaying treatment can lead to a higher rate of future meniscus or cartilage injuries. 
• A patient with a torn ACL and significant functional instability has a high risk of developing damage in other areas of the knee and should therefore consider ACL reconstruction.
• It is common to see ACL injuries combined with damage to the menisci, articular cartilage, collateral ligaments, joint capsule, or a combination of the above. The “unhappy triad,” frequently seen in football players and skiers, consists of injuries to the ACL, the MCL, and the medial meniscus. In cases of combined injuries, surgical treatment may be necessary and generally produces better outcomes. As many as half of meniscus tears may be fixable, and they may heal better if the repair is done at the same time as the ACL reconstruction.

Surgical Options

Patellar tendon autograft prepared for ACL reconstruction.

Patellar tendon autograft. A patellar tendon autograft is made up of the middle third of the patient’s patellar tendon, along with a bone plug from the shin and the kneecap. Considered by some surgeons as the “gold standard” graft for ACL reconstruction, it is often recommended for high-demand athletes and patients whose jobs do not require a significant amount of kneeling.

In studies comparing outcomes of patellar tendon and hamstring autograft ACL reconstruction, the rate of graft failure was lower in the patellar tendon group. In addition, most studies show equal or better outcomes in terms of post-operative tests for knee laxity, or looseness, when this graft is compared to others. 

The potential drawbacks of the patellar tendon autograft are:

• Post-operative pain behind the kneecap 
• Pain with kneeling
• Slightly increased risk of post-operative stiffness
• Slight risk of patellar (kneecap) fracture

Hamstring tendon autograft. The hamstring tendon autograft uses the semitendinosus hamstring tendon on the inner side of the knee. Some surgeons use an additional tendon, the gracilis, which is attached below the knee in the same area. This creates a two- or four-strand tendon graft. Hamstring graft supporters claim there are fewer problems associated with harvesting the graft compared to the patellar tendon autograft, including:

• Less anterior (kneecap) knee pain after surgery
• Less postoperative stiffness
• Smaller incision
• Faster recovery

However, there may be drawbacks to using a hamstring graft, including:

• Post-operative function may be more limited than with the patellar tendon graft.
• The grafts may be slightly more vulnerable to stretching, which can lead to increased laxity (looseness) in the knee.
• The patient may have decreased hamstring strength after surgery.

Hamstring tendon autograft prepared for ACL reconstruction.

Quadriceps tendon autograft. The quadriceps tendon autograft is often used for primary (initial) reconstruction as well as revision (repeat) reconstruction procedures. The surgeon uses the middle third of the patient’s quadriceps tendon and a bone plug from the upper end of the kneecap, which produces a larger graft for taller and heavier patients.

Potential drawbacks include the following:

• Because there is a bone plug on one side only, the fixation is not as solid as for the patellar tendon graft, so loosening may occur.
• There is a high association with post-operative pain in front of the knee and a slight risk of patella fracture.
• Patients may find the incision is not cosmetically appealing.

Allografts. Grafts taken from human donors are safe, effective choices for certain patients. Allografts are also used for patients who have failed ACL reconstruction before and during surgery to repair or reconstruct more than one knee ligament.

Advantages of using allograft tissue include:

• Elimination of pain caused by obtaining the graft from the patient
• Decreased surgery time
• Smaller incisions

With modern sterilization techniques, the risk of any form of disease transmission from donor to recipient is exceptionally low.

Some studies, however, may point to a higher failure rate with the use of allografts for ACL reconstruction. Higher failure rates for allografts have been reported in young, active patients returning to high-demand sporting activities after ACL reconstruction, compared with autografts.

The reason for this higher failure rate is unclear. It could be due to graft material properties (sterilization processes used, graft donor age, storage of the graft). It could also be because the athletes thought the allograft would enable a faster recovery and returned to their sports too soon — before the graft was ready to withstand the loads and stresses of sports. More research is needed to determine whether allografts are a good option for this patient population.

