The ACL or the anterior cruciate ligament is the fibrous band of tissue present in the knee that directly connects the thigh bone (femur) and shin bone (tibia). The ACL is essential for the stability and motion of the knee joint. This way, it prevents the thigh bone and the shin bone from separating and keeps the shin bone from sliding too far forward.
Unfortunately, ACL tears are quite common- affecting several hundred thousand individuals across the world every year. ACL injuries commonly occur while playing sports such as soccer, basketball, and football and other activities that require an individual to make vigorous or repeated motions that work the anterior cruciate ligament, putting it under stress. An ACL tear or injury can happen when the foot is firmly set on the ground and a sudden force hits the knee while the leg is straight or bent (even a little). This can happen while rapidly changing directions, landing from a jump or slowing down while running.
According to research by the National Library of Medicine, when compared to male athletes participating in the same sports, the risk of ACL injury is two to eight times greater in females.
Once torn, the ACL cannot heal on its own as there is no blood supply to the ligament. The most successful treatment option for a torn ACL is usually decided based on diagnosis and the grade of the injury. Minor ACL injuries can be treated with physiotherapy and rehabilitation. But for severe ACL injuries or for a completely torn anterior cruciate ligament, ACL reconstruction surgery is suggested. Surgery is recommended if the individual has a compromised quality of life, pain and instability due to the torn ACL.
● Nonsurgical treatments
For mild ACL injuries, wearing protective braces and regular physiotherapy to strengthen the muscles around the knee can help. Orthopedic specialists suggest the RICE method to treat minor ACL tears. R.I.C.E. means rest, ice, compression, and elevation. Taking these simple steps after a minor ACL injury can help you recover more quickly and get back to regular activities.
Step 1- Take Rest. Immediately after having an ACL injury, you should rest the affected area as much as possible. Orthopedists recommend 24 - 48 hours of no weight-bearing activities following an ACL injury. Continuously working with a moderately or severely injured or torn ACL can increase pain, delay healing, and even worsen the injury.
Step 2- Use Ice Packs. To help reduce swelling, inflammation and pain during the first 48 hours after an ACL injury, use ice packs for the affected area for 20 minutes at a time and repeat the same every 4 hours. If you do not have an ice pack handy, an alternative would be using ice in a thick towel or washcloth (so that it does not wet the area) or using a bag of frozen veggies. Do not use the ice pack for more than 20 minutes at a time, as that may cause tissue damage.
Step 3- Compression. Take a medical bandage and wrap the injured area to help decrease swelling and internal bleeding (if that is present). The compression wrap should be snug, but it is also important to have proper circulation. Signs that your bandage is too tight include increased pain, tingling, numbness, swelling or coolness. If you think you need to use the compression wrap for more than 48 - 72 hours, your injury might be serious and may require prompt medical attention. Contact an orthopedic doctor if you feel so.
Stretching, rehabilitation and physiotherapy can help treat ACL injuries. Wearing a knee brace can also help provide extra stability for the knee with an injured or torn ACL. Though it has not been scientifically proven that wearing a knee brace can prevent one from reinjuring the knee if you do not have a fully functioning ACL due to an injury or tear.
The time-frame for which non-surgical treatment for a torn ACL may be needed will vary based on the grade and extent of the injury and how well the individual’s body is able to heal. Everybody is different and heal at different rates. Overdoing things before the body is ready can lead to new injuries and even longer-term complications such as osteoarthritis or a degenerative joint disease.
People who choose not to have ACL repair surgery are not recommended to participate in sports or other high impact activities or jobs that involve running, twisting or jumping, or activities that put stress on the knee. Individuals who attempt nonsurgical management for a torn ACL and continue to play sports or other high impact activities and workouts are very likely to develop persistent knee instability and are at a high risk of further injuries such as a meniscus/ PCL injury or tear.
Most successful treatment for torn ACL - ACL reconstruction surgery
If non-surgical treatment options do not work and do not provide stability in the knee, surgery may be the best option for you. Discuss your treatment options and goals with a skilled orthopedic doctor so that they can help you determine the right treatment option to get you back to your active routine as safely and quickly as possible.
Orthopedic specialists now recommend arthroscopic surgery techniques for ACL tears. Arthroscopy is a minimally invasive surgical technique to conduct surgeries on the joints. During an arthroscopic ACL reconstruction, the surgeon will make 2 to 3 small incisions around the knee and will insert an arthroscopy (a flexible tube with a camera on one end) through one incision. Small surgical tools can then be inserted through the other incisions to conduct the surgery with minimal incisions, bleeding, surgical risks and complications.
ACL reconstruction surgery is usually completed in about an hour and the patient can usually go home the same day after the procedure. Although, some patients might be recommended overnight hospitalisation. As with any surgical procedure, the effect of anesthesia can be powerful, so, arrange for your ride back home. Do not drink alcohol or smoke for the next 24 hours after the operation.
Immediately after your ACL surgery, you may have some swelling, stiffness and discomfort. Before your discharge, your surgeon will provide you with information on taking care of your knee, and prescribe medications to manage pain and prevent infections. In most cases, orthopedic specialists encourage patients walking and moving around as soon as possible.
If you have been suffering from pain, weakness, and knee instability following an ACL injury and nonsurgical treatments and management options have not been effective, you may be a good candidate to undergo ACL tear surgery or ACL reconstruction. If your orthopedic doctor has recommended surgery, you should ask them questions like-
● What happens during the procedure?
● What if I do not undergo surgery?
● How long will the recovery take?
● Are there any possible side effects?
● How successful is ACL reconstruction?
The decision to have an ACL tear surgery will depend on the grade of the injury, the extent of damage to the ACL and whether it is affecting the individual’s quality of life. If the knee does not feel much unstable and the individual has a sedentary lifestyle, he or she may decide not to have an ACL surgery. But it is important to be aware that delaying ACL repair surgery can cause further damage to the knee. Speak to your orthopedist about your concerns and knowing all essential information about the procedure, decide what’s best for you. But, make sure to pay close attention to your doctor’s recommendations.