ACL ruptures (tears) are common. Every year in the US, between 100,000 and 300,000 ACL reconstruction surgeries are performed.
What is the ACL?
The Anterior Cruciate Ligament is the primary stabilizing structure of the knee. Ligaments are h2 bands of tissue that connect bones to each other. The ACL connects the thigh bone to the shin bone, keeps the shin bone in the correct position and prevents the thigh bone from moving out of position.
What causes an ACL injury?
Most tears occur from pivoting, twisting, sudden deceleration and landing from a jump, not from direct contact injuries. These injuries occur during sports like tennis, soccer, football, basketball, skiing, or gymnastics.
Who is at risk for an ACL tear?
Women are up to 8 times more at risk for an ACL tear than men.
What happens when the ACL tears or ruptures?
There will be immediate pain, swelling and instability, buckling of the knee, and difficulty bending or extending the leg. An ACL injury will affect the ability to pivot or turn the knee, walking will be difficult, and it may be impossible to put weight on the affected leg. The patient may also hear a popping sound as the ligament tears.
How is an ACL Injury diagnosed?
Dr. Van Thiel will conduct a physical exam, discuss how the injury occurred, and order imaging tests to visualize the ligaments, tendons and muscles to confirm the diagnosis of a tear, and reveal any additional damage.
Frequently, the same injury that ruptured the ACL causes damage to the meniscus and the other ligaments. Dr. Van Thiel may decide to examine the knee joint and ligaments with an MRI scan.
How is an ACL tear treated?
Initial treatment will include rest, ice, compression and elevation, pain management, and immobilization of the knee with a brace. The patient may be immediately referred to physical therapy to maintain range of motion and strengthen the quadriceps. Inactive patients may find this approach will work well for them.
Treatment decisions will also depend on whether there is also a meniscus tear or other damage which often accompanies an ACL tear.
However, patients with a complete ACL tear where the ligament is not functioning are best treated with surgery to avoid the risk of additional damage to the knee, including early arthritis in the joint.
Will I need surgery for a partial tear?
Whether surgery is needed depends primarily on knee instability, and the level of activity the patient desires to return to. Young, active amateur athletes can decide to try physical therapy first to get back on their feet, and may be able to delay or avoid surgery.
Recent studies suggest that this may not increase their risk of osteoarthritis or future knee damage. But the answer depends on whether the ACL can still function. Treatment is determined by how much instability there is, and the patient’s desired activity level, not by the age of the patient.
If the patient chooses nonsurgical treatment, recovery can take 3-4 months.
What is ACL reconstruction?
It is a minimally invasive procedure to treat an injured ACL to replace the torn ligament with a tendon taken from the hamstrings, the patella, or from donated ligaments. It is called Arthroscopic ACL Reconstruction. It is an outpatient procedure.
Can a torn ACL be sewn back together?
No, because ACL repairs have been shown in studies to fail over time. This is why a torn ACL is replaced by a substitute graft.
When will Dr. Van Thiel recommend surgery?
Dr. Van Thiel will recommend surgery for an active patient who desires to return to a full physical activity. ACL surgery can help protect the knee and restore healthy joint function.
What is the procedure?
Tiny incisions are made around the joint. An arthroscope, a small camera, is inserted into the knee to view the joint, and small surgical instruments are inserted through these small incisions to remove the torn ACL, and replace it.
Then the surgeon will prepare the bone, and the graft, and insert the graft. Screws, and other devices will hold the graft in place. Any other damage will be treated at the same time. After surgery, the patient will be sent home with crutches and/or a brace.
How long does it take to recover from ACL reconstruction?
Going home, the patient will be instructed to apply ice, rest, elevate the knee and use a compression bandage. Physical therapy can begin within a few days of surgery. Progressive physical therapy will strengthen the muscles to restore stability and flexibility, and function. It can take 6-8 months after surgery, before the patient can return to sports.
Dr. Van Thiel treats patients from all over Wisconsin and Illinois including Rockford, Elgin, Huntley, Dekalb, Crystal Lake, Barrington, McHenry, and Beloit. Schedule an appointment with him today.