Surgical Procedure

Before any surgical treatment, the patient is often sent to physical therapy. Patients who have a stiff, swollen knee lacking full range of motion at the time of ACL surgery may have significant problems regaining motion after surgery. It may take several weeks from the time of injury for the swelling and stiffness to subside enough to proceed with surgery.

Additionally, it is sometimes recommended that ligaments injured at the same time as the ACL be braced and allowed to heal before ACL surgery. For example, medial collateral ligament (MCL) injuries that occur along with ACL injuries often heal without surgery, so it’s possible that only the ACL would need to be addressed during the surgery.

The patient, the surgeon, and the anesthesiologist will select the anesthesia used for surgery. Patients may benefit from an anesthetic block of the nerves of the leg to decrease post-operative pain.

The surgery usually begins with an examination of the patient’s knee while the patient is relaxed (after being given anesthesia). This final examination is used to verify that the ACL is torn and to check for looseness of other knee ligaments that may need to be repaired during surgery or addressed post-operatively.

If the physical exam strongly suggests the ACL is torn, the surgeon will prepare the graft. They either harvest (for an autograft) or thaw (for an allograft) the selected tendon and create the graft to the correct size for the patient.

Passage of patellar tendon graft into tibial tunnel of knee.

After the graft has been prepared, the surgeon makes small (1cm) incisions called portals in the front of the knee and inserts the arthroscope and instruments.

Once the arthroscope and instruments are in place, the surgeon will examine the condition of the knee, trim or repair any meniscus and cartilage injuries, and then remove the torn ACL stump.

Post-operative X-ray after ACL patellar tendon reconstruction (with picture of graft superimposed) shows graft position and bone plugs fixation with metal interference screws.

In the most common ACL reconstruction technique, the surgeon drills bone tunnels into the tibia and the femur so they can place the ACL graft in a way that is as anatomically correct as possible. Once the graft is placed into the knee, it is held under tension and fixed in place with screws, buttons, or other device. These devices are generally not removed after surgery. 

The surgeon then closes the skin incisions and applies dressings over them. The surgeon may also put a post-operative brace and cold therapy device on the patient’s knee. The patient will usually go home the same day as their surgery.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose have become critical public health issues in the U.S. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain begins to improve. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Rehabilitation

Physical therapy is a crucial part of successful ACL surgery, with exercises beginning immediately after the surgery. Much of the success of ACL reconstructive surgery depends on the patient’s dedication to rigorous physical therapy. With new surgical techniques and stronger graft fixation, current physical therapy uses an accelerated course of rehabilitation.

Post-operative Course. In the first 7 to 10 days after surgery, the wound is kept clean and dry, and early emphasis is placed on regaining the ability to fully straighten the knee and restore quadriceps control.

The knee is iced regularly to reduce swelling and pain. The surgeon may order the use of a post-operative brace and a machine to move the knee through its range of motion, although this machine has not been shown to significantly improve patient outcomes.

Weightbearing status (use of crutches to keep some or all of the patient’s weight off of the surgical leg) is also determined by physician preference, as well as other injuries addressed at the time of surgery.

Rehabilitation. The goals for rehabilitation of ACL reconstruction include:

• Reducing knee swelling
  Maintaining mobility of the kneecap to prevent anterior knee pain problems or stiffness
• Regaining full range of motion of the knee
• Strengthening the quadriceps and hamstring muscles

The patient may return to sports when:

• There is no longer pain or swelling
• They have achieved full range of motion in the knee
• Muscle strength, endurance, and functional use of the leg are fully restored
• Sense of balance and control of the leg are fully restored (through exercises designed to improve neuromuscular control).

Most patients are allowed to return to full sports participation within 6 to 12 months, depending on the patient’s progress, strength, and mechanics.

The use of a functional brace when returning to sports is not necessarily required after a successful ACL reconstruction, but some patients may feel a greater sense of security by wearing one.

Potential Surgical Complications

Infection. The risk of infection after arthroscopic ACL reconstruction is very low.  There have also been reported deaths linked to bacterial infection from allograft tissue due to improper procurement and sterilization techniques.

