ACL FAQs

What is the ACL?

The anterior cruciate ligament (ACL) is one of four ligaments that connect the thigh bone to the shin bone. It provides stability when twisting or pivoting, or landing wrong from a jump. When the ACL is injured it is called a tear.

What causes an ACL injury?

An ACL tear is a very common injury incurred often in noncontact sports like skiing, basketball and soccer, and primarily affects young, active people. Each year there are over 200,000 tears and about 50% of patients undergo reconstructive surgeries. 50% of the time there are other injuries that occur with a tear including damage to cartilage or ligaments. When that is the case, surgery will be recommended. Being female makes you more at risk for ACL injury.

What happens when I tear my ACL?

• You may feel or hear a pop
• Sudden knee pain
• Difficulty walking
• Knee Swelling
• Knee buckling
• Knee Instability

What should I do if I injured my knee?

• Immediate care is RICE: Rest, ICE, Compression and Elevation
• Then, call your doctor

Do I need an MRI?     

First you need a diagnosis. Your POA orthopedic surgeon will want to know how you injured your knee. He will examine you, test your range of motion by moving your knee around, and order several imaging tests, possibly including an MRI to confirm the diagnosis.

When should I have surgery?

ACL TEARS: The ACL can be torn completely in half or only partially torn. Whether to have surgery depends on the severity of the tear and your lifestyle. The ACL cannot heal itself.

With a small tear, it is possible to find relief with bracing and physical therapy. However, there may be are consequences when choosing conservative treatment, including knee pain, instability, increased risk of arthritis, and other damage to the knee.

A complete tear is difficult to live with as it results in significant instability and risk. Long-term instability can cause arthritis. Thus, surgery is recommended for complete tears.

TIMING: The optimal timing of ACL surgery and the consequences of delay are under debate. The general consensus is that timing of surgery depends on the status of the knee prior to surgery. Your POA surgeon will assess your knee condition including the amount of swelling, your strength, and range of motion, and discuss timing of surgery with you. Often, reconstructive ACL surgery is performed a few weeks after the injury, in order to wait until the swelling and inflammation have receded.

CONSERVATIVE TREATMENT: Conservative treatment is often successful in delaying or avoiding surgery, when the patient is involved in less physically demanding activities. But, when the patient is a high level athlete, they generally desire surgery as soon as possible in order to return to play.

Patients should ask themselves: “Am I willing to modify my life to fit my damaged knee, or should I have surgery to fit my lifestyle, and return to the activities that make my life enjoyable?”

What happens with surgery?

ACL Reconstruction surgery a minimally invasive arthroscopic procedure to remove the damaged ACL and replace it with a graft. The ACL cannot be sewn together. Your POA surgeon will discuss with you the pros and cons of the various types of grafts, and which type is appropriate to your needs, and condition.

Where is it done?

It is an outpatient minimally invasive arthroscopic surgery under general anesthesia.

How long is recovery?

Typically, it takes six months for full recovery, and up to 12 months for some patients who are young, active people and high level athletes.

Is ACL surgery necessary?

It is common to have a patient with no other knee injury, to undergo physical therapy before surgery to determine if it is possible build the muscles, restore range of motion and stabilize the knee. A program of rigorous, progressive rehabilitation can restore the knee to almost full function, in many patients. Rehabilitation can also help alleviate pain. Studies report that it is possible to avoid or at least delay surgery with physical therapy. One study reported that 60% of patients who delayed surgery found they never needed the operation.

Physical Therapy?

Rehabilitation before and after ACL reconstruction is recommended and is integral to healing. It begins within a day after surgery and continues until the patient has achieved full rehabilitation. Dedication to a complete program of rehabilitation is essential.

Prognosis?

Prognosis is good in the optimal patient who chooses rehabilitation without reconstruction. Patients who choose ACL reconstruction can fully recover and return to the activities that make their lives enjoyable.

At Peninsula Orthopedic Associates in the San Francisco Bay Area, your POA surgeon will discuss all these issues with you, and listen to your needs. Together you will decide the best course of treatment for you.