September 10, 2014 | By Dr. Eric Price
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d2lkdGg6MTAwJTtoZWlnaHQ6YXV0bzt3aWR0aDphdXRvO3RyYW5zaXRpb246dHJhbnNmb3JtIDAuMjVzIGVhc2V9LnRiLWltYWdlIC50Yi1pbWFnZS1jYXB0aW9uLWZpdC10by1pbWFnZXtkaXNwbGF5OnRhYmxlfS50Yi1pbWFnZSAudGItaW1hZ2UtY2FwdGlvbi1maXQtdG8taW1hZ2UgLnRiLWltYWdlLWNhcHRpb257ZGlzcGxheTp0YWJsZS1jYXB0aW9uO2NhcHRpb24tc2lkZTpib3R0b219IH0g
The ACL (Anterior Cruciate Ligament) is a major stabilizing ligament in the knee. A ligament is a dense band of connective tissue, like a rope or cord. The ACL prevents abnormal movement of the thighbone (femur) on the shinbone (tibia).
People with ACL tears often complain that their leg "gives out" and feel that they are unable to trust their leg, especially when they pivot, turn or twist. This sensation is called "instability." Instability can occur during sports and everyday activities.
ACL injuries often occur as a result of an abrupt twisting motion during sports or a fall. Often people say they twisted their knee, felt a pop, and then were unable to walk. Many report that the knee quickly became swollen and filled with fluid.
To diagnose an ACL tear, a doctor will take a history and perform a physical examination along with X-rays and often an MRI. Certain abnormal movements occur in the knee after an ACL tear and the doctor can feel these movements during the examination. The X-rays show the bones of the knee and the MRI shows the ACL.
Treatment options vary from physical therapy, to bracing, to surgery. Options are best discussed with the doctor. Often, people who wish to resume an active lifestyle choose to have surgery. Some patients need to have physical therapy before surgery to improve motion or strength.
ACL surgery is called a "reconstructive surgery" which means the torn ACL is removed and a new one is placed. A torn ACL will not heal back together, either on its own or if a doctor stitches the torn ends together. Therefore, in order for ACL function to be restored, a new ACL must be made. It is made with a graft which will serve as a replacement ligament. A graft is a piece of tissue from another part of the body or a cadaver. The graft is surgically placed in the proper location in the knee to function as a new ACL.
Most of the surgery is done through small incisions with small instruments, but some larger incisions are needed to obtain the graft and place it in its new location. During surgery, the torn ends of the ACL are removed and tunnels are drilled in the shinbone and thighbone. These tunnels allow placement of the graft in the proper location to become the new ACL. The graft is held in place with metal or absorbable screws, stitches or both. Over time, the graft ligament heals to the surrounding tissue and functions as a new ACL.
Patients usually go home the same day, often with a brace on the leg. Recovery after ACL reconstruction surgery is gradual. Several months of physical therapy will be required for a proper recovery. Activity restrictions will apply after surgery until appropriate rehabilitation goals have been achieved. Eventually, running and sports will be permitted.