Viral transmission. Allografts specifically are associated with risk of viral transmission, including HIV and Hepatitis C, despite careful screening and processing. The chance of obtaining a bone allograft from an HIV-infected donor is calculated to be less than 1 in 1 million.

Bleeding, numbness. Rare risks include bleeding from acute injury to the popliteal artery, and weakness or paralysis of the leg or foot. It is not uncommon to have numbness of the outer part of the upper leg next to the incision, which may be temporary or permanent.

Blood clot. Although rare, a blood clot in the veins of the calf or thigh is a potentially life-threatening complication. A blood clot may break off in the bloodstream and travel to the lungs, causing pulmonary embolism or to the brain, causing stroke. 

Instability. Chronic instability due to rupture or stretching of the reconstructed ligament or poor surgical technique is possible. It occurs in 5 to 10% of patients, long-term.

Stiffness. Knee stiffness or loss of motion has been reported by some patients after surgery and sometimes needs to be addressed surgically. The surgeon will either resect (remove) scar tissue or manipulate the knee under anesthesia. 

Extensor mechanism failure. Rupture of the patellar tendon (patellar tendon autograft) or patella fracture (patellar tendon or quadriceps tendon autografts) may occur due to weakening at the site where the graft was harvested (removed).

Growth plate injury. In young children or adolescents with ACL tears, early ACL reconstruction creates a possible risk of growth plate injury, leading to bone growth problems. ACL surgery can be delayed until the child is closer to reaching skeletal maturity; however, this comes with a risk of future meniscus or cartilage injury. Alternatively, the surgeon may be able to modify the ACL reconstruction technique to decrease the risk of growth plate injury during surgery.

Kneecap pain. Post-operative anterior (front of the) knee pain is especially common after patellar tendon autograft ACL reconstruction. The incidence of pain behind the kneecap varies greatly in studies, whereas the incidence of kneeling pain is often higher after patellar tendon autograft ACL reconstruction.

To assist doctors in the management of anterior cruciate (ACL) ligament injuries, the American Academy of Orthopaedic Surgeons has conducted research to provide some useful guidelines. These are recommendations only and may not apply to every case. For more information: Plain Language Summary – Clinical Practice Guideline – Anterior Cruciate Ligament Injury – AAOS

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Partial rupture of the anterior cruciate ligament – symptoms, causes, treatment

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Among the numerous intra-articular injuries, the most common is a partial rupture of the anterior cruciate ligament of the knee. A fragmentary violation of the anatomical integrity of the main stabilizer of the knee joint, in the absence of high-quality diagnostics and proper treatment, entails the development of instability and deforming osteoarthrosis. In addition, even the smallest load can cause repeated, more serious injury. And only a timely appeal to an orthopedist-traumatologist is the key to successful recovery and return to the previous level of physical activity.

CMRT specialist tells

Kuchenkov A.V.

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor • 24 years of experience

Publication date: April 28, 2021

Verification date: January 07, 2023

All facts have been verified by a physician.

Contents of the article

Causes of partial ACL rupture

The human knee joint is the largest, most complex and vulnerable anatomical structure. The anterior cruciate ligament, which keeps the lower leg from excessive forward displacement, consists of a double bundle of collagen fibers. A partial rupture of the ACL is diagnosed with multiple tears of the fibrous fibrous tissue and fragmentary damage to the joint capsule. It can provoke:

• side impact on the knee, thigh or shin
• twisting on the supporting leg, in which the foot and shin remain in place
• a sharp turn of the body during braking
• an unsuccessful jump

Predisposing factors for injury include skiing, contact sports, traffic accidents, heavy physical labor, excessive load after prolonged physical inactivity, violation of the structure of the knee joint. Unlike total, partial rupture of the cruciate ligament does not lead to a complete loss of knee functionality. Often this is the reason for delayed diagnosis and treatment.

Symptoms of a partial rupture of the ACL

Degrees of damage

Diagnosis

Which doctor should I contact?

