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Anterior Cruciate Ligament (ACL) Tears

What is an ACL Tear?

ACL injuries are among the most common knee injuries, affecting over 200,000 Americans every year. Almost 50% of ACL injuries occur with damage to other knee structures, including the articular cartilage, the menisci or other knee ligaments.

An ACL rupture often affects young, physically active people. Women who participate in sports, such as skiing, soccer, basketball, softball, lacrosse, or rugby are four times more likely than men to rupture their ACL.

What is the ACL?

The knee joint is comprised of three bones – the thighbone or femur, the shinbone or tibia and the kneecap or patella. The femur and tibia are held together by the knee capsule and ligaments. Inside the knee joint are two cruciate ligaments located in the center of the knee. They are called the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), and they form an “X” within the knee joint. The ACL keeps the tibia from sliding forward with respect to the femur, provides rotational stability, and is vital to knee joint stability.

How do ACL injuries occur?

People who participate in high risk sports like soccer, football, basketball, and skiing are at risk for injury to their ACL. The majority of ACL injuries result from a sharp twisting of the knee, sudden deceleration while cutting, pivoting, and sidestepping movements, sudden stopping when running, and an awkward landing from a jump. Other causes include direct contact, a fall or traumatic accident.

What are the symptoms of an ACL injury?

A cardinal symptom is a popping sound when the injury occurs, immediate intense pain, swelling, and knee buckling.  While the pain may resolve, knee instability will likely remain. Other symptoms include a loss of range of motion, tenderness at the joint line and difficulty walking.

Can an ACL injury heal on its own?

The ACL cannot heal on its own because the synovial fluid present within the knee joint prevents adequate healing potential. An ACL rupture is a serious injury that has the potential for long-term complications including functional impairment, osteoarthritis and impaired quality of life.

While ACL surgery remains the gold standard treatment to regain knee stability and function, the decision whether to have surgery depends on the patient’s goals. Young active patients who desire to return to an active lifestyle may be suitable patients for ACL reconstruction. Conservative treatment may be valuable for patients who do not seek to return to high activity levels.

What is the most accurate way to diagnose an ACL injury?

The combination of a detailed history, comprehensive physical examination, x-rays, and a MRI (magnetic resonance imaging) is the key to successful diagnosis of ACL injuries.  Because almost half of all ACL injuries occur in combination with other knee injuries, imaging studies such as MRI are important to evaluate the full extent of your injuries. In addition to image testing (MRI), Dr. Jonathan Godin use stability tests as part of his physical exam, including the Lachman and Anterior Drawer tests to properly diagnose an ACL Injury.

What is ACL reconstruction surgery?

ACL reconstruction surgery is a minimally invasive procedure performed with the assistance of knee arthroscopy. A tiny camera is inserted into the knee to view, assess, and treat a torn ACL. Reconstruction involves the removal and replacement of the ruptured ligament with your own tissue (autograft) or donor tissue (allograft). The new ligament is attached to bone with screws or other devices to hold the graft in place. Knee arthroscopy can also be used to repair a torn meniscus commonly found in conjunction with an ACL rupture.

The source of the graft tissue and the technique depend on the age and activity level of the patient, desired outcome, and preferred method of the surgeon. Bone-patellar tendon-bone (BTB) autograft ACL reconstruction has the longest proven track record of successful outcomes, and is the technique to which all others are compared. Other options include the hamstring tendons (semitendinosus and gracilis) along the inner part of the thigh and knee. More recently, the quadriceps tendon has gained popularity as a graft source for ACL reconstruction; however, further data is necessary for a more widespread use.

How long is the recovery?

Recovery from an ACL reconstruction takes an average of 9-12 months including full rehabilitation to restore range of motion, strengthen the muscles, and recover balance. Furthermore, injury prevention after completing the rehabilitation remains of utmost importance to prevent subsequent injuries.

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