ACL Injury, Jeffrey M. Conrad, MD

Dr. Conrad spoke to our Sports Medicine class today regarding an ACL, anterior cruciate ligament, repair surgery. There are 4 main ligaments within the human knee, the medial collateral ligament (MCL), lateral collateral ligament (LCL), anterior cruciate ligament (ACL), and posterior cruciate ligament (PCL). The ACL crosses with the PCL in the notch of the knee and consists of 2 bundles that work together to stabilize the knee, without the ACL the knee would feel unstable. Usually, ACL tears occur in athletes participating in cutting sports, soccer, basketball, football, tennis, etc. Unfortunately, females are 3-8 times more likely to experience an ACL tear compared to males, with a 2.5% increased risk if a primary relative has experienced a torn ACL. There have been several studies that suggest that specific training protocols could prevent 60% of ACL injuries. Most ACL injuries occur with twisting, jumping, landing, or cutting, the athlete will most likely feel and/or hear a popping sound, and an ACL tear often involves more than just the ACL. More often than not the meniscus or other ligaments are also damaged, along with small fractures or bone bruises on the top surface of the tibia. How does it tear? This injury is a deceleration injury, which usually occurs when an athlete twists their knee or has an awkward landing. Most doctors use X-rays or MRIs as their study of choice when dealing with ACL tears. There are two types of surgical treatment, operative and nonoperative, the recovery route depends on the patient's age and activities. In younger patients surgery is usually recommended, if surgery is indicated the goal of the surgery is to reproduce or recreate the original anatomy.

ACL reconstruction involves replacing the torn ligament with another tissue called a graft. The graft may be taken from the patella tendon, hamstring tendon, quadriceps tendon, or even a cadaver graft. The actual surgery takes a little over an hour but recovery takes up to a year. After surgery compliance, which is extremely important, along with rehabilitation are key to a successful return to sport. Patients must pass certain tests and parameters before returning to cutting sports and studies recommend maintenance training for ACL prevention for around two years. How is return to play determined? One of the biggest obstacles in establishing an appropriate successful return to play is in the definitions: "Safe return to play", "Same level of competition", and "Same level of performance." For every month that return to sport was delayed, until nine months after ACL reconstruction, the rate of re-injuring the knee was reduced by 51%.