ACL (Anterior Cruciate Ligament) Tears

What are the nonsurgical treatments?

Nonsurgical treatments include bracing and physical therapy:

Bracing: Putting a brace around your knee will keep it stable. You’ll have to use crutches so that you don’t put weight on that leg.

Physical therapy: Exercises will help your knee function and strengthen the leg muscles around it, supporting it.

Keep in mind that if you choose not to have surgery, you’re at a higher risk of re-injuring your knee.

What are the complications of surgery?

Infection. Infection is rare, but still a risk with any type of surgery.

Stiffness. Stiffness in the knee is common post-surgery, but physical therapy can help it. This can be avoided by performing rehabilitation to regain all of your motion before surgery.

Viral transmission. Receiving a graft from a cadaver always comes with a risk of contracting diseases like HIV and Hepatitis C. There is less than a one in a million chance that you’ll get an HIV-infected graft.

Blood clot. A blood clot can be life-threatening, but it’s rare. The clot can break off in the bloodstream and cause a pulmonary embolism in the lungs or a stroke in the brain.

Kneecap pain. This complication is common when using patellar tendon grafts.

Growth plate injury. Early ACL reconstruction in a child or adolescent risks this. If possible, the surgeon will delay the procedure until the skeleton is fully grown or utilize special techniques to avoid injuring the growth plate.

PREVENTION

Can ACL injuries be prevented?

If you’re an athlete then it may not be possible to completely eliminate ACL injuries, but various training techniques can minimize the risk of tearing the ACL.

If you play soccer, basketball and volleyball, you should be especially mindful of two things: how you take hard, quick steps to accelerate in another direction (or “cut”) and how you land on your feet from a jump or a step (“plant”).

These cutting and planting maneuvers cause about 70% of all ACL injuries.

The jumping, landing and pivoting involved in these sports all stress the knee’s ACL – particularly in female athletes. Initiating a cut (or landing after a jump) can compromise the ACL’s ability to resist rotational forces. Planting incorrectly can overwhelm the ACL’s ability to move the knee the way it is designed to do.

Why are women at higher risk for ACL injuries?

Male and female athletes tend to have differences in how they maneuver in a jump or cut, which puts women at higher risk for injury.

Women tend to activate their quadriceps first, while men tend to activate their hamstrings first. This difference in activation may alter the amount of strain applied to the ACL and other knee ligaments.

In addition, after a jump, women tend to land with their knees closer together than men. Athletes who land with their knees farther apart seem to have less risk of ACL injury.

Fatigue as factor in ACL injuries

Fatigue is a hazard for both male and female athletes. Tired athletes are more likely to use poor mechanics. For example, they may land with their knees closer together. This is especially true when a fatigued athlete makes a split-second decision to execute an unexpected move.

Proper training can help prevent injuries

Studies show that training programs supervised by sports health professionals improve athletes’ leg strength and jump-landing techniques.

Proper training decreases ACL injury rates in basketball, volleyball and soccer. The techniques that improve ACL safety can also enhance performance, and increase vertical jump height, acceleration and the ability to change direction.

Nothing can prevent ACL injuries altogether. But exploring their potential causes and maximizing prevention strategies can stop the “pop” and its frustrating consequences.

OUTLOOK/ PROGNOSIS

Can ACL tears be cured?

With time, surgery and physical therapy, you should regain full use of your knee within six to nine months.

Will an ACL tear ever happen again?

You can re-tear your ACL, yes. The risk or re-tear is generally considered to be five to seven percent.

LIVING WITH

Can I live a normal life with an ACL tear?

Yes, but it may take some time before you’re completely back to how you were before the injury. Whether you choose to have surgery or not, with physical therapy you will eventually be back to normal and able to live your life.

Is an ACL tear “career-ending” for athletes?

After surgery it takes about six to nine months of physical therapy before an athlete is ready to return. By then he or she will no longer have swelling or pain. The full range of motion should be restored and all of the balance, strength and endurance should be back. Most athletes will return to their prior level of functioning.

How do I take care of myself?

Follow your healthcare provider’s instructions, including those of your physical therapist. Work hard at your physical therapy. Take medications as prescribed.

When should I see my healthcare provider?

See your healthcare provider immediately when you injure your knee. They’ll need to evaluate the injury, reduce the swelling, give you pain medication and determine the next steps

What questions should I ask my healthcare provider?

What are the pros and cons for surgery to repair my ACL tear?

Do I have a partial ACL tear or is it torn in two?

What medications should I take?

Do I need to see a specialist?

Who is a good orthopedic surgeon?

Should I see a specialist in sports medicine?

When can I return to work/school?

How soon can I have surgery?

How long do you predict it will take me to recover?

What kind of graft is best for me?

A note from Cleveland Clinic

An ACL tear will only temporarily stop you from working your job or playing the sports you love. Remember, your healing depends on your own choices: choices to use crutches, to have surgery or not, to work hard at your physical therapy, etc. If you commit to your physical therapy and listen to your healthcare providers’ instructions, then your life will be back to “normal” soon.