By William R. Beach, MD
Your ACL (anterior cruciate ligament) is one of the major ligaments in your knee and keeps your tibia (shinbone) coupled to your femur (thighbone). It stabilizes your knee and keeps it from buckling, especially during quick changes of direction. This ligament is prone to injury. Sports and fitness activities that require pivoting, twisting and jumping lead to many torn ACL´s.
Approximately 200,000 ACL injuries occur annually in the U.S. The incidence is higher in high-risk sports such as basketball, football, skiing, and soccer. In the past, we have believed the incidence is higher among females, especially in sports such as soccer. However, a recent Swedish study, published in the American Journal of Sports Medicine, casts doubt on this and suggests that men are more prone to ACL injuries.
Preventing And Diagnosing ACL Injuries At Home
The best way to prevent ACL injuries is to educate yourself on preventative techniques which include stretching and strengthening the leg muscles, especially the front and back muscles of the thigh (quadriceps and hamstrings). But despite these efforts, injuries will still occur.
If you are injured and experience these symptoms, you may have an ACL injury:
• Feeling or hearing a pop in the knee at the time of injury.
• Knee swelling within the first few hours of the injury.
• Limited knee movement because of pain and/or swelling.
• A feeling of instability or “giving away” when walking
If you suspect you have an ACL injury, there are several things you can do before you get to see your physician. You can follow the RICE method. Rest the knee, put Ice on it, use an elastic bandage to give gentle Compression, and Elevate the knee. You can also take over-the -counter anti-inflammatory medications as needed/directed. You may need crutches to get around.
You will need to see a doctor. In many cases, you will first see your family doctor who will likely refer you to an orthopaedic surgeon. As an orthopaedic surgeon who specializes in Sports Medicine, I see many patients with ACL injuries. I understand that the patient is often suffering from physical pain but also with mental anxiety. The injury means that athletes cannot participate in their sport for a certain period of time, which is often an entire season. For the older athletes the injury means they are unable to perform their job or activities of daily living.
How An Orthopaedic Surgeon Treats An ACL Injury
My first goal is to make a proper diagnosis. You may need X-rays or other imaging studies, such as a MRI. Treatment options for you and your injured ACL will depend on the severity and any associated injuries, how active you are, your age and overall health.
An isolated ACL injury in a low demand athlete may require physical therapy and conservative treatment. However, in younger, higher demand patients, surgery followed by physical therapy is usually the best option. When surgery is performed, the ACL must be reconstructed with a substitute tendon and unfortunately is not amendable to simple repair (i.e. a torn ACL can’t just be sewn back together).
The good news is that surgery is usually an arthroscopic outpatient procedure. Arthroscopy is much less invasive which allows me to see and operate on the knee through small incisions. Compared to traditional open surgery, arthroscopy usually results in a faster recovery and return to normal activities.