CNY Orthopedic Sports Medicine, PC: Treatment: Anterior Cruciate Ligament Tear
 
Injuries and Conditions: Knee: Anterior Cruciate Ligament Tear: Treatment Options
 
Overview
A damaged ACL may not necessarily require surgery for a full recovery. Differences in the severity and in the type of injury will dictate the treatment, as will the degree of athletic activity that the patient wishes to pursue after treatment. ACL injuries may range from minor sprains to complete tears of the ligament. Some patients, even with quite severe injuries, may choose to not undergo surgery. However, a completely torn ACL cannot rebuild itself and surgery to reattach or reconstruct the ligament is usually recommended. Selected, less active patients may not always require this procedure.


 
Treatment options:
Conservative Treatment of ACLACL Semitendinosus Autograft Arthroscopic Assisted ACL ReconstructionACL Patellar Tendon Graft



Non-Surgical Treatment: Conservative Treatment of ACL
  • Non-surgical treatments are typically suitable for patients with minor sprains and pulls. These conditions may be treatable with physical therapy methods that condition and strengthen the muscles around the knee through exercise and gradual rehabilitation to compensate for the inured ACL.
  • Even with serious ACL injuries, patients with less active lifestyles may also be candidates for non-surgical treatments. Continued gentle use of the injured knee may allow older and moderately active patients to avoid surgical treatment.
  • Some patients may be suitable for either surgical or non-surgical procedures. In these cases, patients that expect to resume an athletic or an active lifestyle after treatment of their injured ACL will likely benefit more from surgery than from other, non-surgical treatments.


  • Non-Surgical Product Considerations

    Knee: Compression Sleeves
    Knee compression sleeves give added support, increasing stability and helping to reduce swelling in an injured knee. Patients that have light sprains may be directed to use a compression sleeve during the early stages of rehabilitation. Other patients that have ongoing knee problems or chronic conditions may be recommended to use a sleeve on a daily basis. These sleeves are less restricting than most other knee supports and can be worn under loose fitting clothing.

    Knee compression sleeves can be used to treat:

  • Light swelling.
  • Light knee strains.
  • Chronic inflammation.
  • Degenerative joint disease.

  • Knee: Support
    A knee support is a sleeve-like support that fits firmly around the knee. The support is used to reinforce the joint during motion and provide compression to aid healing and reduce pain and swelling. Patients suffering from knee strains or inflammation will usually be directed to use a support during daily activities.

    The thin and flexible construction of the support allows for normal movement of the knee and also allows the support to be worn under loose fitting clothing. To prevent harmful pressure to certain structures, the support applies differing compression around the knee. The sides of the joint receive intermittent pressure to help stimulate blood flow while the rear of the support fits relatively loose to prevent constriction of circulation. The kneecap is aided in positioning, but remains free of compression to allow its natural movement.

    Knee supports can be used to treat:

  • Strains
  • Sprains
  • Inflammation
  • Chondromalacia patella
  • Knee: Ligament Brace
    Functional braces are designed to control abnormal motion of an unstable knee. Because ligaments help stabilize the knee, and a torn ligament leads to instability, these braces are also called Ligament Braces. The intent is to allow a previously injured athlete to compete at a higher level than they would otherwise be able to without the brace. The brace is designed to support either a newly reconstructed ligament such as the ACL, or a weakened or injured ligament, which is being treated in a conservative manner. The role of a functional brace is to increase stability to a previously injured knee.

    Type of Injuries:

  • Pre-operative ACL/PCL ruptures/injuries
  • Non-surgical ACL/PCL injuries
  • General knee instability
  • Pre/post joint replacement with ligament instability.


  • Surgical Treatment: ACL Semitendinosus Autograft
    A torn ACL is usually difficult to stitch together after injury because the torn ends are frayed and difficult to manage. Most often, the torn ligament is replaced with material from the patient's own body (this is refered to as an autograft). In a semitendinosus autograft procedure, the donor material is taken from tendons located on the back of the leg.


    Surgical Treatment: Arthroscopic Assisted ACL Reconstruction
    The ACL, unable to regenerate or heal itself, is replaced with quadrupled semi-tendinosus/gracilis tendons located on the side of the knee.


