Knee

Anterior Cruciate Ligament Injuries

The ACL (Anterior Cruciate Ligament) is a ligament that connects the lower end of the thigh bone (femur) to the top of the lower leg bone (tibia). This ligament is commonly injured in sporting activities and can be problematic because it does not heal well. The poor healing capacity of the ACL is due to the fact that it is bathed in synovial fluid (the fluid that is normally in the knee) and that it is not well vascularized (ie: the ACL does not have an abundant blood supply).

• How it happens

  ACL injuries occur most commonly in patients who play sports. They can also occur with other types of trauma, such as falls or motor vehicle accidents. The most common mechanism of ACL injury is a twisting or pivoting injury on the knee, where the foot remains planted and the knee twists. It also occurs commonly when landing from a jump, when the knee buckles or twists. The patient usually feels a "pop," when the anterior cruciate ligament tears. The knee will also usually swell up within the first twenty-four to forty-eight hours.

• How it feels

  After the knee is injured and the ACL is torn, the knee will often feel very painful due to the ligament injury and the swelling. Patients often have difficulty walking after a tear of the anterior cruciate ligament. Patients may also feel knee instability after they tear their ACL. The knee may feel unstable early after the ACL injury, or in some cases, patients will feel instability after they recover from the injury to the anterior cruciate ligament.

• How it is fixed

  Patients who are very active and participate in cutting and pivoting sports, such as basketball, soccer, and football, will have a very high incidence of knee instability after an ACL injury. For these individuals, surgery is recommended to avoid the risk of future instability related to their anterior cruciate ligament, which can also lead to further meniscus and cartilage damage. For patients who do not participate in cutting and pivoting sports, non-operative management may be considered. This consists of physical therapy and strengthening. For patients who elect to undergo surgery, the anterior cruciate ligament is reconstructed with a tendon. The ACL reconstruction can be done either with a tendon from the patient's own knee, or using an allograft (or transplant) from a donor.

• Recovery/Post-Surgery

  ACL reconstruction is done as an outpatient procedure, meaning that the patient goes home the same day. After ACL reconstruction, a brace is used for a few days and then patients can walk with crutches. Knee motion is started the day after surgery, and most patients can walk normally within one month of the ACL reconstruction. After anterior cruciate ligament reconstruction, patients initially work on range of motion and strengthening and then start light jogging at three to four months after surgery. A full return to sports requires at least six months of recovery after the procedure. The vast majority of patients are able to return to their previous level of activity in sports following successful ACL reconstruction.

Testimonials

"Two years ago, I was the starting varsity midfielder for my high school soccer team, star javelin thrower for track, and was in the best shape of my life. My plan was to attend a Division 1 college and fulfill my dream of playing soccer there. This all changed when I tore my left ACL in the state cup final of my club soccer teams game. I was dribbling beside a girl, and tore it with an effortless cut. It was my sophomore year of high school and I would have to miss my junior year of soccer and the rest of my spring season as well. Although I was completely destroyed by it, I was determined to get back to my full potential. I had an ACL tear, meniscal tear, as well as a microfracture in which another doctor insisted on drilling holes into my bone to heal it."

"I trained for a whole year and was finally cleared to return to playing. One day later, while training with the javelin, I planted with my left leg, and it completely gave out on me, tearing again. My mother researched for days and took me to eight different doctors this time, determined to find the best. Every doctor seemed the same to me; didn't seem to actually care. It was as if I was just another number."

"On the last visit, we took the trip up to Hospital for Special Surgery. When I finally met Dr. Marx, it occurred to me that he was the only doctor out of the eight who actually seemed to care. He was entirely sympathetic and actually showed emotion in what he does. Dr. Marx realized my lateral knee ligament had been loose, which had led to the second tear. Out of the eight doctors we visited, he was the only one to notice that. He reconstructed my ACL as well as my LCL. While in the hospital, I had stayed two nights. A week later while resting on my couch, I received a phone call from Dr. Marx just to see how I was doing and feeling. To have a personal call from the doctor himself really ensured me that I had been in good hands."

"After yet another difficult year of rehab and training, I decided I would return to the sport I loved. I ended up still throwing javelin at my high school and earned 1st place in my division. I am currently a freshman at Philadelphia University, and in the Physician Assistant Program as well. I am also playing Division 2 soccer here on the Women's team and am loving every minute of it. I haven't had any problems with my knee and it's never felt more secure, stronger, or safer before this. I owe all my gratitude towards Dr. Marx and Hospital for Special Surgery, not only for my recovery, but for giving me a direction on where I want to go with my life. After becoming a physician assistant, my dream is to hopefully work at HSS, live in New York, and help young athletes like Dr. Marx did for me. "

~ Lauren Mirabelli