ACL Injury Treatment Options
The majority of ACL injuries occur in young, healthy athletes who suffer traumatic sports injuries. Proper management, including addressing injuries to other structures, is essential to ensure future function. For example, as much as 50% of ACL ruptures are accompanied by a meniscus tear. The meniscus is made of two wedge-shaped pieces of cartilage that act as shock absorbers in the knee joint. The meniscus functions to distribute weight and improve joint stability. The symptoms and treatment of a meniscus tear are similar to treatment of an ACL tear using knee arthroscopy.
The modern approach to treating an ACL injury is a range of care from conservative management, to prehabilitation, and when necessary, surgery and reconstruction. Not all patients need surgical reconstruction if they do not intend to return to pivoting activities. Some may recover good function with conservative management, and can respond well to rehabilitation as a first-line treatment in those cases.
Consideration of various factors including the athlete’s desire to return to play, the ability to restore pre-injury activity levels, and the timing of surgery are factors that will determine the choice of treatment.
The first goal after injury is to reduce and control swelling and inflammation. During the first 24 – 72 hours after injury there will be noticeable bruising (due to bleeding in the joint), pain, and knee instability. Conservative management involves rest, ice, compression and elevation to treat pain, swelling and inflammation. After several days of rest, physical therapy will be recommended to restore range of motion and knee strength. This is called prehabilitation.
Recent studies demonstrate that the “rehabilitation first” approach compared to early/immediate ACL reconstruction provides comparable outcomes at 2 years after surgery. In addition, patients who underwent preoperative rehab (due to limited range of motion) reported better outcomes and knee function after surgery.
The goal of prehab is to minimize the impact of an ACL tear on the muscles, reduce pain and stiffness and swelling, and restore range of motion, strength and function. Prehab is recommended within 72 hours after injury to alleviate pain and regain strength and stability. The prehab exercises are similar to those employed during recovery after surgery.
Prehabilitation is valuable to prepare a patient for surgery. Importantly, prehabilitation provides essential benefits including improved muscle strength, coordination, and movement while resulting in optimal surgical outcomes. In older patients prehab may help them avoid surgery.
Knee instability is the critical factor when deciding whether the patient should undergo surgery. Reconstruction will be recommended when the patient is at risk for additional knee injury to other structure such as the meniscus. In addition, when patients have failed a trial of nonoperative treatment and continue to have symptoms with activity reconstruction will be recommended.
ACL reconstruction surgery is the gold standard treatment for ACL injuries in young, active people. Young athletes typically require aggressive treatment to returnto play. ACL reconstruction is a minimally invasive arthroscopic procedure that protects and reduces damage to healthy tissue, reduces bleeding and scarring, and provides good outcomes. After surgery you will undergo rehabilitation to restore function. Full recovery can take up to a year.
ACL reconstruction surgery uses a graft to replace the torn ligament. New surgical techniques like ACL repairs can help the heal partially torn ligaments which eliminates the need to replace the ligament. There are two types of graft tissue: autograft and allograft. A patient’s own tissue – an autograft – can often be used for surgical reconstruction. Autograft tissue is the safest and fastest-healing tissue that can be used. However, harvesting autograft tissue requires a second incision and surgical site from which the patient must recover. The additional recovery time can extend a patient’s hospital stay. Allograft tissue, taken from another person, takes longer to incorporate into the patient’s body, but does not require a second surgical site to heal. Also, the surgical time and hospital stay may be shorter when allograft tissue is used. Allograft tissue transplants are not at risk of rejection by the body as with organ transplants, so it is not necessary to use drugs to suppress the body’s immune response.
Schedule a consultation
If you’re suffering from an ACL injury, schedule a consultation with board-certified orthopedic surgeon Dr. Jorge Chahla. Dr. Chahla is part of Midwest Orthopaedics at Rush, a nationally recognized orthopedic group. Dr. Chahla is renowned in his own right as one the nation’s leading orthopedic surgeons specializing in sports medicine. During your consultation, Dr. Chahla can diagnose and discuss the appropriate treatment options for you.