If you’ve ever watched a football game, you’ve heard of a sprain or tear of the anterior cruciate ligament (ACL). This is one of the most common knee injuries, particularly among athletes who participate in football, soccer, and basketball. If the patient is young and wants to continue to play sports, it’s likely that surgery to repair the ACL will be necessary. At Urgent Orthopedic Specialists, our surgeons, Dr. Floyd and Dr. Rowland specialize in knee arthroscopy to repair ACL injuries.
What Is The ACL?
To understand the ACL, it helps to break down the anatomy of the knee. Three bones form the knee joint: the thighbone (femur), shinbone (tibia), and kneecap (patella). The kneecap provides protection to the front of the knee.
The bones are connected together by ligaments. In the knee there are four primary ligaments. The cruciate ligaments are on the inside of the knee joint. The anterior cruciate ligament is in the front, the posterior cruciate in the back. Together they form an “X,” and control the back and forth motion of the knee.
The collateral ligaments are on the sides of the knee: the medial collateral ligament on the inside and the lateral collateral ligament on the outside. They control the sideways motion of your knee.
Injuring The ACL
About one half of ACL injuries also involve damage to surrounding structures such as the cartilage, meniscus, or other ligaments. Injured ligaments are considered “sprains” and are graded based on their severity.
- Grade 1 sprain — Ligament is mildly damaged. Slightly stretched, but can keep the knee stable.
- Grade 2 sprain — Ligament is stretched to the point it is loose. This is often called a partial tear. Partial tears of the ACL are rare.
- Grade 3 sprain — This is a complete tear of the ligament. Ligament is split and the knee is unstable. Most ACL tears are complete or near complete.
Causes of an ACL Tear
The anterior cruciate ligament can be injured from a variety of forces. If you look at this list, you’ll understand why football and soccer have so many ACL injuries:
- Stopping suddenly
- Rapid directional change when running
- Rapid slowing down while running
- Landing at a bad angle from a jump
- Direct contact or collision
Symptoms of ACL Damage
- Pain with swelling. The injured knee will swell within the first 24 hours. The swelling and pain may resolve themselves, but if you engage in the sport or activity again, your knee will probably be unstable and you can cause further damage, particularly to the cartilage.
- Loss of full range of motion
- Tenderness along the joint line
- Pain when walking
Diagnosing ACL Damage
Nonsurgical ACL Treatment
Other ligaments such as the MCL often partially tear; they can repair themselves without surgery. The ACL rarely partially tears, however, and it requires surgery more often than not to repair it. Contrary to what you may think, sewing the torn ligament back together is not done, as the ligament will not fully heal and is prone to tear again. Instead, the ligament is reconstructed using a ligament graft.
ACL grafts can be made using donor tissue (allograft) or using the patient’s own tissue (autograft). Athletes and younger patients usually prefer to use grafts from their own tissue, as they are generally stronger. Autografts are usually harvested from the hamstring tendon or the patella tendon at the beginning of the reconstruction surgery through an additional incision.
Older patients may opt to use an allograft from donor (cadaver) tissue. This provides a faster recovery and return to work for those not anticipating putting heavy stress on the ligament (as in sports).
Performing ACL Surgery
We perform our ACL reconstructions as outpatient surgeries at Texas Surgical Center. We wait several weeks after the injury to allow swelling and inflammation to settle down.
In most cases, our surgeons can use arthroscopic techniques, which involve creating a few small incisions in the knee and inserting a camera and tiny surgical instruments through them. He removes the torn ACL and grafts the new ligament into the femur and tibia. Arthroscopic surgery is less invasive, creating less scarring, pain, bleeding, and requires a shorter recovery.
Length of The Procedure
The actual surgery usually takes 1-1.5 hours. Of course, you’ll be at Texas Surgical Center for longer than that for check-in, anesthesia, and post-op recovery.
Recovery After Surgery
Walking After ACL Surgery
Sleeping After ACL Surgery
Length of Recovery After Surgery
It will likely take from one to two months to regain full use of your knee after ACL reconstruction. How quickly you fully recover will involve how diligent you are with flexibility and strengthening exercises and physical therapy. You should expect it to take 6-9 months to fully recovery after ACL surgery. If you’re an athlete, expect between 8-12 months before you can return to your sport.
Contact Urgent Orthopedic Specialists to learn more about ACL surgery where we serve the Midland, Odessa, Big Spring, Stanton, Andrews, and every other small town in between!