Q&A Topic: Management of ACL Tears
David J. Yasgur, MD, FAAOS
Q. What is the ACL?
A. The ACL—the anterior cruciate ligament—is one of the crisscrossing ligaments at the center of the knee. It provides much of the stability of the knee particularly in sports like soccer, basketball, volleyball, and skiing that require running, jumping and cutting (quick changes in direction). Torn ACLs are extremely common injuries. We see an increase in ACL injuries when kids begin to participate in sports and in adults who maintain an athletic life through age 50.
Q. What causes ACL injuries?
A. There are two main causes. A torn ACL can occur with a direct blow to the knee. This might happen in a football pile up when one player lands on the back of another player’s leg. Non-contact ACL injuries are more common. An athlete comes down from a jump or turns and pivots, hears or feels a pop in his or her knee, and experiences the sensation of the knee buckling. If the athlete tries to bear weight, the knee will have a shifting sensation as if bones are moving abnormally with respect to one another. Finally, the knee may swell tremendously.
Q. How should you proceed if you suspect a torn ACL?
A. The athlete should be taken to an emergency room or urgent care facility where they will take an X-ray, confirm that there are no broken bones, provide you with a knee brace and crutches, and send you for an evaluation with an orthopedic surgeon.
Q. How do orthopedic surgeons treat torn ACLs?
A. During the orthopedic evaluation, I’ll take a detailed patient history and perform a physical exam followed by an MRI. If you’re 72 years old with a torn ACL and you don’t participate in running, cutting, or jumping sports, physical therapy will likely enable you to return to an active life without surgery. If you have a partial ACL tear and there is no gross instability on exam, patients may do fine with just a brace and physical therapy for about three months. However, if you have a completely torn ACL and you’re an athlete—child, teen, or adult—you’ll likely require surgery to reconstruct your ACL.
Q. What happens during ACL surgery?
A. ACL reconstructions are always arthroscopic surgeries which means patients just have small incisions. During ACL reconstruction, the damaged ligament is removed and replaced with a new graft to replace the function of the torn ACL. The graft is chosen based on the patient’s needs. Younger, high activity patients will often get a graft from their own body, whereas older patients receive grafts from a deceased donor.
Q. What kind of rehabilitation is involved following surgery?
A. Physical therapy to restore stability and function starts immediately and will last for at least six months. It can take as long as six to 12 months before athletes are strong enough to return to their sports. I follow my patients very closely until the end of their physical therapy to ensure they are really ready for the demands of their sports. We deploy special isokinetic testing to evaluate whether the operated leg has the required strength.
Learn More About Dr. Yasgur
Director of Quality and Outcomes
Orthopedic and Spine Institute
Northern Westchester Hospital
Northern Westchester Hospital is a proud member of Northwell Health.
Read Past Topics from Dr. Yasgur:
Chronic Knee Pain and Knee Replacement
Hip Replacement Surgeries
Patient-Specific Instruments for Total Knee Replacement