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| Understanding ACL Injuries by Michael Adesso |
| Over the past 25 years, there have been great advancements in the surgical repair of injuries. |
| A good example of this is the repair of the Anterior Cruciate Ligament, or ACL. An ACL tear used to mean the end of an athlete’s participation in sports requiring “stop and go” action. Thanks to advances in surgery and rehabilitation, this is no longer the case. |
| In fact, most people are now able to return to their previous activity. |
| First, to understand what happens in an ACL injury, here is a little anatomy: |
| Ligaments are tough, relatively inelastic tissues that connect bone to bone. They contribute to the stability of our joints. The ACL is found at the center of the knee joint and connects the femur (thigh bone) to the tibia (shin bone). It provides the primary stabilization of the knee during active motion. |
| A ligament injury is referred to as a sprain, and is graded as mild (Grade 1), moderate (Grade 2, partial tearing), or severe (Grade 3, torn). |
| Typically, the ligament is injured with an abnormal twisting motion at the knee. An example of this is when a basketball player goes to change direction and his foot “sticks” while his body continues to twist. Many times the twist is accompanied by an audible “pop” at the knee. |
| In Grade 2 or Grade 3 injuries, the knee usually becomes very stiff and swollen within 24 hours. Follow-up with an orthopaedic surgeon is needed to determine the extent of the injury. This will usually include an office examination and possibly an MRI (to determine the grade of injury and identify any other injured structures). |
| If the ACL is torn, the frayed ends cannot be simply sewn back together. The most common way to repair the ACL is using a graft made from the tendon just below the knee cap, pieces of bone and screws. The orthopaedic surgeon will drill tunnels into the knee joint and place the graft where the old ACL used to be. |
| The pieces of bone and screws are used to secure the graft. Dr. Marc Fineberg at the University at Buffalo’s Sports Medicine Institute says one of the most important parts of this process is correct tunnel placement. At UB, Fineberg is investigating the use of a computerized navigation system that may lead to even better outcomes for ACL surgeries. |
| The other methods of ACL repair are the hamstring tendon graft and a donor graft from a cadaver. Each technique has pluses and minuses, and an orthopaedic surgeon should offer all the options. |
| After surgery, rehab will take from four to six months before a return to high level sports. The amount of time may vary depending on your surgeon, the technique used, your age, fitness level and the severity of your injury. |
| Initial therapy will focus on regaining range of motion, decreasing swelling and walking with crutches. Functional exercises including lunges, squats, balance training, hopping and jumping drills etc. will be utilized to get you ready for sports participation. |
| It can take people almost a full year to feel completely fit both physically and mentally after ACL surgery. |
| There is currently no general consensus about preventing ACL injuries. One school of thought is that athletes will benefit from a training program that includes hopping and jumping drills, core strengthening and balance activities and not just focusing on traditional leg machine exercises. |
| Michael Adesso, PT, ATC Director of Physical Therapy University Sports Medicine Amherst Location |