Anterior cruciate ligament (ACL) injuries
The ACL (anterior cruciate ligament) is a band of tough, fibrous tissue that stabilizes the knee. Injuries to the ACL are very common, especially among athletes. Treatment for your injury may or may not involve surgery. Treatment depends on the severity of the injury and how active you hope to be in the future. Treatment also depends on the type of activities you wish to participate in. Your healthcare provider can discuss your treatment options with you.
How we treat Anterior cruciate ligament (ACL) injuries
Reduce pain and swelling
Whether or not you have surgery, you can help reduce pain and swelling with rest, ice, compression, and elevation. Rest with your knee elevated above heart level. Put ice on your knee three to five times a day for 10 to 15 minutes at a time. Keep a thin cloth between the ice and your skin. A compressive wrap may also help reduce swelling. Take any medicines that are prescribed and follow any other instructions you’re given.
Crutches can help you get around during your recovery. They reduce stress on your knee. Follow your healthcare provider’s advice about the use of crutches and how much weight to put on your injured leg. Use crutches or a brace for as long as advised.
Whether or not you have surgery, rehabilitation exercises are important. Exercise is needed to strengthen the muscles that support your knee. It will also help you regain flexibility, reduce pain, and prevent other knee problems in the future. Your healthcare provider can show you the best exercises for your knee. He or she will also tell you how long and how often to exercise.
Both surgical and nonsurgical treatment has been used to recover from an ACL tear. Several types of surgery are available based on your and your healthcare provider's preferences, as well as other factors. Some surgeons will operate soon after an ACL tear. Others prefer several weeks of physical therapy first. There are also different anesthesia choices available.
Preparing for surgery
- Stop taking aspirin and other blood thinning medicines seven or more days before surgery as advised by your healthcare provider.
- Arrange to get crutches to use during recovery.
- Follow any directions you are given for not eating or drinking before surgery.
- Arrange for an adult to drive you home after surgery.
The most common type of surgery for an ACL injury is reconstruction. Several types of surgeries are used.
- Patellar tendon graft. This uses a piece of your own patellar tendon between the knee cap and tibia.
- Quadriceps tendon graft. This uses a piece of your own quadriceps tendon between the quadriceps muscle and the knee cap.
- Hamstring tendon graft. This uses a piece of your own hamstring tendon between the hamstring muscle and the tibia.
- A cadaver (allograft) tendon graft. This uses any one of several tendons from a cadaver.
To rebuild your ACL, your surgeon may do open surgery or arthroscopy. During arthroscopy, a long, thin tube with a tiny camera is inserted into the knee joint so your surgeon can see inside the joint. Tools inserted through small incisions are used to repair the joint.
Here is what to expect.
- You’ll spend a few hours in a recovery area. You’ll have ice on your knee to prevent swelling, and your leg may be in a brace.
- You may get a continuous cooling machine to relieve swelling and pain.
- You may get medicines to reduce pain and swelling. Take these as prescribed by your healthcare provider.
- Depending on the procedure, physical therapy may begin shortly after surgery. This may include light exercises. In some cases, you may use a CPM (continuous passive motion) machine for a time. This machine flexes and extends the knee, keeping it from getting stiff.
- You can usually go home the same day as surgery. Have an adult family member or friend give you a ride.