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 ACL sprain:
Ligament is mildly damaged. Slightly stretched, but can keep the knee stable.
Grade 2 ACL 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 ACL 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.
What Causes 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
What are 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
How is ACL Damage Diagnosed?
We are able to diagnose most ligament injuries with a physical examination of the knee. We compare the injured knee with the healthy knee for range of motion and such. However, an MRI is usually ordered to confirm an ACL tear and rule out other conditions or cartilage tears.
Non-Surgical Options for ACL Treatment
A torn ACL will not heal itself, and partial tears are rare. If the patient is elderly and inactive, options such as bracing and physical therapy can strengthen the surrounding muscles. But the knee will remain unstable if the ACL is not repaired.
How is ACL Surgery Performed?
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.
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. They remove 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.
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).
How Long Does ACL Surgery Take?
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.
What is the Recovery Process From ACL Surgery?
Patients will use a post-op brace and crutches to protect the leg for a few weeks, but we want them moving the knee right away. Some patients may use a continuous passive motion machine to ensure the knee maintains good motion and flexibility without putting any strain on the new ligament.
We will also provide physical therapy for several months to regain strength and stability in the knee. Most athletes can return to competition after 6-9 months but may want to wear a functional knee brace for extra support.
How Long Until I can Walk Again After ACL Surgery?
We will have you up and walking with crutches the same day as your surgery. The goal is to keep mobile, as this helps with your recovery. You’ll likely have a knee brace on your knee that limits the movement in any direction. You’ll likely be able to begin putting your full weight on your repaired leg without crutches just 2-3 weeks after surgery. This depends on how much other work, such as clearing out cartilage, was involved during your repair surgery.
Sleeping After ACL Surgery
The first few days after your surgery will present the most difficulty sleeping. Sleep is an important component of the healing process, so it’s important to find a position that is the most comfortable and allows you to sleep. There is no right or wrong way to sleep, but it’s likely that sleeping on your back or on your side will work the best. If sleeping on your side, you need to sleep with a pillow between your knees.
Be sure to take your pain medication, as this will help you sleep. If you’ve been given sleep medication, take that as well.
It’s a good idea to ice your knee before going to bed, as this decreases swelling and it takes the heat out of the knee.
Don’t wear a knee immobilizer to bed. In most cases, we don’t require patients to wear a brace to bed. It tends to make patients hot and uncomfortable.
How Long is Recovery after ACL 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.