Mamaeva Lidia Semyonovna

Neurologist • Reflexologist • Physiotherapist • Hirudotherapist
experience 48 years

Konovalova Galina Nikolaevna

Neurologist
experience 44 years

Linkorov Yury Anatolyevich

Neurologist
experience 42 years

Charin Yury Konstantinovich

Orthopedist • Traumatologist • Vertebrologist
experience 34 years

Kuznetsova Elena Nikolaevna

Neurologist
experience 32 years

Dikhnich Oleg Anatolyevich

Orthopedist • Traumatologist
experience 31 years

Gaiduk Alexander Alexandrovich

Orthopedist • Physical therapy doctor • Physiotherapist
experience 30 years

Bodan Stanislav Mikhailovich

Orthopedist • Traumatologist
experience 27 years

Kuchenkov Alexander Viktorovich

Orthopedist • Traumatologist • Surgeon • Phlebologist • Sports doctor
experience 24 years

Samarin Oleg Vladimirovich

Orthopedist • Traumatologist • Vertebrologist
experience 24 years

Yan Anzhela Alexandrovna

Neurologist • Reflexologist
experience 23 years

Kareva Tatyana Nikolaevna

Neurologist
experience 22 years

Tkachenko Maxim Viktorovich

Orthopedist • Traumatologist
experience 20 years

Ismailova Elvira Tagirovna

Neurologist
experience 20 years

Agumava Nino Mazharaevna

Neurologist
experience 19 years

Lysikova Tatyana Gennadievna

Neurologist • Physiotherapist
experience 19 years

Bachina Natalya Iosifovna

Neurologist
experience 19 years

Repryntseva Svetlana Nikolaevna

Neurologist
experience 18 years

Bulatsky Sergey Olegovich

Orthopedist • Traumatologist
experience 16 years

Lisin Valery Igorevich

Neurologist
experience 15 years

Shishkin Alexander Vyacheslavovich

Neurologist • Chiropractor
experience 13 years

Pivkovsky Dmitry Igorevich

Orthopedist • Traumatologist
experience 12 years

Dorofeeva Maria Sergeevna

Neurologist
experience 11 years

Filippenko Anton Olegovich

Neurologist • Reflexologist
experience 11 years

Stepanov Vladimir Vladimirovich

Orthopedist • Traumatologist • Vertebrologist
experience 10 years

Teleev Marat Sultanbekovich

Orthopedist • Traumatologist • Sports doctor
experience 10 years

Shtanko Vladislav Anatolyevich

Orthopedist • Traumatologist
experience 9years

Amagova Tamila Magomedovna

Neurologist
experience 9 years

Miropolsky Ilya Andreevich

Neurologist
experience 9 years

Suleymanov Kurban Abbas-Ogly

Neurologist
experience 9 years

Atamuradov Toyli Atamuradovich

Orthopedist • Sports doctor • Surgeon
experience 8 years

Satieva Marina Garunovna

Neurologist
experience 7 years

Akhmedov Kazali Muradovich

Orthopedist • Traumatologist
experience 6 years

Orazmyradov Khalnazar Ataballyevich

Orthopedist • Traumatologist
experience 5 years

Sattorov Abboskhon Nodirovich

Orthopedist • Traumatologist
experience 4 years

How to treat a partial rupture of the ACL?

Head of “Rehabilitation” direction, physical therapist

Braescu Marina Nikolaevna
Physical Therapist • Experience 11 years

Head of Rehabilitation, Physical Therapist

Injuries and diseases of the musculoskeletal system can significantly reduce the level of activity, both in terms of sports and at the household level. Rehabilitation in the “Laboratory of Movement” is aimed at the maximum possible recovery, compensation for impaired or completely lost functions.
A multidisciplinary, comprehensive, but at the same time individual approach allows you to reduce recovery time. The specialists of the clinic strive to form a responsible attitude of the patient to the rehabilitation process and their health.

