ACL knee injuries are among the most common injuries for athletes. The ACL (anterior cruciate ligament) is one of four ligaments that make up the knee joint and is responsible for keeping the shinbone (tibia) from sliding forward on the thighbone (femur) and providing stability for movements requiring rotation of the knee. Soccer players, football players, and basketball players are at a higher risk for developing an ACL knee injury because of the sudden pivots, twists and turns associated with these sports. The ACL can also be torn in cases that do not involve sports, such as tripping, missing a step, or any other traumatic hit to the knee when it is place in an inappropriate position.
An ACL knee injury will present similar symptoms for all patients, however, the severity of these symptoms will vary. Depending on if the ACL is completely torn, partially torn, or just stretched, patients will feel severe pain, limited motion, and hear a sound of a pop when the injury occurs. Some patients will require immediate surgery to repair this injury, while others can live with moderate symptoms. Ongoing instability of the knee is can be problematic for most individuals because the knee can shift with certain movements.
There are several tests that can be performed during a physical examination if Dr. Anz suspects an ACL injury. The Lachman Test, Anterior Drawer test, and Pivot Shift test are examples of what he might perform. During the exam, he will also evaluate the other ligaments of the knee and assess the meniscus to verify that a multi-ligament or complex injury has not occurred. An X-ray or MRI may be required during the initial examination to look for these associated and/or additional injuries, and to assess if the ACL is stretched or has experienced a full tear.
Depending on the patient’s lifestyle and goals, the ultimate objective is to return the patient to their pre-injury activities. This involves an individual treatment plan to regain stability and full mobility of the knee. In the case of minor strains, and mild tears, surgery may not be necessary, depending on a patient’s goals. Conservative treatment consists of rest, ice, elevation, anti-inflammatory medications, and possibly, physical therapy to strengthen the knee. Dr. Anz also may prescribe an ACL brace to help protect the joint during the rehabilitation process.
Dr. Anz will perform ACL reconstruction surgery for patients who present with a complete tear of the ACL or obvious ACL insufficiency. During reconstruction surgery for a torn ACL, he will reconstruct the ligament by replacing it with a graft of a similar size. It is necessary to reconstruct the ligament rather than repair it because a full tear of the ACL has a limited ability to heal after a repair. This procedure can be done arthroscopically and routinely illustrates great success. Recent studies have demonstrated new methods for placement of the graft to restore the anatomy of the original ligament. The graft used during the reconstructive process will be one taken from the patient, or donated using a graft bank from a donor; graft choice is individually decided with the patient.
Dr. Anz will prescribe a detailed and thorough physical therapy program following ACL reconstruction surgery. This will be a progressive process that will initially limit movement, but slowly incorporates range of motion movements and strengthening exercises. Post-operative rehabilitation is a joint effort between Dr. Anz, his patient, and the physical therapist and is recommended to fulfill completely in order to achieve the most optimal outcome.
For additional information on ACL knee injuries, or to learn more about what is involved during ACL reconstruction surgery, please contact the office of orthopedic knee surgeon, Dr. Adam Anz, serving the greater Pensacola, Gulf Breeze, Florida communities.