DESCRIPTION AND SYMPTOMS
What is the acl? What is an acl tear?
The anterior cruciate ligament (ACL) is one of four main ligaments in the knee, along with the medial collateral ligament, lateral collateral, and posterior cruciate ligament. Among its functions is to help control knee rotation and limit the tibia from moving too far forward (anterior translation).
So what is an ACL rupture, what are its causes, and how does it occur?
A tear of the anterior cruciate ligament usually occurs when the knee rotates sharply when decelerated. For example, when jumping or with direct trauma (such as being hit with a football).
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The incidence of ACL injuries in athlete patients is high, especially in sports such as football, baseball, basketball and skiing. It is also more common in women due to their anatomical characteristics. Women have greater laxity (or “elasticity”), narrower necklines (part of the bone where the ligament is housed), and a wider pelvis (increasing potential rotation of the tibia).
ACL injuries do not usually occur in isolation, but are typically also associated with injuries to cartilage, meniscus and knee ligaments.
Other related knee injuries:
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2
Symptoms and diagnosis of an acl tear
A “crunching” feeling, knee instability, or failure.- Limping
- Pain when weight is applied
- Fast-onset joint inflammation
A “crunching” feeling, knee instability, or failure.Diagnosis of anterior cruciate ligament (ACL) tears are made by physical exam and MRI.
If the injury is not treated in time
Ignoring an ACL injury and not treating it is not advised as doing so can cause problems to different areas of daily life:
Work
In many cases, the patient will not be able to go to their job. Especially if it is physically demanding or in which the use of the knee is needed (i.e. turning or bending)
Sport
Knee instability means the patient has to abandon their sporting activities, especially those sports that involve twists and pivots such as football, skiing, basketball, and others
Instability
Pain and swelling prevent regular knee movements. The feeling of instability in everyday activities makes it difficult for the patient to have a normal life.
TREATMENT
What is the treatment for an acl tear?
The goal treatment for an ACL tear focuses on preventing joint instability that appears during sports activities.
Associated injuries such as injuries to cartilage, other ligaments and menisci will determine the type of treatment a patient will receive. Physical requirements of the person, their baseline and work situation, associated injuries and other individual circumstances of each patient are other factors to consider.
In some cases, a rehabilitation and strengthening program of adjacent structures for several months is sufficient. If the feeling of stability is not recovered, the patient will need surgical treatment.
How is an acl tear treated with arthroscopic surgery?
Once the ACL tears, successful treatment involves the creation of a new ligament. In most cases, to accomplish this, a tendon from the patient themselves is used to replace the torn ligament.
There are several tendon options possible for rebuilding, but the most commonly used are:
- Patellar tendon, what we call BTB (bone-tendon-bone).
- “Goose foot” tendon (made up of three tendons, of which only the semitendinous tendon or gracilis tendon are used).
Each type of tendon graft has its advantages and disadvantages. There is also the option that these tendons are not obtained from the patient but rather from the bone bank.
See an animation of ACL tear surgery here: https://www.arthrex.com/es/recursos/animacion/YIm0xmlG3Um2SQFToB06GQ/graftlink-technique
FREQUENTLY ASKED QUESTIONS
How long does an arthroscopic knee surgery take?
Duration time is variable depending on factors such as the surgeon’s experience, the type of injury being treated, and the characteristics of the patient. In the case of arthroscopic knee surgery, they are usually completed in 60 to 90 minutes.
What is recovery like after arthroscopic knee surgery?
- The goal immediately after surgery is to minimize swelling and initiate mobilization exercises. Postoperative physical therapy plans will depend on whether the patient has associated injuries or not (e.g. stitches from a meniscus injury repair).
- Generally speaking, recovery from surgery to fully returning to sports activities requires 6 months of rehabilitation.
What are possible complications from arthroscopic knee surgery for ACL tears?
Complications after arthroscopic surgery for anterior cruciate ligament (ACL) tears may include:
- Infection
- Knee pain
- Knee stiffness
- Graft failure
REFERENCES
Abram SGF1, Price AJ1, Judge A1,2, Beard DJ1. Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017. Br J Sports Med. 2020 Mar;54(5):286-291. doi: 10.1136/bjsports-2018-100195. Epub 2019 Jan 19.
Vermeijden HD, van der List JP, O’Brien R, DiFelice GS.Return to sports following arthroscopic primary repair of the anterior cruciate ligament in the adult population. Knee. 2020 Apr 14. pii: S0968-0160(20)30076-4. doi: 10.1016/j.knee.2020.04.001. PMID:32303448
Crossley KM, Patterson BE, Culvenor AG, Bruder AM, Mosler AB, Mentiplay BF. Making football safer for women: a systematic review and meta-analysis of injury prevention programmes in 11 773 female football (soccer) players. Br J Sports Med. 2020 Apr 6. pii: bjsports-2019-101587. doi: 10.1136/bjsports-2019-101587. Review.
If you want to learn about arthroscopic surgery options for ACL tears or would like to speak with Dr. Villanova directly to discuss your injury, you can contact her by clicking here:
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