ACL Tears

By Drew Heideman, PT, ATC

ACL Tears

ACL Tears or Torn ACL

A torn ACL can be a very painful and debilitating injury that weakens and destabilizes the knee. Also, this can be the worst news a sports medicine physician can bring to his coach or report to bring to his weekend warrior patient for his of her coach. Until about 15 years ago, a knee injury such as this often ended an athlete’s career. Furthermore, attempts at ACL reconstruction were often met with stiff or arthritic knees because the types of repair or reconstruction were not biomechanically sound.

Anatomical diagram of an ACL tear with labels on the anatomy

ACL tear

Each year in the NFL and the NBA, a big-time athlete has a tear of the anterior cruciate ligament (ACL) of the knee. It has been said when God designed the ACL, he obviously was not thinking of the NFL or NBA. In the general public, occurrence of an ACL injury is about 50 per 100,000 people per year. Snow skiing is the most common sport for ACL tears with over 25,000 per year.

A torn ACL can be a very painful and debilitating injury which weakens and destabilizes the knee. This can be the worst news a sports medicine physician can bring to his coach. Until about 15 years ago, a knee injury such as this often ended an athlete’s career. Stiff or arthritic knees were the result of these procedures. These types of repair or reconstruction were not biomechanically sound.

Basic research in sports medicine has now led us to improved procedures. I can now reconstruct and make new ACLs which are as strong as the body’s original ACL. Newer techniques and arthroscopic surgery have reduced the amount of trauma to the knee. In this country, tissue from other parts of the body or the knee is used for the new ACL.

Patellar Tendon Grafts

The most popular ACL reconstruction performed today is using a strip of the patellar tendon. Which is the tendon that connects the kneecap to the tibia or lower bone below. A 1 cm strip of this tendon and a small piece of bone from the kneecap and the lower tibia are harvested at the beginning of the procedure. I then drill holes in the exact location of the previous ACL, this forms the new ACL. An allograft or cadaver patellar tendon replaces the ACL. The cadaver graft is frozen to for a later time.

Knee Pain

Pain in the Knee

Hamstring Tendons Grafts

Reconstructions using the hamstring tendons are also popular in many areas of the United States. Advances in the treatment of ACL injuries are not confined just to surgical treatment. In recent years, an increasing number of therapists and sports medicine physicians have adopted an accelerated form of ACL rehabilitation. This new ACL rehab features early weightbearing and knee extension. Following surgery, place the athlete in a post-op brace.

The athlete can begin walking on the knee as soon as pain and swelling allows. This innovative approach is credited with dramatically decreasing the incidence of stiffness. The key to this accelerated program is regaining a full range of motion of the knee as soon as possible. Therefore, patients and players are able to fully extend and bend their knees to 90 degrees after the first week. As soon as pain allows, early weightbearing prevents wasting or atrophy of the leg muscles. This allows for a more functional performance of day-to-day activities. When the range of motion and normal function return to normal, exercises that emphasize strength, power and endurance are started.

Often, patients may begin straight-line running by three months after their surgery.  Usually agility-type exercises can be begin between five and nine months. Therefore, many of these elite athletes and weekend warriors may be ready sooner to perform sports-specific activities.  It is critical to the athlete and patient to understand that the “new” ligament is being remodeled by the body. It does not reach its full strength until six months to a year. Sports-specific activities that involve running, jumping and cutting are very hazardous for this first six-month period. Often during this period of time, athletes will wear ACL braces to help protect the knee ACL graft as the athlete returns to normal play.

Rehab or Physical Therapy – ACL Tears

All athletes and patients are not equal when doing physical therapy.  The exact time to recover from this injury varies from person to person. Persons with limited mobility and some older individuals may not even need the surgery. Upon completion of a comprehensive ACL rehabilitation program, they may resume low-demand activities. For those patients who do require surgery, the exact time to return to their specific sports may vary. Many therapists and physicians disagree about the exact length of time that ACL rehab encompasses.  I have seen that many athletes find that their knee continues to require extra rehab for over a year and that the knee continues to improve for up to two years after one of these complex surgeries. With early, prompt diagnosis, modern surgery and an aggressive rehab program, many people do return to their sport and enjoy an active lifestyle

Knee Anatomy

Human Knee joint

If you want to see a video about a Torn ACL, go to: ACL

Related Articles: Knee Pain and Total Knee Replacement FAQ

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By: Drew Heideman, PT, ATC

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