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 by 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.
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.