Beware This Severe Knee Injury
Especially in contact sports like football, basketball, and soccer, knee injuries are incredibly common. Of all the possible knee injuries, an anterior cruciate ligament (ACL) tear is particularly severe. The ACL is a ligament located behind the kneecap that connects the thigh and shin bones. Together with the posterior cruciate ligament (PCL), the ACL helps with stability, flexibility, and lateral movement. A blow to the knee or sudden change in direction can result in a torn ACL. Overuse without proper recovery can also lead to an ACL tear. In many cases, an orthopedic surgeon will suggest arthroscopic knee surgery, but the patient will make the final decision.
Time for ACL reconstruction?
A torn ACL can lead to pain, swelling, and knee instability. The injury prevents running or placing excess load on the joint, which can prevent athletes from competing. ACL reconstruction is almost always advised. The procedure replaces the torn or damaged ACL with a new graft. The surgeon uses multiple small incisions to access the knee and remove the damaged ligament. A new graft, either from the patient’s hamstring or a donor, is inserted using screws to fasten the ligament. After ACL reconstruction, the patient will need significant physical therapy (PT) and knee rehabilitation. While ACL reconstruction is not mandatory, there are 3 reasons a surgeon will strongly recommend the procedure.
1. Assessing severity
There are different degrees of ACL injury, graded 1-3 based on severity. A grade 1 injury is the least severe, often a stretch or sprain of the ligament. Grade 2 indicates a partial ligament tear, but there is still a degree of function. The most severe form, grade 3, occurs when the ligament is completely severed and no longer functional. Grade 1 and 2 injuries can typically be treated non-surgically. In some grade 2 cases, surgery may provide better results. However, for a grade 3 tear, the surgeon will almost always suggest arthroscopic surgery to remove and replace the ligament.
2. Activity level matters
Any type of ACL tear can cause pain and instability, but for lower-grade tears, the knee can still provide some function. The patient can walk or sometimes even run with the injured ligament. At the same time, recovery from this injury can take several months, with no guarantee the athlete will return to full strength and fitness. Grade 2 and 3 tears can impact people who want to return to sports or other physical activities quickly. Therefore, a surgeon will suggest reconstructive surgery, ensuring PT’s success and promoting a better recovery.
3. The risk of secondary complications
If treating an ACL tear without surgery, pain management and intense PT are required. Over several months, there should be a significant reduction in pain and improved function. However, further complications can occur if the damaged ligament is untreated or inadequately treated. For example, the damaged ligament can place more strain on other ligaments like the medial collateral ligament (MCL) or PCL. Other parts of the leg will begin to compensate for the instability, leading to muscular or ligament injuries in the thigh, calf, or ankle. Additionally, there is a significant risk of developing osteoarthritis in the injured knee. ACL reconstruction not only provides stability and reduces pain but also protects the long-term joint health of the patient.
Make the right choice
Many patients with an ACL tear can benefit from arthroscopy. This minimally invasive option uses small incisions, which results in less post-operative pain and a faster recovery. Surgery can be a deterrent for many patients. However, replacing the ligament is an excellent way to ensure the prolonged strength and health of the knee. Consider the surgeon’s suggestions and return to the game as soon as possible.