Braescu Marina Nikolaevna
Physical Therapist • Experience 11 years

Rehabilitation

Consequences

Prevention

Treatment and rehabilitation after partial ACL rupture in CMRT

Anterior cruciate ligament rupture of the knee joint: symptoms, causes and treatment 900 01

Rupture of the anterior cruciate ligament is a severe injury in which there is a click in the knee and pain. If left untreated, it can lead to serious consequences in the future.

Contents

• Anatomy of the knee joint
• What is an anterior cruciate ligament injury
• Causes of torn anterior cruciate ligament of the knee
• Symptoms of injury
• Types and stages of injury
• Diagnosis of torn anterior cruciate ligament of the knee
• Treatment of torn anterior cruciate ligament ligaments of the knee joint
• Complications of injury
• Pathology prevention

Anatomy of the knee joint

The knee joint is made up of three bony structures. They are covered with cartilage, which is an elastic and elastic tissue that performs a shock-absorbing role.

Between the femur and tibia there are two C-shaped ridges, the cartilaginous structure of which includes the medial and lateral menisci. They also act as shock absorbers and keep the surfaces of the joints in line with each other.

Ligaments

They are the connective tissue that holds muscles, bones and joints together. The stability of the knee joint is possible due to the interaction of four main ligaments.

Muscles

The knee joint is adjacent to several groups of strong muscles responsible for human movement. On the lateral and anterior surfaces of the joint is the quadriceps femoris muscle, which allows you to extend the knee. The muscles of the back of the thigh are responsible for knee flexion.

What is an anterior cruciate ligament injury

If any of the knee ligaments connecting the upper and lower leg bones is damaged, it is called an anterior cruciate ligament injury. When the gap is small, then this is a mild degree of damage. Total rupture of the cruciate ligament of the knee joint or separation of the segments from the whole bone indicate a severe injury.

Causes of anterior cruciate ligament tear in the knee joint

Most often, the injury occurs during sports training. The cause may be a sudden change in direction of running, a fall to the feet after a jump, or a blow to the knee with a foreign object. At risk are football players, skiers and other athletes who often make active movements, jumps.

Falls from stairs can cause injury. The cruciate ligaments become weaker as the body ages. Therefore, in people over forty years of age, the risk of injury in dangerous cases is higher than in young people.

Causes of injury:

• inaccurate knee movements, for example, when abruptly stopping while running, jumping from a height, falling;
• sharp turns of the leg, in which the foot remains in one place, and the lower leg turns inward;
• hitting the front of the knee with a heavy object;
• traffic accidents.

Symptoms of injury

Signs of damage:

1. During an injury – a sound in the knee, resembling crackling, pain.
2. Swelling of the injured area in the first few hours after injury. This sign may indicate bleeding inside the joint. If the swelling appeared suddenly, then most likely the damage was serious.
3. Inability to stand normally due to inadequate support.
4. Insufficient range of motion due to swelling and pain.
5. “Offset” knees forward.

An injury can be suspected if, after a provoking factor, the knee began to bend in atypical directions, especially when several such movements are observed at once.

If the injury occurs during sports training, it usually cannot be completed. This also applies to other physical activities. However, the ability to walk remains.

The main sign of a rupture is bulging or bending of the knee, sometimes with swelling and pain. Such signs may not appear immediately after the injury, but later if it is not treated.

In advanced cases, the clinical picture consists of signs of joint instability. It manifests itself in the form of a shifting of the lower leg when moving, the inability to sit down on one leg. There are also positive symptoms of the “drawer”, rapid fatigue of the injured leg, static pain in the lower back, hip, healthy limb. Muscle atrophy of the injured leg is considered an objective manifestation.

Types and stages of damage

Based on the duration and size of the injury, there are:

• acute tear;
• partial rupture of the anterior cruciate ligament of the knee;
• avulsion of the anterior cruciate ligament along with part of the bone;
• chronic rupture of the anterior cruciate ligament of the knee joint, chronic instability of the knee joint.

Depending on the severity of the injury, there are different degrees of damage to the cruciate ligament.

