ACL Treatment Options
“In My Office”
‘I have a torn anterior cruciate ligament in my knee – what are my options for treatment? Will I ever be able to enjoy running sports again?
An anterior cruciate ligament tear (ACL) can be a devastating injury. Aside from the pain and swelling, there may be an impending sense that you may not be able to recover normal knee function and your active lifestyle. The majority of ACL tears (see blog on ACL anatomy) occur in the middle of the ligament. Occasionally, the ligament will tear directly from the attachment to the thighbone (femur). It is quite unusual for the ligament to be able to be reliably repaired directly back to the bone and reestablish normal tension and strength. In most instances, a new ligament must be created (called a ‘reconstruction’ rather than repair) using a graft (tissue substitute).
The graft source may be from your own leg (autograft) or from a cadaver donor (allograft). Synthetic ACL replacements alone have not been shown to be reliably durable in stabilizing the knee. The graft must be placed precisely in the position of your native ACL. Anterior cruciate ligament reconstructions are generally performed in an arthroscopically assisted manner. Small incisions for the arthroscopic tools are all that enter your knee, although somewhat larger incisions may be needed to obtain an autograft. The indications for reconstruction of the torn ACL include functional instability (your knee gives way or buckles during activity) or demonstration on examination that the ACL is incompetent and unable to prevent a pivot shift (excessive displacement of the lower leg (tibia) on the femur. If you intend to be involved in running, jumping, cutting, or pivoting activities there is a 75 – 80% chance of incurring additional injuries and further damage to your knee if it is not stabilized.
Bracing can help stabilize your knee to a degree, but cannot completely control twisting of your knee, which is the most likely cause of recurrent instability. If you are lower demand in your activities, a specific ACL brace may suffice. If you choose to undergo anterior cruciate ligament reconstruction, there is an 85 – 90% chance that you can return to full unrestricted athletic activities provided you completely rehabilitate your knee and regain full range-of-motion, leg strength and agility. A small number of patients have pain, weakness, or ongoing looseness. Occasionally, a patient will choose to modify their lifestyle and demands to avoid further injury to their knee.