Anterior Cruciate Ligament Tear

About the Anterior Cruciate Ligament(ACL)

The anterior cruciate ligament is one of 4 major ligaments that maintains knee joint stability. As a result of traumatic injury the ACL can be torn. An injury that results in disruption of the ACL causes acute knee pain and swelling. In cases of substantial partial or complete tearing of the ACL the knee can become what is known as ‘ACL deficient’.

Symptoms

Symptoms of ACL insufficiency include knee pain, weakness, intermittent swelling and episodes of the knee giving out or buckling. In cases of acute ACL injury, symptomatic treatment is recommended initially with pain management, bracing and a physical therapy program to restore motion and diminish inflammation in the knee. In cases of ACL injury where the sufferer is deemed ‘low ACL demand’ nonsurgical treatment is initially recommended. Low ACL demand would include individuals with sedentary work and lifestyles with minimal recreational sports activity.The likelihood of symptomatic instability in this patient group is low and under these circumstances ACL reconstruction is not necessary. In cases of ACL injury where the sufferer is deemed ‘high ACL demand’ a surgical reconstruction is likely the best treatment. High ACL demand clients include those that work at physically stressful jobs and/or are engaged in routine athletics and sports activity. The likelihood of symptomatic instability in this group is moderate-high and under these circumstances an ACL reconstruction is recommended.

The Procedure

At Regional Orthopedics ACL reconstruction is performed as an outpatient procedure and is done arthroscopically utilizing hamstring tendon as the graft material. The tissue for ligament reconstruction can be harvested locally from the patient at the time of ACL surgery (autograft) or can be taken from a tissue bank (allograft). The procedure is done in a minimally invasive fashion which limits postoperative discomfort. Recovery time is minimized with an allowance of full weight bearing after the procedure. Typically the patient should be walking without a cane by the end of the second week and riding a stationary bicycle. Recovery time for return to competitive sports is 3-6 months.
Other ligament Injuries- other ligaments that can be injured include the medial collateral MCL, lateral collateral LCL and posterior cruciate PCL . Injury to these ligaments along with the ACL can occur individually or can occur in combination (multiligamentous injury). Depending on the pattern of injury and the nature and extent of knee instability, nonsurgical management in a brace or surgical repair/reconstruction of the ligments may be indicated. At Regional Orthopedics PCL reconstructions are done arthrosocopically utilizing allograft tissue, LCL reconstructions are done through an open incision based over the lateral aspect of the knee; autograft and/or allograft tissue is utilized, MCL repairs are done through an open incision over the medial aspect of the knee and typically do not require the use of tissue grafting. These procedures are performed on an outpatient basis. Recovery time is variable depending upon extent of the reconstructive procedure.