Choosing ACL Surgery or Therapy For Your Knee Injury

Feb 14, 2013
Tagged with: Choosing ACL Surgery or Therapy For Your Knee Injury

How to choose what’s best

What is the ACL?

The Anterior Cruciate Ligament, or ACL, is one of four ligaments that connect the bones of the knee. Ligaments are dense bundles of connecting tissue that stabilize and limit movement in joints. In the knee, the ACL is the most important of the four ligaments. It stabilizes the knee by limiting forward motion and rotation.

How is the ACL Damaged?

Damage to the ACL, whether a partial or complete tear, is a very common sports injury. But less active people can damage their ACL too. A tear typically results from hyper-extension of the knee or from a sudden rotation of the knee. Those with relatively weak leg muscles are more prone to knee injuries.

After the initial injury the knee will become swollen and will be painful to walk on. An examination by a physician is necessary to determine if ligaments have been damaged and, if so, the extent of the damage. This is typically done by MRI imaging, though standard X-rays, or measurement of the range of motion with a KT 1000 may also be used.

The immediate goal for post injury treatment is to reduce the pain and swelling, and to maintain range of motion. This may be done by applying ice packs to the knee joint, wrapping it with an ACE bandage, and rest with the leg elevated. It’s important to maintain the range of motion and regain strength in the knee minimize to further damage. A standard knee brace available at drug stores can be used to stabilize the knee once you are up and walking.

Is Surgery Required?

The recommendation by your doctor to have reconstructive surgery on an ACL tear will be based on your age, your activity level, the stability of the damaged knee, and if other parts of your knee have been damaged.

The injury is not life threatening, indeed repair of the ACL may not be necessary at all. Post surgery rehabilitation of the knee and ligaments takes months of work and considerable commitment. If the injury does not interfere with your pre-injury lifestyle and activity level, it may be best to opt out of surgery.

Whether or not you opt for surgery, it is likely your physician will prescribe therapy and exercise to strengthen the muscles around the knee to improve stability and limit further damage.

Preparing For ACL Surgery

If you and your doctor have decided the best course of action is to have your damaged ACL reconstructed through surgery, you will need to prepare. Typically before surgery the goal is to:

1. Keep the swelling in your kneed to a minimum
2. Recover the range of motion in your knee
3. Be able to walk normally

Your physician may order various tests depending on your age, including an EKG, blood and urine tests and a chest x-ray.

Types of Reconstructive ACL Surgery

ACLs are not repaired, they are reconstructed. In fact, of the three most common surgery options, all three involve replacement of the ACL. The surgery options most often used today are:

1. Patellar Graft Reconstruction
2. Hamstring Graft Reconstruction
3. Allograft Reconstruction

1. Patellar Graft Reconstruction

This procedure has become one of the most popular methods to reconstruct the ACL. It involves removing a portion of the patellar tendon, which is one of the four tendons of the knee. The tendon section removed will include bits of bone on either end that are inserted into prepared ‘tunnels’ near the attachment sites of the original ACL. This method creates a very strong tendon attachment. Both the bone and patellar that are removed fill-in and heal nicely within six to eight weeks of the surgery.

2. Hamstring Graft Reconstruction

This procedure is growing in popularity. It involves the removal of a small portion of the hamstring tendon. Like the patellar graft, tunnels are drilled near the attachment sites of the original ACL tendon and the tendon ends inserted and secured with special screws. These screws eventually dissolve and fill-in with bone as it heals. This is a popular procedure for younger patients who are still growing since there is less chance of damage to growth plates.

3. Allograft Reconstruction

This procedure takes tendon tissue directly from cadavers. The surgeon may opt for patella tendons, hamstring tendons, or even the Achilles tendon. The attachment technique is the same for the Hamstring or Patellar reconstruction surgeries. This procedure may be a good choice for patients with limited tissue selection of their own.

Post Surgery Care

ACL reconstructive surgery is generally done on an outpatient basis. Depending on the anesthesia you will be up within a couple hours and ready to go home. But don’t expect to drive yourself home. After any generally anesthesia you should not operate a vehicle and should have someone monitor you for the next 24 hours.

Following surgery, physical therapy will be required to complete your rehabilitation. Initially the goal will be to walk with crutches, contract thigh muscles, and work on lifting your leg. Usually within 2-3 weeks you will be walking without crutches and can begin more rigorous exercise to rebuild the important muscles around your knee. Even if your leg muscles were well developed, don’t be surprised to find the muscles attached to your knee have atrophied considerably, this is normal.

With persistent exercise and therapy you should be able to regain normal use and activity of your legs within six to eight months.


Author Bio:

Donna Shannon conducts workshops on Mind and Body in the United States and Canada.  She believes that both the mind and body promote healthy well being.  She often writes about acl surgery and tips on preparing for it at eHealthMD.

Author: Christy Weatherspoon