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How is it treated?
The initial phase of treatment involves swelling and pain control using a combination of ice, medications, rest and walking aids. Once achieved, the next stage will see the athlete working to regain motion range in the injured knee, and muscle tone especially in the quadriceps muscle. Working with a physiotherapist at this stage may be useful to monitor the progress of recovery.
The aim of treatment is to allow the athlete to return to his chosen sport to the level he is able. Once the ACL is torn, it will not “grow back” and heal itself. Although the knee has lost an important stabilizer, the athlete may regain some control of stability in the knee through a rehabilitation programme. If this cannot be achieved, then surgical reconstruction of the ACL is an option to consider.
You may consider surgery if:
• You find that your knee is unstable and has feelings of giving way during daily or sporting activities.
• You are a young and active individual, and you are not willing to give up or scale back your athletic pursuits.
• You participate in high-demand sports at a competitive level that requires a stable knee for pivoting and cutting motions.
• There are associated injuries to other ligaments, cartilage or menisci in the knee.
Recurrent instability in the knee will cause subsequent damage to the cartilage and menisci, and result in early arthritis. It is best to discuss your treatment options with your doctor in person so that he can assess and tailor a plan to your specific expectations.
What is an ACL reconstruction?
It is an operation performed to recreate the ACL using a graft tendon to replace the form and function of the torn ligament. This graft can come from the patient himself, such as a hamstring tendon from the same leg or other leg, patella tendon etc. A second option is to take an allograft from a deceased donor. These allografts are commercially available and cleansed to minimize the risk of disease transmission.
Currently, this operation is usually performed as “key-hole” surgery using a specialized viewing camera and instruments to allow the surgeon to work in the knee joint with small skin incisions. The graft tendon will be positioned in the knee joint through drill holes in the femur and tibia, and fixed in position. In the same sitting, the surgeon will also examine the other knee joint structures such as the cartilage and the menisci for injury, and deal with them appropriately.
Intra-operative pictures showing a torn ACL in the knee
Post-reconstruction picture showing ACL graft in position
What happens after surgery?
This is the time when the athlete’s involvement will determine the success or failure of the surgery. You will need to work closely with your physiotherapist and surgeon in your recovery. The lack of patient participation in the rehabilitation programme is a common cause of poor results and inability to return to sports following ACL surgery.
Immediately after surgery, there will be some pain and swelling in the knee. The initial management is similar to that of an acutely injured knee (see above). Once adequate swelling and pain control has been achieved, the athlete can start on the rehabilitation exercises. There will be various different phases in the programme, with specific emphasis for swelling and pain control, range of motion and muscle strengthening exercises, balancing and agility exercises, and sports-specific drills before you return to your sporting activity of choice.
Everyone recovers from injury and surgery at different rates. Your surgeon and therapist will keep an eye on you to make sure you are making satisfactory progress. Generally, most athletes can return to pivoting and cutting sports about 6 to 9 months after their surgeries.
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Expert Author:
Dr Chong Kian Chun, Island Orthopaedic Consultants
The article above is meant to provide general information and does not replace a doctor's consultation.
Please see your doctor for professional advice.
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