    Surgical Treatment: ACL Patellar Tendon Graft
    The ACL, unable to regenerate or heal itself, is replaced with a section of the patellar tendon, located on the front of the knee.


    Surgical Product Considerations

    NSAIDs
    NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) are a group of drugs used to control pain. This category of medications includes both prescription and common over-the-counter painkillers such as ibuprofen. NSAIDs are effective for many types of pain that can occur because of inflammation of muscles, joints and bones. The drugs work quickly and people often notice some benefit within a few hours of taking the tablet. However, the complete effectiveness of the drug may not be realized for up to four weeks. For each individual, some varieties of NSAIDs are more effective than others. Often, patients will find that one or two varieties are helpful whereas others may not be as effective in controlling symptoms. It is usually necessary to try several brands and continue with the one that is most suitable. NSAIDs can be used to treat:
  • Pain resulting from inflammation or swelling.
  • Pain after injury.
  • Joint pain and arthritis.

  • Knee: Cold Therapy
    Cold therapy is used to reduce pain and swelling and is a convenient method to apply cold to an injured or rehabilitating extremity, such as a knee or shoulder. A cuff fits like a sleeve around the extremity and utilizes cold water supplied by a connected thermos or canister to chill the extremity. Water flow into the cuff can be controlled by different mechanisms. The simplest way is gravity; elevating the canister fills the cuff and controls the amount of pressure against the extremity. Water flow may also be controlled by a pump which will automatically circulate the cold water to and from the cuff. After surgery or immediately following an injury, the canister should be refilled with cold water every one to two hours to maintain a proper temperature. The cold therapy may also be used during rehabilitation, especially after physical activity, reducing the inflammatory heat from exercise.

    Cold therapy can be used to treat: Knee, Shoulder, Elbow, Wrist and Hand, Back, Hip, and Foot & Ankle Injuries.

    Knee Examples include:

  • Pre-operative ACL/PCL injuries.
  • Non-surgical ACL/PCL injuries.
  • General knee pain or swelling.
  • Soft tissue injuries.

  • Arthroscopic Assisted ACL Reconstruction
    Your physician will recommend products based on the needs of your rehabilitation schedule.

    Surgical Hardware Considerations
    The technology involved in the reconstruction or repair of an injured anterior cruciate ligament has significantly evolved over the last several years. Typically, a synthetic screw or anchoring device is utilized to fasten the replacement ligament to the femur. This is placed under arthroscopic control. The tibial end of the graft is usually anchored to the bone by a metal staple or screw. In addition, a screw is placed next to the graft within the tibial tunnel that has been drilled in the bone. This screw, known as a bio-absorbable interference screw, pushes the graft firmly against the inside of the bone tunnel to assist in the healing process. The screw is made of a material that gradually dissolves after the healing process is complete, and is eventually replaced by bone.


     
    Factors in Transplant Source
    The source of the replacement graft for an ACL reconstruction can come from different places and consist of different parts. Frequently mentioned terms are autografts and allografts.
  • An autograft comes from your body. The advantage of this type of graft is that it is readily available and is completely compatible with you, as it is already part of your body. The most frequently utilized autografts are quadrupled semitendinosus/gracilis (hamstring) tendons and bone-patellar tendon-bone. With appropriate surgical technique and rehabilitation, both of these grafts are suitable for ACL reconstruction, with equivalent success rates.
  • An allograft comes from a human cadaver. The advantage of this type of graft is that it does not require taking a piece of tissue from another of your important parts. The disadvantage is that the tissue must be carefully processed and sterilized to make it free of disease and viruses, as well as make it compatible with your body and immune system. The sterilization process can weaken or change the physical characteristics of the graft. Failure rates have been found to be higher than for autografts.
  • Synthetic grafts are not presently utilized due to unacceptable failure/infection rates.

    Although bone-patellar tendon-bone has historically been more utilized, recent studies and surgical technique innovations have resulted in the more frequent usage of quadrupled hamstring tendons. Advantages of the quadrupled hamstring tendons include a smaller surgical incinsion, a stiffer and stronger graft, and avoidance of patellofemoral problems frequently associated with bone-patellar tendon-bone grafts.

    As with all surgical procedures and options, consult your surgeon to determine which option is best for you and your knee.


  • About the Review Team
    This website and its content may not be reproduced in whole or in part without written permission