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Anterior cruciate ligament injuries occur most commonly in 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.
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.
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.
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 ACL reconstruction.
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