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FAQ- Anterior Cruciate Ligament
(ACL) Tears |
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by: Brian Borer, MSPT
Flemington Facility Director |
So you've injured your ACL, joining the thousands of people who do this
every year- but now what? Unless you know someone who has injured theirs
or you are a serious athlete, chances are you couldn't even point to the
area of the body where your ACL is located (it's in your knee, by the way).
Here at Sports Physical Therapy, we have treated hundreds of ACL injuries
and most people have the same questions, so we thought we'd share some of
them with you.
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1. What is the ACL and
what does it do?
The anterior cruciate ligament (ACL)
is one of 4 ligaments of the knee joint. It connects the femur (thigh bone)
to the tibia (lower leg bone) and provides stability in the knee joint.
More specifically, the ACL prevents the tibia from sliding forward or
internally rotating independently of the femur.
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2. Is surgery necessary
if I have torn my ACL?
Not everyone with a torn ACL requires
surgery. Surgery is usually recommended for younger patients, those wishing
to return to sports or activities involving frequent cutting and changing
directions, and athletes in competitive sports. Unfortunately, when the ACL
is torn, there are often additional injuries to the knee such as a meniscus
tear, which may make surgery necessary.
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3. Should I have
physical therapy prior to my surgery?
Many surgeons require their patients
to have physical therapy prior to surgery to decrease swelling and increase
range of motion and strength. It has been our experience that patients who
have preoperative physical therapy and achieve full range of motion, minimal
swelling, and good strength prior to surgery, typically have better
rehabilitation results. Ask your doctor if pre-op therapy may help you.
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4. If I opt not to have
ACL surgery, what can I do to help my knee improve?
Patients who have torn their ACL and
have decided not to have surgery should see a physical therapist, who can
design a specific treatment plan, which will include stretches and exercises
to restore leg muscle strength, range of motion in your knee, and improve
balance and proprioception (your body’s awareness of joint position). In
addition to the exercises and stretches, your therapist should manually work
with you every visit. Physical Therapy is usually prescribed for 3x/week
until you are maximally rehabilitated. You may also receive an ACL
brace to wear during sports or physical activity to help stabilize your
knee.
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5. How is the surgery
performed and what is used to replace the ligament?
ACL reconstruction is an outpatient
procedure (in and out the same day), in which a graft will be used to
replace the torn ligament. There are 2 types of grafts- autograft (from
your body) or allograft (from a cadaver). The 2 most common grafts used are
taken from the patellar tendon or the hamstring tendon. There are
advantages and disadvantages to both autografts and allografts and your
surgeon will discuss with you which one would suit you best. Using an
autograft generally provides a stronger graft, but recovery can be
more painful due to the additional surgery required to harvest the graft
from your body. An allograft tends to produce better recovery results- less
pain and swelling, however risk of infection is slightly greater and these
grafts are usually less stiff than an autograft.
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6. What should I expect
immediately after surgery?
After surgery, you will be groggy
from the anesthesia, but can go home once most of those effects have
dissipated (you will need someone to drive you home). Your knee will
be wrapped in a dressing, placed in an immobilizer or brace that will keep
your knee fully straightened, and will be required to use crutches. You
will most likely be prescribed pain medication and be instructed to take one
aspirin a day to prevent blood clotting. It is a good idea to get
these prescriptions filled ahead of time (if your doctor will allow it) to
minimize post-operative stress. Some surgeons will have you utilize a
CPM (continuous passive motion) machine immediately after surgery, which
will automatically bend and straighten your knee very slowly.
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7. When can I start
physical therapy?
In our experience, the sooner the
better. At our facilities, we typically see patients 2 days after surgery,
where we will remove the bulky dressing, clean the wound, and redress the
site with a smaller dressing. We will also begin gentle range of
motion exercises and give you a home program to help start your
rehabilitation. We have found that patients who see us 2 days post-op come
in feeling very uncomfortable and sore, but leave a great deal better.
It has been our experience that the longer you wait to begin physical
therapy following surgery, the more difficult and painful it is to restore
your range of motion and strength. Discuss therapy with your surgeon
before your surgery, so you can set up your appointment in advance.
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8. What will my
rehabilitation be like?
A physical therapist will design a
specific exercise program for you to restore joint mobility and strength.
Your physical therapist will use manual therapy techniques such as joint
mobilization, soft tissue mobilization, and PNF (Proprioceptive
Neuromuscular Facilitation) techniques, as well as modalities such as
ultrasound, ice, and electrical stimulation.
Don't worry if you don't understand
these terms, your therapist will explain all aspects of your therapy
program. You will most likely attend therapy 3x/week until your knee
has been maximally rehabilitated. The therapy process may be difficult
at times (especially in the beginning), but if you have a positive attitude,
work hard, and play an active role in your therapy, you will be better
before you know it.
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9. How long will it
take until I can return to sports or regular exercise?
Each patient recovers at their own
rate and your physician and physical therapist will determine when you are
ready to return to sports. Factors such as type of sport or activity, and
if there were coexisting injuries in addition to the ACL tear (meniscus
tears, other ligament tears) will be considered before you are cleared to
return to normal activity level. That being said, you can generally expect
to resume activities 6-12 months following surgery.
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If you have torn your ACL, it is
important to discuss all options with your doctor to determine which route
is best for you. These questions are the more common ones we field,
but if you have more specific concerns, you can always contact us through
email at
princeton@sportspti.com or.
Good luck with your rehabilitation however you decide to go about it.
Remember, with the right rehabilitation, you should be able to get back to
all activities you enjoyed before the injury.
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