The Anterior Cruciate Ligament, the “ACL”, is an important stabilizing ligament in the middle of the knee. It is at risk of being torn in skiers, soccer players, and other athletes who commonly use cutting or twisting movements. About half of the time, an ACL tear will be accompanied by a meniscal tear and/or medial collateral ligament tear due to the overwhelming rotational or hyperextension force to the knee. Patients with ACL tears typically experience sudden pain and giving way of the knee, sometimes with an audible “pop” at the time of injury. The knee will typically swell with fluid, become painful and unstable.
If this happens to you, initial treatment includes a period of rest, ice, compression, elevation (RICE), bracing, crutches, and anti-inflammatories. Early range of motion of the knee as tolerated with a trained physical therapist is also helpful. Then, an MRI is usually ordered to better visualize the ACL and further assess the knee injury.
Definitive treatment of an ACL tear depends on the patient’s age, desired activity level, and associated injuries. For young, active patients, ACL reconstruction offers a good chance of a successful return to sports and the pre-surgery level of activity.
Like many things in medicine, ACL reconstruction has advanced over the years. Mansfield Orthopaedics at Copley Hospital offers patients a minimally invasive “double-bundle” ACL reconstruction done arthroscopically. This reproduces the two naturally occurring components of the ACL, the anteriomedial and posterolateral bundles, through a few small incisions. Our orthopaedic suregeons can restore the location and orientation of the two ACL bundles using cadaver tissue or the patient’s own tissue to build a new ACL. Surgery usually takes 60-90 minutes, and any meniscal or cartilage injury can also be addressed arthroscopically at that time. (You can learn more here.)
Patients who undergo ACL reconstruction take on the small risks of surgery to regain knee stability and the ability to return to sports. Surgery is done on an outpatient basis and physical therapy is restarted one week after surgery. Rehabilitation after ACL reconstruction is a lengthy process – it takes many months for the body to reincorporate the new tissue into the knee. Patients who have undergone ACL reconstruction may start sports-specific agility training and drills five to six months after surgery, and running four months after surgery. It does take one year for full recovery and to properly rebuild muscle strength.
Leah Morse is a Certified Physician Assistant with Mansfield Orthopaedics at Copley Hospital. After completing Physician Assistant School and her Master’s Degree at Wagner College in New York City, Morse worked with the Neurointerventional Surgery team at Roosevelt Hospital in mid-town Manhattan. She relocated to her native Vermont in 2010 to work at Mansfield Orthopaedics, specializing in Hip and Knee joint replacement and sports medicine. Morse coordinates both the research program and the inpatient total joint replacement team.