ACL Surgery

Ligaments play an important role in ensuring your knees can handle basic activities like walking, climbing, and kneeling.  The Anterior Cruciate Ligament (ACL) and the Medial Collateral Ligament (MCL) are just two of the ligaments found in your knees.  Injuries in these areas often happen during sudden twisting motions.  Surgery is a popular treatment option for a torn ACL or MCL and reconstruction is the most common type of ACL surgery. It involves replacing the torn ligament with another graft or tendon from your own knee.

ACL Surgeries in the United States

According to a 2006 research of the Orthopedic Society for Sports Medicine on allografts, approximately 350,000 Americans undergo ACL reconstructions annually (Wojtys, 2010). In another research, the results showed a 37% increase in ACL reconstructions between 1994 and 2006.

From 2002 to 2014, the average annual ACL surgery increased by 22%. This is according to a study of US residents’ private insurance data. During this period, there were 75 procedures conducted for every 100,000 people. More females had this type of surgery than males. In addition, the average annual surgeries for teen girls rose by 59 %, with 269 procedures performed for every 100,000 people. 

Statistics also showed that injuries from softball and baseball comprise the highest number of ACL cases. The mean age of patients with ACL injuries remained constant between 1994 and 2006.  In 1994, the mean age was 28.8 years with most patients falling between 25.7 years old and 31.8 years. In 2006, the mean age was 28.7 years with most patients ranging between the ages of 26.6 and 30.8 years (Buller, 2014). The number of individuals getting ACL reconstruction also increased during this period, with the largest increase being 924%  in 2006. Most patients were younger than 15 years.  The same study also noted a 177% increase in women undergoing ACL and a 404% increase in the outpatient setting. The increase was attributed to more females engaging in sports.

Common Reasons for Getting an ACL Surgery

common reasons for ACL Surgery

Athletes participating in sports that involve turning, pivoting, and twisting are at high risk of ACL injuries that are likely to require ACL surgery. A common scenario for a ligament injury is an athlete running and quickly changing directions, twisting or tearing the ligament in the process. Another scenario is jumping and landing badly.  

While ACL surgery is a common treatment for ligament injuries, not every torn ligament requires surgery.  Surgery is often the chosen treatment of people suffering from persistent pain or pain that restricts activities of daily living, such as walking. Individuals who want to remain active in sports also often choose to have the surgery. 

Here are other reasons for ACL surgery:

1. Knee popping

Knee popping is common among many athletes. This may happen when doing squats, kneeling, or standing up from a kneeling position. There are three categories for the popping noise you might hear when you have this injury: (1) pain-free popping, (2) painful popping noise at the time of injury, and (3) recurrent painful popping noises that may not have been caused by an injury.

The popping sound can be a symptom of ACL injury, especially when you hear the popping noise occurred after an injury. Your treatment options include surgery and knee braces.

2. Knee hyperextension

Knee hyperextension could result in ACL injury. The severity of your condition may vary based on the cause of the injury. Symptoms include  swelling of the knee, limited range of motion, instability of the injured leg, and a sharp localized pain. This injury may happen when yo force your knee to go beyond its normal range of motion, putting stress on the ligament. 

3. Knee swelling

If swelling occurs around the ACL within six hours after the injury and becomes severe in the next two days, consider going to the doctor. Your healthcare provider may scan your knee ligament to diagnose the problem.

4. Knee pain and discomfort

If knee pain and discomfort persist, seek medical attention so your doctor may determine if you need an ACL surgery.

Your doctor may use X-rays, MRIs, and Arthroscopy to determine the extent of the injury. X-ray shows the broken bone but it does not show the injury to the ACL. MRIs are essential as they clearly show the image of the ACL, allowing doctors to easily detect the tear. Doctors use arthroscopy to determine partial ACL tears. The process may involve a surgical incision to allow the surgeon to see the tear.

You may also choose to have ACL surgery if;

  •     – you have completely torn your ACL or if your ACL is partially torn and your knee is unstable.
  •     – you have gone through a knee rehab program and your knee is still unstable.
  •     – you’re very active in sports or your work requires you to have strong and stable knees.
  •    –  you are willing to undergo the long and vigorous stages and phases of surgery and rehab.
  •     – you have chronic ACL deficiency and your knee is unstable thus affecting their life
  •     – you’ve injured your cartilage, tendons, or other parts of your knees.

Rehabilitation After Surgery

ACL surgery rehabilitation

The procedure usually takes a few hours and most patients begin their post-operation rehabilitation after 24 hours. Your healthcare provider should remove any drain on your knee before having you start with rehabilitation or physical therapy.

The post-operative rehabilitation involves four major phases.

