Anterior Cruciate Ligament (ACL) Tears: Treatment Options

Anterior Cruciate Ligament (ACL) Tears: Treatment Options

It is important to know the treatment options for ACL injuries.

If left untreated, the knee remains unstable and can wear down the surface cartilage in the knee, causing osteoarthritis.

Older patients who are not particularly active, as well as younger patients who do not participate in cutting or pivoting sports, may be treated without surgery.

This is done with a brace for stability and physical therapy for strengthening and range of motion, regardless of how severe their injury is, the main focus is to increase balance and strength to stabilize the knee, since the ACL is no longer helping to keep the joint stable.

However, a surgical reconstruction of the ACL has shown to do a better job of making the joint more stable and lowering the risk of injury to other structures in the knee, like the meniscus or surface cartilage.

Patients who are very active in sports or in their job will likely benefit from surgery for their ACL if there is a grade 3 complete tear of the ligament.

There are many factors that come into play when returning to full sport or activity after ACL surgery. These should be discussed with the surgeon to make sure the patient can return quickly and safely.

In some cases, the location of the ACL tear is near the top of the ligament. It may be possible to repair the ligament itself instead of using different tissue to create a new ligament. If the tear is in the middle, a reconstruction usually gives the best outcome.

If the surgeon and the patient decide that surgery is the best option, here is what the process looks like on surgery day.

The patient is brought into the operating room. The patient lies in a supine or face up position on the operating table. A leg holder is used to stabilize the leg during surgery.

To do a reconstruction, the surgeon will need to use a piece of tissue or graft to create a new ligament. If the surgeon will use the patient's own tissue, called an autograft, the 3 main graft options are the patellar tendon, hamstring tendon, or quadriceps tendon. Depending on which graft will be used, a separate incision may have to be made in one of these locations to harvest this graft.

Sometimes, donor tissue from a cadaver called an allograft will be used. The patient and surgeon will decide which type of graft will be best.

After surgery, the road to recovery begins. A special brace is used to help protect the knee while still allowing some movement to prevent stiffness. As time goes by, the physical therapist will make sure the range of motion of the knee continues to improve. Strengthening is the final phase, but it can take the longest. During this phase, the patient works to achieve their activity goals.