Are you an athlete who participates in sports that involve jumping or quick stopping? If so, you may be at risk of tearing your anterior cruciate ligament, or ACL. An ACL injury is one of the most common injuries suffered by athletes. ACL specialist, Dr. Robert Boykin provides diagnosis and both surgical and nonsurgical treatment options for patients in Asheville who have suffered an ACL injury. Contact Dr. Boykin’s team today!
ACL Injury Overview
The knee joint is stabilized by four major restraints including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and posterior lateral corner (PLC) complex. The anterior cruciate ligament is in the front of the knee joint (anterior) and crosses (cruciate) in front of the PCL. The main function of the ligaments is to prevent the bone in the leg (tibia) from moving forward relative to the bone of the thigh (femur). The ACL also contributes to the stability of the knee with rotational movements or twisting.
The ACL is the most commonly torn ligament in the knee. In many cases, this is associated with athletic participation, but may also happen with certain other traumatic injury patterns to the knee. At the time of injury some patients report hearing a pop, experience pain in the knee, and note swelling of the knee joint. Due to the environment of the ligament and the nature of injury, the ACL typically does not heal on its own. However, certain patients can be treated with rehabilitation and strengthening of the muscles around the knee without surgery. This is recommended for patients with a lower activity level and those of advanced age. In younger, active patients surgery is usually recommended to help patients get back to their level of pre-injury activity. Dr. Boykin specializes in the treatment of ACL injuries for patients in Asheville, Arden, Fletcher and surrounding communities.
ACL Reconstruction Overview
The surgical treatment for ACL tears is known as an ACL reconstruction procedure to put a new graft in place of the torn ACL. During surgery the knee is first examined while the patient is asleep to verify the instability and assess all other ligaments. Dr. Boykin will then look in the knee with a camera and examine the extent of the damage, including injury to any other structures. Other knee injuries are then repaired, including meniscal tears and damage to the cartilage. The ACL can be seen clearly through the camera, and small instruments are used to remove the damaged ends of the ligament. The torn ligament is next reconstructed (it is necessary to reconstruct rather than repair the ligament due to its limited ability to heal) using a graft of a similar size to the native ACL. Recent research has shown the importance of placing the graft in the exact position of the original ACL and Dr. Boykin will use new techniques to ensure proper placement. The graft can come from the patient (patellar tendon, hamstring tendon) or a donated ligament can be used. The decision for type of graft is made based on a discussion of the risks and benefits of each between the patient and Dr. Boykin.
Recovery Following ACL Surgery
After surgery patients are placed into a brace and immediately started on a specific ACL rehabilitation program. Patients typically use crutches for two weeks and may use a functional type brace once they return to activities for the first year. Depending on the specific procedure and type of graft, most patients are allowed to return to full activities between 6-9 months. This procedure has been shown to be very successful in stabilizing the knee and allowing athletes and active people to return to play.
ACL reconstruction FAQ
Does an ACL tear require surgery?
Dr. Boykin will carefully evaluate a patient’s physical exam and imaging to determine the severity of an ACL tear. The vast majority of active patients will opt for surgical reconstruction if they desire to return to activities that require cutting or pivoting. Certain partial tears and select patients may be able to avoid surgery after an ACL tear by participating in progressive physical therapy and rehabilitation which can restore the knee to a functional state. Dr. Boykin and his team can advise patients about how to best achieve their goals and educate patients on how to prevent instability. For those not undergoing surgery he may suggest a hinged knee brace to be used during activities where the knee is at risk of sustain further injury.
Can an ACL be repaired?
In most cases where the ACL is completely torn it is not able to be “repaired” given the blood supply of the ligament and the fact that the remaining ligament is usually extensively damaged. Reconstruction of the ligament (rebuilding a new ACL with a graft) is the preferred procedure and gold standard treatment.
Can an ACL reconstruction be done twice?
Dr. Boykin can perform a revision ACL reconstruction to repair the failed ligament. Revision surgery requires an extensive workup because the results of ACL revisions are not nearly as successful as the first-time revision.
Which ACL surgery is best for athletes?
