ACL Tear Treatment Options
Although most ACL tears occur in young, healthy athletes, they can occur in all ages and are not all sports related injuries. Proper treatment is vital to ensure future function and protect the knee from further damage. Treatment options vary depending on the patient, their level of activity and the severity of their injury and the type of tear.
Partial tears are rare. Most are complete tears. For athletes who have a complete tear of their ACL, surgery is often the best option to restore stability to the knee joint. However, for athletes with a partial tear of the ACL, nonsurgical treatments such as physical therapy and knee bracing may be enough to provide relief from symptoms and allow the athlete to return to their sport. For older individuals who are less active, conservative management with activity modification may be sufficient to restore function.
The first step in treating an ACL tear is to get a proper and accurate diagnosis. Gentle exercises to prevent quad atrophy like straight leg raises and quad sets are initiated as well as ankle pumps to prevent blood clots. During the first 72 hours the knee will swell, bruise and cause pain and instability. The immediate goal is to reduce swelling and pain by applying ice to the area for 20 minutes at a time, several times a day, taking anti-inflammatory medications to treat pain, and keeping the knee elevated. You will use crutches and a brace if needed to stabilize the knee. Once the swelling has gone down, the next step is to begin a physical therapy or home exercise program.
Physical therapy for an ACL tear will focus on regaining range of motion in the knee and strengthening the muscles around the joint. The therapist may also use treatments such as electrical stimulation to help reduce pain and inflammation. Dr. Harrison may recommend a comprehensive program of rehabilitation for athletes who have a partial tear.
However, ACL tears do not heal without surgery, and about 60% of ACL tears also damage the meniscus. In this case, surgery is often the best option.
For active patients with an ACL tear who desire to return to preinjury levels of sports, the surgical gold standard is ACL reconstruction. Surgery may be delayed due to concomitant injuries such as a Medial Collateral Ligament tear. Most patients undergo surgery within 10-14 days of their injury. This time period allows the patient to restore some range of motion and reduce swelling prior to surgery.
- Prehabilitation is physical therapy before surgery to prepare the patient for surgery. The goal is to control swelling and inflammation, retain range of motion and strength as early as possible.
- Most ACL tears cannot be sutured back together. Arthroscopic ACL Repair may be available for certain types of ACL tear. There are pros and cons for repair. Speak with Dr. Harrison about whether this is a procedure appropriate for your specific circumstances.
- Bridge Enhanced ACL Repair or BEAR implant for midsubstance ACL tears is suture repair of the ACL augmented with a protein implant placed in the gap between the torn ends. It is offered as an alternative to ligament reconstruction. It may be beneficial for young and active patients who are at increased risk of future ACL injury and graft failure after ACL reconstruction. To learn more speak with Dr. Harrison.
- ACL Anatomic Reconstruction is the gold standard surgery for ACL tears in the active patient. It involves the removal of the damaged ACL and replacement with a graft of tissue from the patient’s patellar (kneecap) tendon, quadriceps tendon, hamstrings tendon or a graft from a donor.
ACL reconstruction surgery is performed arthroscopically. Arthroscopic reconstruction is minimally invasive which offers less time in hospital, less pain, less damage to surrounding tissues, less bleeding and quicker recovery.
Postoperative rehabilitation is essential to restore full strength, range of motion and function. Recovery can take at least six months. Most patients can return to sports between six to twelve months after surgery. Return to sports is based on clearance from the physician, rehabilitation team, athlete’s coach, and athlete’s physical and mental readiness. Each patient is different and objective testing is used to help determine when a patient can return to training, then sport, and finally competition.
When you injure your knee, contact Dr. Jeffrey Harrison. He will strive to return you to your pre-injury state.
At a Glance
Dr. Jeffrey Harrison
- Board-Certified, Fellowship-Trained Orthopedic Surgeon
- Head Team Physician US Women's Alpine Team and Weber State University
- Performs over 800 surgeries per year
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