If it is slightly stretched, moderate swelling and pain appear. A person cannot fully move, but the stability of the joint is maintained.

Partial rupture causes more swelling and pain than in the previous case. The stability of the joint is maintained, but the strength of the ligament is reduced. This is fraught with repeated injuries in the future.

Complete rupture of the cruciate ligament of the knee joint is accompanied by severe swelling, severe pain. The person is unable to lean on the injured leg. There is instability of the joint.

Diagnosis of rupture of the anterior cruciate ligament of the knee

Examination by an orthopedic traumatologist. First, he learns from the patient when and what symptoms appeared, what preceded them. Also, the doctor finds out the general features of the patient’s health.

A reliable criterion for a cruciate ligament tear is “anterior and posterior drawer” symptoms. For diagnosis, the doctor asks the patient to lie on his back on the couch. The doctor sits next to him, while the patient’s foot rests on his thigh. The specialist grabs the upper third of the lower leg with a brush and tries to move it forward or backward. If the lower leg moves too much, then this indicates a positive test result.

The following methods are additionally used:

1. MRI. Allows you to examine soft tissues, to establish associated deviations.
2. X-ray. It is carried out to determine the damage to bone structures.

Anterior cruciate ligament tear treatment

If an injury is suspected, the load on the injured limb should be minimized. You can take an analgesic. It is important to seek medical help as soon as possible.

After an injury, the doctor may recommend that the patient apply ice packs or cold compresses to the affected area to reduce swelling. The procedure is carried out at least two days every two hours and takes 20 minutes.

If the patient is young, surgery is usually performed. For elderly patients, conservative treatment is suitable, since they are not as physically active as young people.

Conservative

Without surgery, the cruciate ligament cannot recover and function the way it used to. However, if the stability of the joint is preserved and the physical activity is low in the future, the doctor may recommend conservative therapy, which includes:

1. External stabilization. To prevent instability of the knee joint, the patient is advised to wear a brace. Crutches help relieve stress on the knee.
2. Physiotherapy. They are prescribed after the swelling and pain have passed. Physiotherapy helps the affected area to recover.

Anterior cruciate ligament tear surgery

The ligament cannot be repaired by stitching. The only exception is the Segond fracture. In other cases, surgeons replace the ligament with grafts (other tendons in the knee area) to form a new one. Sometimes the role of the physiological structure is assigned to the endoprosthesis.

Reconstructive surgery is performed by arthroscopy. In this case, the doctor makes small punctures (1-2 cm long). Through one puncture, he places an arthroscope into the joint. This allows you to examine the affected area from the inside. In this case, the picture is displayed on the monitor in an enlarged form.

Through another puncture, the surgeon inserts small instruments with which to perform the operation. Arthroscopy can be used to accurately perform manipulations with a low degree of trauma. This operation allows you to sew or remove part of the menisci, transplant cartilage, etc.

After surgery, the ligament becomes elastic and anatomically correct within six months. Sometimes the process takes longer than six months. After this period, the doctor decides whether the patient can return to sports.

The rehabilitation period includes physiotherapy and exercise therapy. Physiotherapy allows you to restore the mobility of the knee. Physical exercises are aimed at strengthening the muscles, which is necessary for the prevention of re-injury.

Trauma complications

Incorrect or untimely treatment disrupts the movement mechanism in the knee. The bones begin to come into contact with each other, which can cause injury to the cartilage and rupture of the menisci. This is fraught with the development of osteoarthritis.

Other complications:

• joint contracture – decreased range of motion in it;
• arthrosis;
• chronic instability of the joint.

Prevention of pathology

Prevention is aimed at preventing injuries. For this, athletes have special programs.

Unfortunately, a tear in the anterior ligament cannot be completely ruled out. Even a careless fall can lead to it.

If you develop symptoms that indicate joint damage after triggers, do not self-medicate. Seek medical attention soon for diagnosis and treatment. Remember that ignoring injury can cause serious health problems.

The doctors of the rehabilitation clinic in Khamovniki will help you regain normal knee mobility after injuries and return to a full life.