ACL Injuries: Prevention and Treatment
By Nicholas J. Avallone, M.D.
Anterior cruciate ligament (ACL) injuries are common in athletes from their teenage years through their mid to late forties. In female high school and college soccer and basketball players these knee injuries have become a virtual epidemic. According to the latest published data, ACL injuries in these female athletes are between 3 and 8 times more frequent than their male counterparts.
The ACL is a major stabilizing ligament in the center of the knee. It enables the knee to perform twisting and cutting maneuvers. Without it, participation in sports such as basketball, football and soccer becomes difficult, if not impossible.
Prevention of ACL injuries has been a focus of orthopedic surgeons and athletic trainers alike in recent years. Appropriate warm-up and strengthening exercises are key elements in any ACL injury prevention program. Various approaches are available. One regimen that has been shown to reduce ACL injuries by up to 88% is from the Santa Monica Orthopaedic and Sports Medicine Research Foundation. The exercises in this program can be found online at www.aclprevent.com.
ACL tears usually occur through noncontact injuries such as planting to kick a ball or landing awkwardly after a jump. Pain, swelling and an inability to bear weight are common presenting symptoms. A physical exam maneuver demonstrating relative laxity in the knee can further increase suspicion of the injury. The sports medicine specialist typically orders an MRI to confirm the diagnosis and see if there are additional injuries in the knee.
After the diagnosis of an ACL tear is made, a conversation with the athlete’s orthopedic surgeon must ensue to determine the course of care. Few people can cope with a torn ACL, even in normal activities of daily living. Thus, most will opt for surgical intervention. To help prevent postoperative stiffness in the knee, range of motion must be restored prior to ACL reconstruction.
Two main types of tissues can be chosen to reconstruct the ACL: the patient’s own tissue or that taken from a cadaver. Harvesting a portion of a patient’s patellar tendon or hamstring tendons has the advantage of more rapid incorporation of the graft; thus speeding healing time. However, this portion of the procedure can be painful. Cadaver tendons eliminate pain from harvesting the patient’s own tendon, but they have been shown in recent literature to have a higher failure rate in young patients and a slower incorporation rate. The patient should consult openly with their surgeon about which graft choice is right for them. Minimally invasive arthroscopic techniques are utilized to place any of the above graft choices.
A brace and crutches are typically utilized in the early postoperative course. Three to four months of physical therapy are usually required to appropriately rehabilitate after an ACL reconstruction. Most people will return to their sport within 6 to 9 months after their surgery.
For further information about ACL injuries and other orthopedic conditions please contact Orthopedic Associates of the Greater Lehigh Valley at 908-859-5585 or visit them at www.bonedrs.com.
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