Here are some frequently asked questions about anterior cruciate ligament (ACL) knee injuries:
ACL tears
Do females tear their ACLs more than males?
Yes, but not because they are female. The research we have done over the past 25 years tells us that the size of the notch (space) in the knee is the primary reason that some people are more likely to have an ACL tear than others. The notch inside the knee is where the ACL is located. Our research shows that the smaller a person’s notch is, the more likely they are to tear their ACL. A male with a small notch is just as likely to tear their ACL as a female with the same notch size. It also works the other way around; females with large notches are no more likely to tear their ACL as a male with the same size notch.
Can kids with open growth plates have an ACL reconstruction?
Yes, kids with torn ACLs can have ACL reconstruction at Shelbourne Knee Center because the way we do surgery does not disrupt the growth plate. However, kids need to be at a certain stage of their growth. This will be determined at your evaluation.
Is it possible to partially tear my ACL?
Technically, an ACL can be “partially” torn, but it is rare. What you have to consider is whether the knee is stable or not. If the ACL cannot keep the knee stable with dynamic (twisting/cutting/pivoting) activities, the ACL is not working properly. If this is the case, it does not matter whether the ACL is fully or partially torn.
Why don't ACL tears heal without surgery?
When the ACL tears, it separates and the frayed ends do not touch. Since the ends do not touch, they cannot grow back together.
SURGERY
How soon after ACL reconstruction will I be able to walk without crutches?
You can start walking short distances without the use of crutches immediately after surgery, but if you are feeling dizzy or light-headed, you can use crutches to help you walk. Your therapist or trainer will work with you to make sure that you are walking properly after surgery and most patients are able to walk without crutches after 1-2 weeks.
When will I be able to go back to my day-to-day activities after ACL reconstruction?
Returning to day-to-day activities is a gradual process that is dependent on your ability to maintain good motion and keep the swelling down. For the first week after surgery, you will be on a bed rest period that helps to keep your knee from swelling and allows you to have better motion. The second week is a “transition” week, where you can gradually start standing and walking more, as long as you keep your swelling down. Your physical therapist or athletic trainer will teach you how to monitor your swelling and modify your activity level should you develop increased swelling.
How often do I have to go to physical therapy after ACL reconstruction?
We try to minimize the number of visits that you return to the office for physical therapy, as you are taught how to do most of your exercises on your own. These “check-in” visits allow us to check your progress and make changes to your program, as well as instruct you on how to progress back to your desired activities. Usually patients come in at one week, two weeks, one month, two months, four months, six months, nine months, and one year after surgery. Sometimes patients come in a little more often if needed.
When will I return to sports after ACL reconstruction?
It depends on when you get your strength and range of motion back and you have no swelling. On average, our patients return to their sport at about 4-6 months after surgery. This all depends on the person and the sport.
Why should I get a second opinion before having surgery?
Full recovery from an ACL tear requires treatment by an experienced orthopedic surgeon and rehab specialist. The first surgeon an injured athlete sees may not be the best doctor to provide this level of care. A national study shows that only about 50% of athletes who have ACL reconstruction are able to return to sport at the same level. Based on our research, 85-90% of our patients return to their desired sport at the same level within a year. An ACL tear isn’t an emergency and doesn’t require surgery right away. Take the time to seek a second opinion before making a decision about treatment. When you meet with an orthopedic surgeon about treatment, ask them about their choice of graft, how many ACL reconstructions they do in a year, their rate of patients returning to sports at the same level, and recovery time.
GRAFT
Why do you use the patellar tendon graft?
There are several graft choices available for an ACL reconstruction. We use the patellar tendon because it has a higher success rate than the other graft options available. It is the strongest type of graft found in the body and is just as strong as a normal ACL. The other benefit is that the tendon will grow back after taking the tissue out to create the new ACL. This means that the patient will not have permanent strength loss due to the graft harvesting process.
What about other grafts like hamstrings or allografts?
Hamstring tendon grafts are not as strong as patellar tendon grafts. Once the hamstring tendons are taken for the graft, they do not grow back and therefore, leave the hamstring weaker than it was before surgery. Also, hamstring grafts tend to stretch out over time, causing the graft to “fail” and no longer work properly. Allografts, or cadaver grafts, are not taken from the patient’s own body. There is a higher failure rate with allografts. Since they heal slowly, patients cannot get back to their activities as fast as when you use the patellar tendon.
Why doesn’t the Shelbourne Knee Center use screws to fasten the ACL graft in place?
The new ACL graft is what we call a “bone-tendon-bone” graft, in that it is made up of tendon in the middle with small pieces of bone on each end. These bone plugs fit tightly into the tunnel that has been drilled into the thigh bone and the shin bone. The bone plugs heal to the bone around it very quickly, like how a bone fracture would heal. We use plastic buttons on each end of the tunnels to hold the graft in place while the bone plugs are healing. In our experience, screws are not necessary to hold the graft in place.