Anterior Cruciate Ligament Injury (ACL Injury) Overview
The anterior cruciate ligament (ACL) is one of the four major knee ligaments, and is considered the main stabilizing ligament. The ACL is responsible for providing proper movement of the joint and preventing slippage that creates an unstable knee. An ACL injury is quite common, most frequently seen in athletes and active individuals. An ACL injury can range from a small sprain to a complete ACL tear. Chicago, Westchester, Oak Brook and Hinsdale, Illinois area knee specialist, Dr. Nikhil Verma treats numerous symptoms of an ACL injury with non-surgical and surgical approaches.
The ACL runs through the knee from the front of the tibia to the back of the femur, and is critical to maintaining knee stability and providing protection to the menisci of the knee. An ACL tear, rupture and other forms of damage are extremely common in athletes from unnatural pivoting and twisting movements or from a direct blow. When the ligament is stretched beyond its normal range, the tibia slides out from under the femur, leading to an ACL tear or stretch. Higher risk patients include those involved in skiing, football, basketball, soccer, tennis and gymnastics. In almost all sports, women are at an elevated risk of an ACL injury.
Symptoms of an ACL Injury
The most common symptoms of an ACL injury includes an acute injury followed by pain, swelling and limited range of motion. These symptoms will vary based on the severity of the injury. A mild sprain may feel unstable with limited swelling while a severe ACL tear may have a “popping” sensation at the time of injury with substantial swelling.
Diagnosis of an ACL Injury
During your orthopedic consultation with Dr. Verma, a physical examination will be performed to assess the symptoms of the ACL injury. A series of X-rays are important to rule out any broken bones, arthritis and other knee injuries. An MRI may be used to determine any additional damage and to confirm the diagnosis.
Functional Sports Assessment (FSA)
Current research has indicated that ACL injury risk may be estimated by an physical assessment of CORE and lower extremity function including strength, motion and leg position during provocative activities such as running, jumping, landing, and rapid directional changes. When abnormalities are identified, corrective therapy activities can be instituted that may help to reduce risk of ACL injury. This test is generally recommended in healthy individuals, to determine risk of ACL injury and institute a protective rehabilitation program in high risk individuals. In addition, an FSA can be used after surgery to determine readiness for return to sport as well risk stratification for injury to the same or opposite knee following resumption of sports activities.
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Treatment of an ACL Injury
Not all injuries to the ACL require surgery. The severity and symptoms of the ACL injury determine treatment. An injury to the ACL is typically diagnosed as a complete or partial tear. In many cases complete injuries require surgery to restore stability to the knee. However, in some patients taking into consideration age and activity level, non-operative management including bracing and physical therapy may be appropriate. Partial tears may be considered for surgery or non-operative treatment based on the activity demands of the patients and stability of the knee.
Have you sustained an ACL injury?
There are two ways to initiate a consultation with Dr. Verma:
You can provide current X-rays and/or MRIs for a clinical case review with Dr. Verma ($250).
You can schedule an office consultation with Dr.
If an ACL injury does not include knee instability or a severe ACL tear, a combination of ice, heat, rest, elevation, physical therapy, bracing and modified activity may be recommended by Dr. Verma. Success of non-operative treatment is based on patient ability to return to recreational activities and any recurrent symptoms of knee instability or giving-way.
A more severe ACL tear or injury may require surgery to restore normal knee function and range of motion. An arthroscopic knee reconstruction is the treatment choice in many cases. This procedure involves removing fragments of the damaged ACL and replacing it with another form of soft tissue, called a graft. Graft options include taking your own tissue, most commonly from the patellar tendon and hamstrings. Advantages of using your own tissue include decreased risk of re-rupture and better incorporation by the body. In some cases, an allograft, or donor tendon, may be recommended. The main advantage of allograft tissue is lower surgical morbidity and faster initial recovery as no tissue is harvested from the patients knee in order to reconstruct the ACL. However some studies have suggested higher risk of re-rupture associated with allograft use, particularly in younger patients.
Following ACL surgery, initial goals of surgery are to reduce swelling and restore motion. Patients are generally able to bear weight in a brace immediately after surgery. Return to work or school is usually possible at 5-10 days after surgery. Formal physical therapy is initiated at approximately five days after surgery. In general, patients are able to initiate an exercise bike by 4-6 weeks, light jogging with progression to return by 12-14 weeks. Return to sports is anticipated at 5-8 months following surgery based on individual progress.
For more information on the treatment of an ACL injury, please contact the orthopedic office of Dr. Nikhil Verma, knee specialist treating patients living in the communities of Chicago, Westchester, Oak Brook and Hinsdale, Illinois.