The knee contains four major ligaments vital to knee stability and mobility. They are the anterior cruciate ligament (ACL), the medial collateral ligament (MCL), the posterior cruciate ligament (PCL) and the lateral collateral ligament (LCL).

ACL injuries are common and send more athletes to the bench for longer periods than almost any other acute injury. The other ligaments are often injured at the same time as the ACL. Torn ligaments do not have the ability to repair themselves.

What are the types of ACL tears?

ACL tears may be partial or complete, but most are complete tears. About 50% of ACL injuries involve damage to the meniscus, cartilage or other ligaments. Combined injuries are best treated with surgery. An ACL injury is a risk factor for knee osteoarthritis., and almost 25% of patients with knee arthritis are found to have a torn ligament.

What are the symptoms of an ACL tear?

• The patient may hear a popping sound and the knee will buckle
• Knee instability that makes it difficult to walk
• Loss of range of motion
• Joint tenderness
• Pain and swelling within 24 hours after the injury. This may resolve on its own, but instability will remain.

Knee instability creates the greatest risk of post-traumatic arthritis. Female athletes suffer more ACL tears than male athletes.

What causes and ACL injury?

ACL injuries occur frequently in people who participate in high impact sports that require abrupt changes in direction, sudden stopping, awkward landing from a jump, and/or direct impact to the knee. ACL injuries are common during tennis, basketball, football, skiing and soccer.

70% of ACL injuries occur without contact, 30% are the result of direct impact.

Athletes with partial tears can recovery with progressive rehab in about 3 months, and patients can learn what causes instability and how to avoid it. However, instability is always a risk. Complete ACL ruptures will prevent sports participation or even walking. Repeated episodes of instability can further damage the knee.

Diagnosis

Your La Mesa Grossmont Orthopaedics specialist will review how the injury occurred and your medical history. The physical exam will compare your uninjured knee range of motion, etc. with your injured knee. Most ACL tears can be diagnosed with a physical exam.

However, because 50% of ACL injuries also damage other parts of the knee joint, X-rays and imaging studies will be ordered to identify additional injuries like a broken bone.

How are ACL tears treated?

Partial tears:

When the patient has a partial tear and does not have an active lifestyle or the desire to return to high levels of activity, conservative treatment including rest, icing, elevation, anti-inflammatory medications and activity modification. Once the swelling resolves pain and dysfunction can be successfully treated with physical therapy and if needed, a knee brace.  Recovery usually takes about three months.  Continued knee instability is an indication for surgery.

Complete tears:

An ACL tear is an acute injury, but it is not an emergency.  Surgery is usually delayed allowing for inflammation and swelling to subside. The patient may be instructed to go through physical therapy before surgery to strengthen muscles to support mobility.

ACL reconstruction surgery is necessary to restore stability and function. The goal of surgery is to create a stable knee and allow patients to return to their chosen sports. This is minimally invasive arthroscopic surgery that causes only minor trauma to surrounding tissues, causes less pain and joint stiffness and a short recovery. Recovery can take up to six months.

With arthroscopic surgery, proper strengthening and rehabilitation 96-98% of patients return to their sport of choice. Each patient will determine a personalized course of treatment from their Grossmont Orthopedic surgeon. Call today to schedule a consultation to get the correct diagnosis and learn about your options.