The ACL or anterior cruciate ligament is one of the major ligaments in the knee. Damage to this ligament often occurs after a blow to the knee. This often happens in sports related injuries and is seen a lot in American football players after experiencing a side tackle. Other sports such as soccer, skiing, basketball, cheerleading and rugby also have high instances of players suffering ACL injuries. The effects of this injury are debilitating and can take an extended period of time for recovery.
To determine if there is an ACL injury there are three common types of tests a physician may employ. The anterior drawer test and Lachman tests are where the physician flexes the leg and manipulates the tibia to determine greater movement than normal. An MRI can also be used to determine damage. If damage is found, a course of treatment will be prescribed. Small tears will usually be allowed to heal by naturally, but more severe injuries will require surgery and ACL reconstruction.
ACL surgery is done arthroscopically, which is a less invasive type of surgery. Only small incisions are made which can reduce recovery time for the patient. There are three main types of ACL reconstruction to graft tissue to the knee. These types include patellar tendon, hamstring tendon and cadaver.
The patellar tendon connects the kneecap to the shin and is very strong and large. The graft is typically made from the injured knee, but in cases of a possible second surgery this may be taken from the other knee. The piece is positioned and then screwed into place. This type of surgery is popular with athletes because it is the fastest way to return the knee to its peak performance. However, it is generally very painful.
The hamstring tendon is similarly locked in place by screwing end loops of a graft from the hamstring to the tibia and femur. The hamstring is not as strong as the patellar tendon so it will force use of a brace for approximately two weeks. This will immobilize the knee to allow for healing. This surgery is significantly less painful and is a viable option to the patellar tendon. Over time, studies indicate this surgery is just as effective but it takes longer for a person to be able to resume normal activities.
The cadaver surgery is when the tendon is removed from a cadaver to use in place of the patient’s own tendons. Because the removal is the most painful part of the surgery, this type reduces the post operative pain associated with ACL reconstruction. Because this is being taken from another body, however, there is a risk of rejection that can cause complications.
ACL reconstructions are commonly performed and are highly successful. Care should be taken to reduce the amount of stress put on the knee from blows, jumping or changing position quickly. Resuming walking can occur after approximately three weeks, more intense activity after four months, and full recovery is typically complete after six months.