ACL Injuries

The Anterior Cruciate Ligament (ACL) is one of two key ligaments in the knee joint, playing a crucial role in stabilizing the knee during movement to allow for pivoting and twisting motions that are common in sports. It connects the femur (thigh bone) to the tibia (shin bone) forming a crucial part of the knee’s complex structure.

It prevents the tibia from sliding too far forward relative to the femur, which is essential during activities that involve sudden stops, jumps, or changes in direction, such as sports like soccer, football, basketball, and skiing. The ACL also helps control the rotational movement of the knee, ensuring that the joint moves within its normal range of motion and preventing excessive twisting that could lead to injury.

When the ACL is injured, often referred to as an ACL tear, it can lead to knee instability, difficulty with movement, and pain. This type of injury is common in athletes but can occur in anyone due to sudden or awkward movements. This injury is typically classified by the severity of the damage, ranging from a minor sprain to a complete tear of the ligament.

1. In its mildest form the ligament is stretched but remains intact, called a Grade 1 sprain. Symptoms include mild pain, swelling, and a feeling of instability or discomfort in the knee.
2. A Grade 2 Sprain means the ligament is partially torn. This type of injury often results in more noticeable instability in the knee, moderate pain, and swelling.
3. A Grade 3 Sprain is a complete tear, where the ligament is torn in half. This results in severe instability in the knee, making it difficult to walk or bear weight on the affected leg. The knee may feel like it is “giving way” during activities. Pain and swelling are usually significant, and a “popping” sound or sensation is often reported at the time of injury.

ACL injuries happen most often during high-risk sports such as football, soccer, basketball, gymnastics and skiing in which the athletes perform sudden stops, aggressive changes in direction, or jumping and landing.

Women are at two to four times higher risk that men for ACL injury, this is due to an anatomic difference in hip-knee angle, muscle strength, and hormonal influences. Other predisposing factors include poor conditioning, improper equipment (shoes, ski bindings/boots), or adverse weather conditions. Artificial turf results greater friction and is responsible for more knee injuries that on grass surfaces.

Sports Medicine specialists such as Dr. Ahsan and Sincer Jacob can diagnose an ACL injury by listening to the patient’s story of how the injury occurred and performing stability tests during physical examination. As part of the comprehensive evaluation, x-rays of the knee and MRI (magnetic resonance imaging) scan are also done to check for any additional injuries that may occur up to 50% of the time, such as damage to the meniscus, cartilage in the knee that cushions the knee bones and prevents them from rubbing together.

Treatment for ACL injuries can range from physical therapy to reconstructive surgery, depending on the severity of the tear and the patient’s activity level.

 With a grade 3 injury, the fibers are damaged beyond repair; this is similar to that of a rope being pulled apart. As a result, the ACL must be replaced with a tissue graft, either from the patient (autograft) or a donor (allograft).  Studies have universally shown that autograft is superior to allograft for quality of healing and reliability in ACL reconstruction. Dr. Ahsan is proficient in performing ACL reconstruction with patellar tendon, quadriceps tendon, and hamstring tendon autografts. This procedure is performed using knee arthroscopy, a minimally invasive technique that allows for a clear view of the entire knee joint to treat other problems such as a torn meniscus at the same time. The best time for surgery is typically 2-3 weeks after the initial injury because it allows time for the swelling and pain to reduce. Dr. Ahsan will prescribe “Pre-hab” at this time initiate rehabilitation prior to undergoing surgical treatment to ensure restoration of a normal gait pattern and quadriceps tone prior to surgery.

Recovery time depends on multiple factors including additional procedures at the time of ACL reconstruction and graft selection. Successful return to sports requires fully regaining muscle strength, balance, and stamina to a level equal to or preferably better than prior to the injury. Dr. Ahsan carefully prescribes a protocol for physical therapy, strength training, and a focused return to sport regimen that can be accomplished in 7-12 months after reconstruction. Along each step of the way, our team evaluates strength and progression to guide the recovery.