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ACL Injury Guide

We’ve all heard about the dreaded ACL knee injury. Athletes greatly fear it, as it can halt or even end their career even with proper treatment. In this blog post, we’ll take you through a full guide on how to deal with an ACL knee injury. Even if you don’t suspect you’ve injured your ACL, it’s important to educate yourself on this common affliction.

But First, Some Knee Injury 101

Knee injury affects more than 12 million Americans each year. Your knee is essentially the largest joint in your body and experiences highly repetitive usage. For this reason, cartilage tears and ligament sprains are the most common knee injuries treated by orthopedic surgeons.

What exactly do ligaments and cartilage do?

Ligaments are situated around the knee. These ligaments both brace the knee on impact and aid in over-all motion control. Your knee’s cartilage complements the ligament by cushioning the knee, also absorbing some of the shock of impact.

What’s the difference between an ACL, MCL & PCL?

The ACL stands for “anterior cruciate ligament” and it is located in the front of the knee. The MCL is the “medial collateral ligament” and it connects the femur and tibia. The PCL or “posterior cruciate ligament” is located behind the knee. The ACL and MCL are very common injuries. The PCL is more difficult to injure.

What causes an MCL or PCL tear?

MCL and PCL injuries are usually the result of a significant blow to the knee. This is something frequently seen is heavy contact sports such as football and rugby. These sort of injuries have unique ligament-specific braces, and may also require a sports therapist or surgery.

What is a patellar tear?

A patellar dislocation is another commonplace injury that involves the patella (aka the "knee cap".) The patella is situated in the patellofemoral cavity between the distal femur and the tibia, held in place by a number of ligaments and tendons. These ligaments can be damaged by a direct blow to the knee or an awkward motion, which in turn can lead to the knee cap sliding out of place. Most of these dislocations involve the patella moving laterally to the left or right side. The result is severe swelling, reduced mobility and an intense pain felt inside of the knee cap.

Who is at risk for a knee injury?

If you play impact sports, your knees are at risk. Proper stretching, strength training and warming up can help mitigate that risk. The American Academy of Orthopaedic Surgeons reports that women are more likely than men to suffer ACL injuries. In fact, a female soccer player is four times more likely than a male soccer player to tear their ACL. This is likely due to how a female’s hips distribute weight on the knees. For this reason, female athletes should take extra care and use strategic weight lifting to strengthen muscles and stabilize the knees.

What Causes an ACL Tear?

Now that you know a little bit more about other common kinds of knee injuries, let’s talk about what makes ACL injuries different. ACL injuries are typically the result of maneuvering. A quick turn or twist, or change in speed, while performing a rigorous activity can result in an ACL tear. These types of tears can also result when landing from a jump, a good example of sports that carry this risk include basketball, volleyball, soccer and skiing. A person who experiences an ACL tear will often hear a pop, followed by their knee giving out and considerable pain.

ACL injuries result in pain, swelling and knee instability. A physician or sports doctor can either conduct special tests or an MRI to decide the degree to which the ACL is injured and if other ligaments were torn as well. It is quite common for multiple ligaments to be injured simultaneously. An ACL injury can lead to significant long-term knee instability and for this reason, many seriously injured individuals opt for surgery. ACL Surgery is certainly not required, however. Torn ligaments, including the ACL, can heal on their own and some individuals prefer physical rehab rather than undergoing the knife.

Treatment for ACL Tears

There are both surgical and non-surgical treatment options available for ACL tears. The best form of treatment will largely depend on the person’s activity level and the severity of the injury. For those who live fairly sedentary lifestyles, non-surgical treatment may be an option, depending on how serious the injury is. Children may also need to forgo surgery because there is a risk of plate damage since their young bodies are still growing. A non-surgical treatment program will involve extensive physical therapy. The patient may also wear a hinged knee brace to help with instability and prevent further injury.

For serious athletes and those with physically demanding jobs or active lifestyles, surgery is most likely the best option. For full ACL tears or combined injuries, surgery is also usually recommended.

There are several things to consider when evaluating ACL surgery, including:

  • What is the extent of your injury? Is it a small tear or something more substantial? The more extensive the injury, the longer non-surgical rehabilitation will take.
  • How important is a healthy ACL to your lifestyle? Do you play high impact sports? Are there certain activities that are critical to your quality of life that you are not willing to give up, such as skiing or soccer?
  • After several weeks of recuperation, does your knee feel "normal" or do you experience knee instability? Does it cause you pain or significant anxiety? Does it impede your ability to do important activities?

Knee Surgery Recovery + What to Expect

The surgery for an ACL tear is called ACL reconstruction. It is a procedure done under general anesthesia, meaning the patient is "asleep" for the operation. The surgery replaces the damaged ACL with healthy tissue from elsewhere in your body (autograft) or a donor (allograft), usually using tissue from the knee cap or hamstring tendons. The procedure is executed with a tiny knee arthroscopy camera which the surgeon will use to observe and treat the affected area. The new tissue is usually attached with screws or similar devices. After the surgery is complete, the patient will need to wear a post-surgical knee brace to support and stabilize the knee during rehabilitation.

