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While you may not need surgery, recovery can still be extensive.

Injuring your ACL

Injuring your ACL can sideline you for months. While you may not need surgery, recovery can still be extensive. You’ll need to follow your doctor’s and physical therapist’s recommendations in order to return to sports and perform optimally.

ACL injuries may occur in athletes, especially in sports such as basketball, soccer, and football. One of the four major ligaments in the knee, our ACL contributes to the stability of our knee joint. When you injure your ACL you may experience symptoms such as your knee feeling like it’s going to give out, loss of range of motion, pain, swelling, and tenderness near the joint. ACL injuries can often coincide with other knee injuries such as damage to the articular cartilage, other ligaments, or the meniscus. Injuries to the ACL are graded from grade 1 sprains (the least severe) to grade 3 sprains (the most severe). Partial tears to this ligament are rare, and most ACL injuries involve near complete or complete tears.

What is recovery for an ACL injury like?

It’s likely that the treatment for your ACL injury will take months. After the doctor confirms your diagnosis with tests such as x-rays or MRIs, and conducts a physical exam, you will be recommended the best treatment option based on the severity of your injury. Factors such as prior injuries and whether any additional injuries have been sustained to the knee will affect what treatment you may need. Nonsurgical treatments will include bracing your knee and physical therapy, which will help strengthen the muscles in your knee and the muscles that support the joint.

Surgery for ACL Injuries

In most cases, your ACL tear cannot be stitched back together. In order to surgically repair the ACL, your doctor may try to restore the torn ligament with a tissue graft. With tissue grafts, regrowth of tissue can take time and you can expect to need six months or more before you can return to regular activity.

Treatment is especially complex for active patients and athletes, especially when it comes to sports that require pivoting, turning, or hard-cutting. Unlike other conditions, when treating ACL injuries doctors look at activity levels and not age when coming up with treatment plans. In young or adolescent patients, ACL reconstruction can be complicated by growth plate injuries which can lead to bone growth problems. Due to this, surgery may be delayed to decrease risk of these complications. In addition, those with ACL injuries are also more likely to develop secondary knee damage, which can make reconstructive imperative for rehabilitation. When it comes to ACL injuries related to sports, the injury can often coincide with menisci, joint capsule, collateral ligaments, and articular cartilage injuries. When more than one injury occurs, surgical treatment is likely needed to produce optimal outcomes.

Before surgery, you will likely be required to attend physical therapy. Physical therapy prior to surgery can help you obtain a larger range of motion which can help with the healing process post-surgery. It can take three or more weeks post-injury in order to regain full range of motion. Prior to surgery, you may be required to wear a brace while you heal.

During surgery under anesthesia, the doctor will examine the leg to verify the ACL is torn as well as check for other injuries that may need to be repaired during or after surgery. If the ACL is torn, a tendon is then harvested (or thawed for an allograft) and prepared. Performed arthroscopically, the surgeon will examine the condition of the knee during the first step of the procedure. Any injuries to the meniscus or cartilage can be trimmed or repaired during this time. After this, the torn ACL stump is removed. There are several different ACL reconstruction surgical techniques. The most common technique involves the drilling of bone tunnels into the tibia and the femur in order to place the graft in a similar position to the torn ACL. Sutures are placed using a long needle which is passed through the tibia, through the femoral tunnel, and out through the thigh. This pulls the graft into position through the tibial tunnel and then up into the femoral tunnel. The graft is then fixed in place using interference screws, staples, spiked washers, or posts. Variations of this technique can also be used and involve two-incision, double bundle, and over-the top techniques depending on the surgeon’s preference or if the surgery is a revision or reconstructive procedure. During the final part of the surgery, the surgeon will probe the graft in order to make sure there is good tension, assess the stability of the graft, and test range of motion. Dressings will be applied and a post-operative brace and cold therapy device may be used. You may be able to recover at home the same day post-surgery.

Rehabilitation for ACL Injuries

You will feel some pain after surgery and will want to talk to your doctor about pain management options. Prescription pain medication as well as NSAIDs may be recommended. As an athlete, there are several options for braces that can offer compression, heating, and icing features which can help both with pain and stiffness. Physical therapy will be a major part of your rehabilitation. Exercises will start immediately after surgery and can determine how well you recover. Post-surgery, the first ten to fourteen days involve keeping the wound clean and regaining the ability to fully straighten the knee as well as restore control of the quadricep. You will work with your physician to determine if you are able to bear weight on the leg. In the following four to six months, you will work to reduce swelling, maintain mobility, and regain range of motion and strength. You can return to sports when there is no longer any pain or swelling and have regained a full range of motion and strength. Your doctor may recommend that you use a functional brace, but it is not always required.

Preventing an ACL Injury

In order to prevent ACL tears, you want to avoid injury during movements such as changing direction rapidly, stopping suddenly, slowing down suddenly, landing badly from a jump, or direct collisions. Targeted strength training, improving balance, wearing proper footwear, and warmups and stretching can all help prevent ACL injuries. Follow your coaches, doctors, and physical therapist’s advice when returning to sports after your ACL injury.

To learn more about the ACL injuries visit the American Academy of Orthopaedic Surgeons. Make an appointment to discuss your options with one of the specialists at Essex Orthopaedics & Sports Medicine.

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