ACL Tear Symptoms and Treatments
It’s that time of year again. There is snow in the mountains and the resorts are full of skiers. It also means that this is the time of year for knee injuries. There are roughly 15 million skiers in the US who are participating in an exhilarating sport where knee injuries account for 30% of all ski injuries.
A sprain or tear of the anterior cruciate ligament (ACL) is one of the most common knee injuries. When you injure the ACL, you will often hear or feel a “pop”. The injured knee will become swollen and tense resulting in limited mobility. A tear to the ACL can be painful but not always. Very often after tearing the ACL there will be a sensation of knee instability.
Who is at risk?
Anyone who participates in activities that involve jumping, cutting, and pivoting is at risk. This injury occurs most often when landing awkwardly. Interestingly, women are at a 4 to 9 times greater risk for tearing their ACL than men. The reasons for this gender difference are multi-factorial. One hypothesis is strength imbalance between the quadriceps and hamstrings. Another proposed reason for the gender difference in the rate of ACL injury is anatomic differences between a female and a male.
Presently there is a great deal of interest in the biomechanical difference seen between men and women with jumping and landing from a height. Studies show that when landing from a height, women put much more stress on their ACL compared to men. This research has led to the development of ACL injury prevention programs that address the differences in strength and coordination. These programs have been very successful and have been shown to reduce ACL injuries in women by 70% to 90%.
ACL Injury Prevention Programs
KIPP, Knee injury Prevention Program: https://www.luriechildrens.org/en-us/care-services/specialties-services/institute-for-sports-medicine/knee-injury-prevention-program/Pages/index.aspx
PEP, Prevent Injury Enhance Performance: http://smsmf.org/smsf-programs/pep-program
FIFA 11+: http://f-marc.com/11plus/manual/
Employing these programs as part of the warm up before training or a game can play a significant role in preventing ACL injuries.
The consequences of a torn ACL are quite profound. It is estimated that there are between 100,000 to 250,000 ACL reconstructions performed every year at a cost of around $17,000 per case. In addition to the financial cost there is also the physical and psychological cost of recovery after surgery.
It wasn’t that long ago that an ACL tear was a career ending injury. That changed about forty years ago when ACL reconstructive surgery was first described. Since then much has been learned and refined, today more than 90% of those injured will return to their active life style after surgery.
The surgery involves replacing the torn ACL with a graft. The graft can either come from the patient or a cadaver. The source of the graft is determined by the patient and surgeon. The surgery is done on an outpatient bases and is approximately an hour long. Following the post-operative rehabilitation is vital for a successful outcome.
It takes about a year to recover from ACL reconstruction. There are individuals who come back earlier but most patients feel subjectively they are recovered by 12 months. However, current research indicates it take nearly two years to return to your full potential.
Before you get out on the slopes have your equipment inspected by a ski technician and have the DIN on your bindings set for your skiing ability.
If you think that you have had an injury to your ACL seek an expert medical evaluation. These injuries rarely require immediate surgery. If the ACL is torn it is best to wait a few weeks until the swelling and range of motion of your knee returns to normal. This helps avoid potential complications associated with early surgery. To verify a tear X-rays and an MRI are often part of the medical evaluation.
At Heiden Orthopedics we are looking forward to a safe and enjoyable ski season. But if you are injured, let us help, because at Heiden Orthopedics, we care.
Thanks for the great manual
I got shoulder ACL torn ligaments from bike fall on oil asphalt on Oct. 20,2019. Surgery was only 3 ties around. After 2 months, I reacted so hard and my ACL stretched to 11.3 cm. No need to redo it under 12cm. Shoulder still has small bump and moving up a little. I can feel my two bones rubbing or popping once a while, no pain. Is that normal acceptable? I can ride my road bike again but still afraid of riding MT bike and could break again if fall again? What is the best kind of surgery and excercise to build stronger ACL? Thanks.
I assume that you are referring to the AC or acromioclavicular joint in your shoulder and not the ACL (the anterior cruciate ligament) in the knee? If so, if the popping in your shoulder is not painful, then I would try to continue with your activities as you are able, including mountain biking. If your shoulder does become painful or if you feel it is limiting the activities you want to do, then I would recommend you follow up with your orthopedic surgeon. For good shoulder exercises, we always recommend the AAOS website for shoulder stretching and strengthening exercises. I hope you find this information helpful.
I have a full tear of my ACL. I tore it 6 weeks ago. My MRI says that’s my only tear. I haven’t had my surgery yet. Is it possible my doctor missed something on my MRI? My knee is still very swollen after 6 weeks. And I’m in a lot of pain! I’m wearing a brace. I cannot walk without it.
Pain and swelling after ACL tear are extremely common. What is making you think the doctor may have missed something?
Although we try to be thorough, doctors are human and can miss things from time to time. If you are not completely confident in the information you are receiving, it never hurts to discuss your concerns with your doctor, or get a second opinion.
I attempted skiing for the first time at 50 which wasn’t smart I realize now because I fell and heard the pop. Mri verified I tore my acl , mcl, and fractured a bone. I’m opting to have the surgery because I want to still be active (not skiing again) in rafting , kayaking , and hiking. I’m also a Realtor which requires climbing steps daily. My question is what are your thoughts on a cadaver ligament? At my age the doctor thinks this will be the easiest recovery for me. I’ve read several things about it that concern me .
You can definitely raise your concerns to your surgeon and he or she can answer any questions you have about using an allograft, but I will say that it is very common for patients over the age of 25-30 to routinely choose an allograft (cadaver tissue) to reconstruct their ACL. Outcomes are very similar post-op and it typically is a slightly easier recovery as your own tissue does not have to be harvested. Also, it is rare to have any immunogenic response to the allograft as they are sterilized, if that is one of your concerns. Hope this helps!
My MRI says I have a degenerated ACL, a thickened MCL, and a mild extrusion of my medial meniscus in one knee. I fell on concrete while running 2 years ago. MRI at time of accident showed none of those conditions. Why do I have these conditions now? I have had no other accidents, but I did feel pain when I got out of my car one year ago. My knee has been painful since then. Could it have been the twisting motion getting out of the car that caused all of this damage? Knee was doing better after rehab, but I’ve been using a knee scooter and the knee in question is being used to push off of scooter, bend to sit down and stand up. Now it’s very sore. I am using the scooter for a midfoot fusion, so I can’t really get another surgery now or go to rehab. Advice is appreciated. Should I rest and ice or start doing some of the rehab exercises I learned?