ACL reconstruction surgery is fairly common and usually quite successful (90+%). There are, however, risks associated with any major medical operation. For ACL reconstruction the risks include infection, stiffness, the continuance of instability or pain, and difficulty performing certain tasks.

After surgery, the patient will undergo a rigorous rehabilitation period. Rehabilitation usually starts several days after surgery. The main focus is on strength and mobility. The major goals are to strengthen the damaged knee and muscles surrounding the knee, such as the quadriceps muscle, as well as work on restoring range of motion and stability.

Physical therapy does involve doing lots of repetitive exercises and does require plenty of determination and focus. Serious athletes will spend almost every day, or at least several times a week, in the training room working on strengthening their knee. It is very important that the patient is willing to spend several months of hard work to restore their knee to full strength.

The rehabilitation process will generally last from six to nine months before an athlete is cleared to play contact sports again. The physician and trainer may also suggest that the patient wear a knee ACL ligament brace while playing to help protect and provide stability to the knee.

You’re Not Alone: Some ACL Injuries Worth Remembering

Throughout the past century, great careers and memorable moments have been shaped by this injury. If you have recently learned you have torn your ACL, remember that you aren’t alone. Even the world’s greatest athletes had sustained this excruciating tear. Here is a list of 5 memorable athletes that have undergone the same injury you are currently facing.

5. Pelé

Pelé is considered by many to be the greatest soccer player of all time, and in his native country of Brazil, he is regarded as a national icon. And why not, he scored almost 1300 goals throughout his career. A large part of the legend surrounding Pelé came as a result of his astounding performances at the World Cup (he helped Brazil to 3 cup victories in 4 competitions) – the first of which almost never came to fruition.

In 1958, Pele was a rising star in the footballing world. But, shortly before the World Cup tournament was due to begin, he was hobbled by a knee injury, and many thought that he would be left out of the squad. Fortunately, his teammates closed ranks and insisted on his selection to the team. He missed the first two games of the tournament, but when he finally hit the field he made history. As the youngest player in World Cup history (he was only 17 years old), he scored six goals, including a hat-trick against France. He led Brazil to the trophy, was named the young player of the tournament, and the legend of Pele was born.

4. Greg Oden

Oden’s story is much less joyful than Pele’s. An imposing 7’ center during his college basketball days at Ohio State, Greg Oden was selected as the first pick by the Trailblazers in the 2007 NBA Draft. He was expected to be an inspiring player in the professional ranks, ready to take Portland back to the playoffs.

Unfortunately, knee problems emerged almost immediately. He missed his entire first season due to a microfracture in his knee. This was just the first of many debilitating injuries. He suffered another knee injury in February of the following season, missing three weeks. In his third season (2009-2010), he suffered yet another knee injury, fracturing his left patella. This would sideline him for the remainder of the season. And in November of 2010, he would undergo microfracture surgery yet again, missing yet another season.

Ultimately, his injuries left him out of the competition, and the Trailblazers released him in March of 2012. In his entire 5-year career, he only managed to play a single season’s worth of games.

3. Tom Brady

As one of the most decorated professional quarterbacks of all time, Brady is known as the backbone of the New England Patriots. In 2007, the Patriots nearly had an immaculate season, falling only to the Giants in the Super Bowl. And in 2008, Brady was expected to lead the Patriots to a similarly successful year.

In the first quarter of the first game of the season, though, he suffered a hard knock to left knee delivered by the Chiefs’ Bernard Pollard. He tore his ACL and MCL and would be sidelined for the rest of the season. This injury would end his streak of 111 consecutive starts (fourth all time among quarterbacks), and end the Patriots’ hopes of making the playoffs. Luckily, with the help of effective medical care and a DonJoy medical brace, Brady made a full recovery for the 2009 season and led the Patriots back to the playoffs again.

2. Tiger Woods

Everybody knows that Tiger Woods is one of the most decorated golfers in PGA history, but you might not know about the impact that knee injuries have had on his career. Coming into the 2008 US Open Championship, Tiger was suffering from an injured left knee. Always the fighter, he insisted on playing through the weekend. Hobbling around the course on a bum knee, he dramatically won in a 20-hole playoff with runner-up Rocco Mediate.

He had surgery to repair an ACL injury shortly after the victory. But, it seems he has never fully recovered, and he has not won a major championship in the years since.

1. Mickey Mantle

Mickey is regarded as one of the leading players of his era, leading the Yankees to 7 World Series championships and holding a slew of records for home runs, RBIs, and other statistics revolving around power hitting during the 1950s and 60s. But the real question is this: just how good would he have been if he could have stayed healthy?

He first suffered a knee injury as a 19-year-old, getting his foot stuck in a rubber drain in right field while chasing down a fly ball in the World Series. This was before many proper treatments for sports injuries even existed, and he was plagued by knee and other injuries likely stemming from a torn ACL for the rest of his career. If he could have stayed healthy, he may have been the greatest statistical ballplayer of all time.