A tear of the anterior cruciate ligament (ACL) is one of the most dreaded sports and professional injuries, having ruined or damaged the careers of countless high-profile sportsmen. A ruptured ACL is excruciatingly painful and can disable a person for months, if not forever, however some people can recover.
An injured ACL cannot be repaired; instead, it must be replaced with a new one. Surgery is the only way to restore full function to your knee. However, replacement surgery using artificial knees has improved greatly in recent years. Men who have had their knees replaced experience an improvement in quality of life equal to that of men who have natural knees, and women's knees are now also being replaced at a rate higher than that of natural repairs.
Replacement surgery is usually done around the age of 50 because by then most individuals have lost much of the ability to repair the damage done by aging joints. Young people often suffer multiple joint injuries as they develop muscle strength outside of their hips and knees which causes them to rotate their legs outwards instead of inwards. This accidently tears the muscles that support the ACL.
Individuals who suffer from ACL injuries may experience pain when standing up after sitting down, when walking over rough surfaces, or when doing any activity that requires jumping or pivoting. The risk of additional injuries increases if you have other medical problems such as heart disease or diabetes.
Skeletal immaturity, sports science, and rising recurrence have all led to an increase in ACL injuries among adolescent players. Every other day, we learn about a renowned professional athlete who will be out for an extended period of time after ripping their anterior cruciate ligament (ACL). From Michael Jordan to Karl Malone to John McEnroe, the number of athletes that we have seen lose part or all of their seasons due to an ACL injury is staggering.
The most common cause of an ACL tear is a sudden change in direction when playing soccer, basketball, or football. Young athletes may be able to tolerate these changes in direction because their bones are still growing and becoming more stable. As adolescents reach skeletal maturity, these small changes in direction become extremely difficult for them to handle without suffering an ACL injury.
As young athletes begin to develop skills that require them to change directions on the fly, such as while dribbling or shooting, they face an increasing risk of injuring their ACL. Because these injuries often occur during high-stress situations when mental focus and physical ability combine to produce explosive movement, it isn't surprising that many cases involve young athletes who have "let their guard down" either by looking away from the play for a second or forgetting for a moment that they are under great stress and must keep their feet planted on the ground to maintain control.
An ACL (anterior cruciate ligament) damage happens when the ACL—the tissue bands that connect your knee bones—stretches or rips. ACL injuries are common in sports, particularly when athletes make abrupt stops, fast spins, or land awkwardly. Other factors also may play a role in whether you suffer an ACL injury. For example, if an athlete is more prone to ACL tears, they may suffer more often or later in their career because of this risk factor.
The most common site for an ACL tear is at its junction with the tibia (shin). However, it can happen at any point where the ligament crosses from one bone to another. These points include the anterior side where it connects with the top of the femur (thigh), as well as the posterior side where it attaches to the bottom of the tibia. A tear can also occur between these two points.
Other muscles and tissues around the knee may be injured in conjunction with an ACL rupture. These other injuries include meniscus tears and fractures to surrounding bones such as the tibia and fibula.
An ACL tear can cause severe pain, instability, and loss of function of the knee. In addition, there is evidence that repeated trauma to the unstable knee may lead to osteoarthritis later in life.
There are two types of ACL repairs: replacement surgery and reconstruction.
Non-surgical care of ACL injuries is more likely to be effective in individuals with partial rips and no instability symptoms, according to the American Academy of Orthopaedic Surgeons. During low-demand sports, have full tears and no signs of knee instability. Are willing to forego participation in high-demand sports.
In general, surgical treatment is recommended for individuals with complete ruptures and those who experience recurrent instability episodes after non-operative management. Surgical options include ACL reconstruction with use of a donated tendon or synthetic material, and artificial ligament replacement. The choice of procedure depends on the individual's injury history and preferences for activity level. Both techniques can yield good results; however, there may be differences in long-term outcomes depending on the type of repair performed.
Individuals who suffer from chronic instability due to a complete rupture are better off having a surgical reconstruction than a conventional ACL repair. Conventional repairs do not provide enough stability to return the knee to its original state, while reconstructions using donor tissue or prostheses can achieve better results over time.
Those who are considering ACL surgery should understand that both procedures offer similar recovery times but that patients who undergo a reconstruction may have longer hospital stays compared with those who receive an implant.
Both treatments carry risks specific to each technique. Patients who have a reconstruction may experience problems with graft incorporation (the bone healing into the tendon), as well as increased risk of infection and blood clots.