Anterior Cruciate Ligament (ACL) injuries get a lot of scientific and lay press exposure especially lately as NFL players are suffering them more and more. But what is the ACL and what does injury to it mean?
The ACL is one of four major ligaments that hold the knee together. It helps control rotation (twisting) and translation (abnormal shifting) of the knee – which is made up of the tibia and femur. It can tear by itself or along with other structures including other ligaments, cartilage, and meniscus. The ACL is an important ligament when playing pivoting sports such as soccer, basketball and football. When the ligament is torn the knee may give way or buckle when playing these types of sports.
How does the ACL tear?
The majority of ACL tears (70%) come from noncontact injury, like running fast then coming to a jump stop in basketball, and the knee buckles. Other injuries come from contact as a slide tackle in soccer. When it tears usually there is severe pain (but not always) and a large amount of swelling that develops quickly.
Does an ACL tear require emergency surgery?
Absolutely not, and not all patients need surgery at all. ACL treatment is very individualized. Treatment depends on several factors including age, activity level, desire to play sports and other medical factors. If surgery is selected then the treatment is a reconstruction – we replace the ligament by using a tendon. The surgery is done arthroscopically (with a camera) and you can go home the same day. The timing of surgery varies but in general it is best to wait until the swelling is gone and the knee has full range of motion.
What if I don’t want surgery?
Nonsurgical management consists of therapy to restore motion and strength in the knee. In general activities such as running, biking and swimming and others that don’t involve pivoting or sudden stops can be done without an ACL. A brace can help stabilize the knee as well. Return to activities can be several weeks after the tear. We do not recommend return to pivoting sports without an ACL due to the high risk of injuring other important structures, which can result in permanent worsening of the knee.
If I have surgery can I definitely play sports again?
The goal of surgery is to make the knee stable so it can withstand the forces of stopping, going and pivoting. The majority of people who have reconstruction return to their pre-injury level – but not all. So many factors go into a successful surgery such as return of strength, motion, balance, and endurance.
Often we forget to mention the Fear Factor associated with return to playing sports. Just watch Robert Griffin III play football Sunday and you’ll see what I mean. Many athletes are very tentative (rightfully so) when returning to sports, and some give it up all together to avoid future injury or possibly surgery. What you must understand is that the new ACL is no better than what you were born with so it can tear again!! With good surgical technique and functional rehabilitation success can be obtained.
How soon can I get back to sports after ACL surgery?
This is the hotly debated topic of today. No one has the true answer or criteria yet to predict successful return to play. In general 6-9 months is the average return to play time after ACL reconstruction. Some people take longer than other for many reasons. Look at Derek Rose from the Chicago Bulls compared with Adrian Peterson of the Minnesota Vikings. Same surgery, both elite athletes with very different recovery time.
ACL injury can be a huge blow to some athlete’s plans for the future. By seeking a board certified sports medicine trained Orthopaedic Surgeon you can assure yourself the best possible outcome.