What is an ACL tear?
The ACL is located in the middle of the knee. It connects the thigh bone (femur) to the tibia and prevents the tibia from sliding forward and rotating too much. If you tear your ACL, any sudden change of direction, such as lateral movement or rotation, during sports such as soccer, basketball, tennis, rugby or martial arts, could cause your knee to fail.
Most cases of ACL tears occur in non-contact injuries caused by sudden twisting of the knee during training or competition. Soccer players can also have the same problem when they cross the ball over long distances, putting too much pressure on the standing leg.
Bad news for the female athletes reading this: Women are at greater risk for ACL tears because their knees are not consistent in alignment, size and shape.
Athletes who tear their ACL often feel a "pop" and then a sudden swelling of the knee (due to bleeding from the torn ligament). In addition, there is a key symptom: the patient is unable to walk or continue playing sports immediately due to the knee pain. When the swelling in the knee eventually subsides, the patient may feel that the knee is unstable and even unable to hold up, making it impossible for the patient to play the sport they love most.
Several famous athletes have experienced ACL tears. These include: Zlatan Ibrahimovich, Ruud Van Nistelrooy, Francesco Totti, Paul Gascoigne, Alan Shearer, Tom Brady, Tiger Woods, Jamal Crawford, and Derrick Rose. If you have experienced similar problems, you are not alone. The good news is that these athletes were able to successfully continue their professional careers after ACL reconstruction. With the right treatment, you can be like them, too！
How to Diagnose ACL Tear
You should visit your GP if you suspect you have a torn ACL. They will be able to confirm this with a diagnosis and recommend the best steps forward. Your doctor will perform some tests to determine whether you have an ACL tear, including:
1.A physical exam where your doctor will check how your knee joint moves in comparison to your other, uninjured knee. They may also perform a Lachman test or anterior drawer test to check the range of motion and how well the joint works, and ask you questions about how it feels.
2.X-ray exam where your doctor can rule out a fracture or broken bone.
3.MRI scan that will show your tendons and soft tissues and allow your doctor to check the extent of the damage.
4.Ultrasound scan to assess the ligaments, tendons, and muscles.
If your injury is mild you might not have torn the ACL and only stretched it. ACL injuries are graded to determine their severity as follows.
Can a torn ACL heal on its own?
The ACL usually doesn't heal well on its own because it doesn't have a good blood supply. It's like a rope. If it's completely torn in the middle, it's hard for the two ends to connect naturally, especially since the knee is always moving. However, some athletes who have only a partial ACL tear can return to play as long as the joint is stable and the sports they play don't involve sudden twisting movements (like baseball).
Is ACL reconstruction surgery the only treatment option?
ACL reconstruction is the complete replacement of the torn ACL with a "tissue graft" (usually made of tendons from the inner thigh) to provide stability to the knee. This is the recommended treatment for athletes who have an unstable knee and are unable to participate in sports activities after an ACL tear.
Before considering surgery, you should consult with a specialist physical therapist recommended by your surgeon and undergo physical therapy. This will help restore your knee to full range of motion and strength, while also allowing for relief of bone damage. Some doctors also believe that ACL reconstruction is associated with a lower risk of early arthritis (degenerative changes) based on x-ray findings.
ACL repair is a newer treatment option for some types of tears. Doctors reattach the torn ends of the ACL to the thigh bone using a device called a medial brace. However, most ACL tears are not suitable for this direct repair approach. Patients who have had a repair have a high rate of revision surgery (1 in 8 cases, according to some papers). There is currently a lot of research on the use of stem cells and platelet-rich plasma to help the ACL heal. However, these techniques are still experimental, and the "gold standard" treatment is still ACL reconstruction surgery.
Who can benefit most from ACL reconstruction surgery?
1. Active adult patients who participate in sports that involve rotation or pivoting.
2. Active adult patients who work in jobs that require a lot of physical strength and involve rotation or pivoting.
3. Older patients (such as over 50 years old) who participate in elite sports and who do not have degenerative changes in the knee.
