How is an ACL injury treated?

Dr. Bradley S. Raphael, MD
Orthopedic Surgeon

More and more athletes are sustaining tears of the anterior cruciate ligament (ACL) of the knee. Unfortunately, this ligament has a poor blood supply and cannot heal on its own. Therefore, the most common treatment for this injury in the active patient is a reconstruction or rebuilding of the ACL. This is accomplished by taking a tendon from either the front of the knee (the patellar tendon) or the back of the thigh (the hamstring tendon) or from a cadaver tissue bank (called an allograft). This is then weaved through the knee joint exactly where the old torn ACL was.

Dr. Howard J. Luks, MD
Sports Medicine Specialist

Perhaps the more important question is should an ACL tear be repaired? Not every patient who tears their ACL requires a repair or a reconstruction of the ACL. Once again, this is the circumstance where orthopedists need to strive to not treat just an MRI finding–yet they should strive to treat the patient. There are many people who tear their ACL and go on to live very active and productive lives without any evidence of instability, buckling or giving way. Clearly, these patients do not require an ACL reconstruction. That said, there are numerous patients who sustain a rupture of the ACL and have instability with sports. That presents as a feeling of the knee giving way or buckling when you turn, pivot or twist. Those patients have the option of trying an intense physical therapy program, a custom-made brace or they may choose to have an ACL reconstruction. Furthermore, there are patients who will experience instability, buckling or giving way with simple activities of daily living. Most of these patients choose to have an ACL reconstruction to improve their quality of life. Bottom line, not all ACL tears require a repair. This is another instance where you should be acquainted with a shared decision-making process where you are presented with the alternatives and you make an informed decision based upon your quality of life, your desire to continue to participate in certain activities, and whether or not you feel the surgery is in your best interests.

Once you have chosen to proceed with an ACL reconstruction you will be presented with a number of choices. The ACL tissue itself cannot be repaired. Instead, we reconstruct or replace your ligament. You have options of using your own tissue as a graft to reconstruct your ligament. You also have options of using cadaveric tissue to serve as a graft your ACL. There are advantages and disadvantages to both of these grafts. This is yet another discussion that you should have with your orthopedist prior to considering an ACL reconstruction.

Initial treatment for an anterior cruciate ligament (ACL) tear involves rest, ice, bracing the joint to provide stability and pain-relieving medication. Cortisone injections also can relieve pain. Platelet-rich plasma injections also can stimulate the body to repair itself.

For the elderly and those with low-activity levels, physical therapy can help relieve pain and allow the person to regain some mobility. However, to truly heal, surgery is required. A tissue graft is used to reconstruction the ACL. Your orthopedic surgeon can help you decide the best surgical option.

Physical rehabilitation is then recommended to help you regain strength and movement.

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Non-operative treatment for a complete ACL tear is an option for individuals with a lower level of physical activity who do not complain of instability. Non-operative treatment for ACL injuries typically includes increasing strength, endurance and proprioception (the neural input regarding body position and movement) around the knee to compensate for loss of stability. Typical strengthening activities include quad sets and 4-way straight leg raises and progressing to squats (being careful to keep the knees in line with the toes and the shoestrings visible at all times). Eventually, more dynamic activities such as stairclimbing and jogging will be included. Particular emphasis should be placed on correct form and building muscle endurance. Balance activities generally start on stable ground (i.e. single leg stance), progress to an unstable surface (i.e. foam), and culminate in more dynamic activities on unstable surfaces with extremity movements. Operative treatment followed by a course of physical therapy is the more common approach to ACL injury, particularly in young, active individuals. A graft surgically replaces the torn ACL, and a rehabilitation period of approximately 6-8 months follows before full return to athletics is allowed. Post-operative rehabilitation typically follows a similar course as non-operative treatment with a special emphasis on monitoring for infection or other medical emergencies. Later activities emphasize plyometrics and proper form with sport-specific mechanics.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.