What is an ACL Injury?
Ligaments attach bone to bone and although there are several ligaments surrounding the knee the most important to the active individual is a small ligament in the center of the knee called the ACL. It is crucial in providing stability to the knee for running, jumping, cutting, pivoting and downhill activities.
How Do I Tear My ACL?
Although the injury can occur by a violent collision or fall over 80% occur through a non-contact event that people describe as a “hyperextension” or “shifting” episode.
Is There a Difference Between Girls/Women and Boys/Men?
Yes. Females have a much higher risk of ACL tears, as well as a higher risk of reinjury after surgery. In addition, surgical technique needs to be altered to protect the growth plates of a growing child.
What Are the Symptoms of an ACL Tear?
For some the knee is extremely painful with inability to bear weight, but for others the symptoms don’t prevent the person from finishing the offending activity. Very often the knee swells or “feels stiff” within the first several hours.
If no other structures are injured the pain and swelling resolve within days; however, the universal complaint is that the knee feels “unstable”, “weak”, “wants to hyperextend”, “give way”, “can’t trust it.”
How Is the Diagnosis Made?
The most accurate way to make the diagnosis is through a detailed history and thorough physical exam by an experienced sports-trained physician.
Do I Need X-Rays Or An MRI?
X-rays are necessary to make sure there is no injury to the bone. An MRI helps assess other injuries to the parts of the knee such as the meniscus or articular cartilage, but is not essential.
Do I Need Surgery?
People can perform nearly all activities of daily living (sitting, standing, walking, bicycling, swimming) without an ACL. With higher demand activities the knee will shift or give way. This will be an inconvenience and annoyance, but more importantly will cause further damage to the knee, particularly the meniscus and joint surface.
Therefore you have two options: change your lifestyle and strengthen your knee or have surgery to fix the ACL tear.
Can I Just Wear a Brace?
Braces have been shown to help reduce instability episodes but do not adequately stabilize the knee to prevent reinjury.
Do I Need Immediate Surgery?
No. Except in rare circumstances, surgery can wait and results seem better if you wait at least 2 weeks beyond the injury. Unless you have a displaced meniscus tear you should delay surgery until the timing is best for you.
If I Choose Surgery What Does That Mean?
We feel 50% of the success of surgery is performing a technically correct procedure and the other 50% is your ability to properly rehabilitate your knee afterwards. Depending on your demands this may take a year or more.
With regards to the surgery itself, “repairing” the ligament historically has had a very high failure rate. Therefore the ligament is usually reconstructed or replaced utilizing a tendon or graft.
The surgery is performed as an outpatient procedure. This means you go home that day, though most people will miss a week of school or work.
Is the Surgery Performed with an Arthroscope?
Yes, but incisions will be required to obtain and/or attach the graft.
Where Do You Get The Tendon Or Graft? Can I Choose?
The graft is obtained from other tendons around your knee (autograft) or a tendon from a cadaver (allograft). There are several options of both autograft or allograft tendons. They each have their advantages and disadvantages and what is best for one person might not be best for another. We believe strongly in individualized ACL reconstruction. In other words, we focus on what is best for you. Your surgeon should be familiar with all options and take the time to explain the pros and cons of each reconstruction for optimal results.
What Is Rehabilitation Like and When Can I Return to Full Activities?
Proper rehabilitation involving a knowledgeable physical therapist is crucial to achieve a good result. Rehabilitation occurs in stages (see attached rehab protocol) and is predicated on the biology of the graft healing and the supportive strength of your leg. Rarely will a patient be fully recovered sooner than 9 months. Optimum recovery requires the following factors:
The graft completely healed (9-12 mos)
Return of leg strength (6-18 mos)
Neuromuscular control or coordination (9-18 mos)
Restoring confidence (9-24 mos)
Beware of the promise of “accelerated rehab.” There is a very high failure rate with these programs.
Since Dr. George Wade pioneered the modern surgical treatment of the ACL in the Treasure Valley, ISMI surgeons have performed well over 10,000 successful ACL reconstructions and treated countless others non-operatively in the pediatric, recreational, scholastic, collegiate, and professional athletic population.
To set up an appointment for further evaluation, please call (208) 336-8250.