4. Children or adolescents with ACL tears. Adjusted techniques can be used to reduce the risk of growth plate injuries.
5. Athletes who have other knee injuries besides ACL tears, such as posterior cruciate ligament (PCL), collateral ligament (LCL), meniscus, and cartilage injuries. Especially for some patients with meniscus tears, if he can repair the ACL at the same time, the effect will be better。
What are the different types of ACL reconstruction surgery?
1. Hamstring tendon – This can be easily harvested from the inside of the knee through a small incision during surgery (autograft). A torn ACL can also be replaced with a tendon donated by someone else (allograft). Athletes with hypermobility (hyperlaxity), very loose medial collateral ligaments (MCL), or small hamstring tendons may be better candidates for an allograft or patellar tendon graft (see below).
2. Patellar tendon – One-third of the patient’s patellar tendon, along with bone plugs from the tibia and kneecap, can be used for a patellar tendon autograft. It is as effective as a tendon graft, but carries a higher risk of knee pain, especially when the patient kneels and has a knee fracture. The patient will also have a larger scar on the front of the knee.
3. Medial knee approach and tibial alignment femoral tunnel technique – At the beginning of ACL reconstruction surgery, the surgeon drills a straight bone tunnel (tibial tunnel) from the tibia to the femur. This means that the bone tunnel in the femur is not where the ACL was originally located. In contrast, surgeons using the medial approach technique attempt to place the bone tunnel and graft as close to the original (anatomical) location of the ACL as possible. Some surgeons believe that using the tibial-based femoral tunnel procedure leads to rotational instability and increased revision rates in patients’ knees.
4. All-medial/graft attachment technique - The all-medial technique uses reverse drilling to reduce the amount of bone that needs to be removed from the knee. Only one hamstring is needed to create the graft when reconstructing the ACL. The rationale is that this approach may be less invasive and less painful than the traditional method.
5. Single-bundle vs. double-bundle - Some surgeons attempt to reconstruct two bundles of the ACL by drilling four holes in the kneecap instead of two. There is no significant difference in the results of single-bundle or double-bundle ACL reconstructions – surgeons have achieved satisfactory results using both approaches.
6. Preserving the Growth Plate - The growth plates of children or adolescents who have an ACL injury remain open until about age 14 for girls and 16 for boys. Using the standard ACL reconstruction technique (transvertebral) may damage the growth plates and stop the bone from growing (growth arrest). The surgeon should examine the patient's growth plates before treatment, wait until the patient has completed growth, or use a special technique to avoid touching the growth plates (periosteum or adventitia).
When is the best time to have an ACL reconstruction after an injury?
Ideally, you should have surgery within a few weeks of your injury. Delaying surgery for 6 months or more increases the risk of damaging the cartilage and other structures of the knee, such as the meniscus. Before surgery, it is best if you have received physical therapy to reduce swelling and regain full range of motion, and strengthen your quadriceps (front thigh muscles).
What is the recovery process after ACL reconstruction surgery?
1. After the operation, the patient will feel knee pain, but the doctor will prescribe strong painkillers.
2. After the operation, you can use crutches to stand and walk immediately.
3. Some patients are in good enough physical condition to be discharged on the same day.
4. It is important to receive physical therapy as soon as possible after the operation.
5. You may need to use crutches for up to 6 weeks
6. You can return to office work after 2 weeks.
7. But if your job involves a lot of physical labor, it will take longer for you to return to work.
8. It may take 6 to 12 months to resume sports activities, usually 9 months
How much improvement can you expect after ACL reconstruction surgery?
According to a large study of 7,556 patients who had ACL reconstruction, the majority of patients were able to return to their sport (81%). Two-thirds of patients were able to return to their pre-injury level of play, and 55% were able to return to an elite level.
Post time: Jan-16-2025