Athletes who undergo treatment from Dr. Boykin have the most success with an ACL reconstruction which is placed in the correct anatomic position with excellent fixation and when the patients follow their rehabilitation protocols. Dr. Boykin prefers a an autograft ACL reconstruction (using tissue from that patient’s body) which is the best treatment for athletes with proven results.
Does ACL reconstruction lead to knee replacement?
ACL reconstruction surgeries are among the most common orthopedic procedures performed in the United States. However, despite surgery intended to stabilize the joint, individuals who undergo an ACL reconstruction have a greater risk of developing posttraumatic arthritis of the knee than patients without an ACL tear. Much of this finding may be attributed to the damage that occurs to the knee at the moment the ACL tears rather than the actual reconstruction itself. For patients who do not undergo reconstruction and live with an ACL deficient knee, there is a higher chance of recurrent instability episodes leading to further damage to the meniscal and cartilage tissues with an increased risk of arthritis as well.
When can I start running after ACL surgery?
This is a common question from the athletes that Dr. Boykin treats. Generally, the graft needs 12 weeks to heal properly. Around three months after surgery if patients have complied with Dr. Boykin’s physical therapy and strengthening regimen, light jogging is allowed. Full running is not encouraged before the quadriceps muscle has been sufficiently strengthened and cutting and pivoting sports are allowed once the quadriceps is recovered to near the strength of the normal (uninjured) leg – usually 6-8 months after surgery. Can you walk with a torn ACL?
When the ACL is injured, it can be stretched, partially torn, or completely torn. Complete tears make the knee joint very loose and unstable. Walking is possible with an isolated ACL tear but Dr. Boykin recommends the patient first be placed in a hinged knee brace to provide stability. Patients who believe they have torn their ACL but don’t have a diagnosis should avoid putting weight on the leg until they have seen a doctor.
What are the different graft options for ACL reconstruction?
ACL grafts that come from the patient are called autografts and are most commonly taken from the central patella tendon (called a bone – patella tendon – bone autograft) or from the medial hamstrings. A donated ligament from a cadaver, called an allograft, can also be used. The decision for the type of graft is made (based on a discussion of the risks and benefits of each) between the patient and Dr. Boykin along with a review of the current evidence-based literature. In general, autografts are strongly preferred for young athletes and older patients may do well with either autograft or allograft.
What happens if you don’t reconstruct a torn ACL?
Patients with a partially torn ACL typically will do well without surgery if the knee is stable. Most patients can safely swim, hike, bicycle, and do other similar activities without doing further damage to their knee. However, if the ACL is torn completely, it will not heal by itself. Left untreated, patients will experience knee instability and chronic ACL deficiency can develop leading to further damage to the knee and difficulty returning to sports
How long is recovery from ACL reconstruction?
Depending on the specific procedure and type of graft, most patients are allowed to return to full activities between 6-9 months. This procedure has been shown to be very successful in stabilizing the knee and allowing athletes and active people to return to play.
Is ACL surgery a major surgery?
ACL reconstruction surgery is routinely performed by Dr. Boykin in an outpatient setting where the patient is allowed to go home the same day. Modern instruments and technology allow the procedure to be completed with arthroscopy (camera surgery), improving the accuracy of the surgery and enhancing recovery. Injury to the ACL is common, especially in athletes. Reconstruction and rehabilitation take time and patients must be willing to complete the required physical therapy in order to return to a normal work and play routine.
How long until you can walk after ACL reconstruction?
Patients undergoing ACL reconstruction will be sent home on crutches and in a hinged knee brace. Full weight bearing is allowed after 2-6 weeks after, depending on whether other damage required repair (meniscus, cartilage, other ligaments) at the time of the ACL reconstruction. The brace is discontinued after full weight bearing when the quad muscle is functioning well enough to allow a normal gait and support the leg.
For additional information on the treatment for a torn ACL, or to learn more about ACL reconstruction surgery of the knee, please contact the office of Dr. Robert Boykin, orthopedic knee surgeon treating patients in Asheville, Arden, Fletcher and surrounding North Carolina communities.