Phase 1:Critical Management, Encouragement of Motions, and Retraining of Basic Movements

In this phase, the major objective is to increase your range of motion and strength. Your therapist may encourage you to walk without crutches.

Pain may prevent you from wanting to put any weight on your knees. To encourage you and prevent swelling in the knee, your therapist may advise  you to elevate your knee to the level of your heart and apply ice on the site and around it.

Compression wraps may also help manage the swelling around your leg and minimize activities during the first few weeks after surgery. Massaging the area around the tissues also helps reduce pain. As soon as pain and swelling decreases, you may start with Phase 2.

Phase 2: Strength Restoration and Proprioception

The main aim of this stage is to reduce pain and monitor any factors that may cause pain.  It also focuses on strength restoration and proprioception.  Experts recommend various balance exercises such as jumping and pivoting in the correct alignment.

Phase 3: Eradication of Differences in Strength Between Both Legs and Coordination of the Legs

The major goal of this phase is to eradicate any differences in strength between both legs. Your therapist will encourage you to perform strenuous exercises approximately three to four times a week. In most cases, you may need to do more sets on the leg that underwent surgery than on the one that did not. Make sure not to overdo the exercise with an aim of restoring strength quickly. In this phase, your therapist  may also encourage you to run and perform impact exercises like jumping

Phase 4: Athletic Enhancement and Return to Activity

This phase is also called the “Athletic Enhancement” phase. Your healthcare provider may encourage you to do certain movement exercises  at faster speeds. Furthermore, you may notice the addition of a few cardio exercises in your routine. A test may also be conducted to determine if you’re ready to engage in any type of sport.

During these phases, your physical therapist will provide instructions that you should follow to the letter, otherwise,  you may be at risk of re-tearing your ACL. According to research, there’s about 5-15% re-tearing incidences among recovering patients. (Busam ML et al, 2008)

Home Care and Lifestyle Changes Post-Surgery

ACL surgery wound care

After surgery, you should be careful in performing activities of daily living. Common lifestyle changes include:

  • – Taking rest: By using crutches, you could reduce the stress and pressure in the knee, thus letting it rest and heal quickly.
  • – Use of Ice: Applying ice every few hours helpsreduce swelling and inflammation in the knee.
  • – Compression: Using compression wraps or elastic bandage may lessen stress and pain on your knees.
  • – Elevation: Elevating the knee above your heart when you are lying in bed helps minimize pain and swelling.

Home

Consider having someone rearrange your furniture so it’s easier to move around with crutches or a cane. Experts also advise avoiding stairs. Remove rugs and electrical cords that could put you at risk of slipping and tripping. 

Diet

When it comes to diet, think about increasing your intake of iron and vitamins. Your healthcare provider may also advise you to avoid blood thinners and Vitamin K. Make sure to hydrate and drink lots of fluids to enhance the healing process. Avoid drinks such as alcohol and coffee. You should also watch your weight and how much effort you are putting on your knee joints.

Wound Care

While caring for the wound, ensure that it is always clean and dry. Change the dressing as necessary and as recommended by the hospital. If you see any signs of infection on the surgical site, call your doctor immediately. 

Exercise

You can perform simple aerobic exercises such as walking, running, swimming, and dancing.  Walking is important as it helps build strength and burns calories. Make sure you’re strong and stable enough before deciding to go for a run. It’s important to talk to your therapist before going back to running. You may resume swimming within three to six weeks after the surgery, but be sure to confirm this with your therapist first. 

Yoga is a good exercise that may help you avoid stiffness. In addition, it enhances flexibility. You may also play golf as it encourages you to walk and use all the muscles in your body.

The number of individuals undergoing ACL surgeries has increased in the United States. Patients who are more proactive in their rehabilitation and  therapy programs have greater chances of healing quickly and lower risks of recurring ACL tears.

References:

  • – Busam ML, Provencher MT, Bach BR, Jr. Complications of anterior cruciate ligament reconstruction with Bone-patellar tendon-bone constructs: care and prevention. Am J Sports Med. Feb 2008;36(2):379-394.
  • – Stanley, L. E., Kerr, Z. Y., Dompier, T. P., & Padua, D. A. (2016). Sex differences in the incidence of anterior cruciate ligament, medial collateral ligament, and meniscal injuries in collegiate and high school sports: 2009-2010 through 2013-2014. The American journal of sports medicine, 44(6), 1565-1572.
  • – Wojtys, E. M., & Brower, A. M. (2010). Anterior cruciate ligament injuries in the prepubescent and adolescent athlete: clinical and research considerations. Journal of athletic training, 45(5), 509-512.