Knee injuries often occur among active teens, especially athletes, and a torn anterior cruciate ligament (ACL) – a ligament that helps give the knee its stability – is a common knee injury. Teens who play contact sports (like football and basketball) or so-called “cutting” sports (like soccer and baseball that feature swift, abrupt movements such as pivoting, stopping or turning on a dime) are most likely to get ACL injuries. The injury also happens when a person jumps and lands on the feet with knees straight or “locked” instead of flexed, putting excessive pressure on the knee joint and causing the ACL, a rope-like band, to tear or break apart. Anterior cruciate ligament injuries are more frequent in females with between 2 and 8 times more females suffering a rupture than males, depending on the sport involved and the literature reviewed. The reason for this is as yet unknown, however areas of current research include anatomical differences; the effect of estrogen on the ACL and differences in muscle balance in males and females. ACL injuries can be very painful, causing someone to be unsteady on the feet and have difficulty walking. Depending on the person’s age and the severity of the injury, a torn ACL often requires surgery in addition to 6 to 12 months of rehabilitation.
When someone tears an ACL, there may be an audible pop or crack at the time of injury and a feeling of initial instability. There could be masked symptoms, later developing extensive swelling. A torn ACL is extremely painful, in particular immediately after sustaining the injury. Swelling of the knee, usually immediate and extensive, can be minimal or delayed. The patient will notice restricted movement, especially an inability to fully straighten the leg. There might also be widespread mild tenderness. If a tear is suspected, the person should immediately stop play or competition. It is important to apply RICE (Rest, Ice, Compression, Elevation) to the knee immediately and to seek medical attention as soon as possible. Surgery is performed more often than not following Anterior Cruciate ligament tears. The decision on whether to operate is based on a number of factors, including the athlete’s age; lifestyle; sporting involvement; occupation; degree of knee instability and any other associated injuries. Older people who are less active and perhaps injured their ACL following a fall as opposed to during sport would be unlikely to undergo surgery. A younger, fit person who regularly plays sport and would be more likely to adhere to a complex rehabilitation program is very likely to be offered surgery.
Surgery involves either repairing or reconstructing the torn ACL. With a repair, the existing damaged ligament is sutured (stitched) if the tear is in the middle. If the ligament has detached from the bone (avulsed) then the bony fragment is reattached. Surgical reconstruction of the torn ACL is performed using either an extraarticular technique (taking a structure that lies outside the joint capsule such as a portion of the hamstring tendon ) or an intraarticular technique (using a structure from within the knee such as part of the patellar tendon) which will replace the anterior cruciate ligament. After surgery, a person will need to walk with the assistance of crutches, limit physical activity, and wear a full-leg brace for 4 to 6 weeks, depending on the severity of the injury.
Recovery from ACL surgery is a lengthy process that can take from 6 months to a year. Rehabilitation (“rehab”) therapy is needed to help heal the knee and to: restore range of motion, regain strength in the knee, thigh, and shin muscles (and prevent atrophy, the breakdown of muscle tissue), reduce pain and swelling and improve balance. Most people undergo rehab at a center three times a week, with daily exercises they practice at home. Accelerated rehab programs require more frequent therapy and speed up recovery to 4 to 6 months. In the early stages of recovery, you’ll have to wear a leg brace, followed by a knee brace, to reduce the risk of reinjuring the knee. Keeping the knee iced and elevated can help to reduce swelling. Over-the-counter or prescription painkillers and anti-inflammatory medicine can help you deal with the pain and feel more comfortable. While most sports are off limits – especially the activity that caused the injury in the first place – you might try some low-impact activities that may be fun and even therapeutic, like swimming, bike riding, or protected running. Talk to your doctor about what activities might help you.