Usually, an acute tear to the ACL results in sudden pain and a sense of giving way. Many patients report feeling or hearing a “pop.” The knee often swells within the first one to three hours after the injury. When the ACL injury is chronic, knee shifting or giving way frequently occurs with activities.

An examination in an orthopedist’s office can often determine when there is a significant ACL injury. However, sometimes if the injury has just occurred, it can be difficult to tell if the ligament is injured because pain and stiffness often limit the exam.

Your physician will usually obtain X-rays to evaluate the bones for a fracture or arthritis. An MRI can be helpful to confirm damage to the ACL and assess for additional injuries.

An ACL tear cannot heal on its own. However, not all ACL tears require surgery. Whether or not the ACL needs treatment primarily depends on your activity level. The ACL is most important for cutting and pivoting sports, such as tennis, basketball, and skiing. Those with strenuous jobs involving heavy lifting and climbing also usually need a functioning ACL. For those who desire unrestrained activities, or who are unable or unwilling to modify their activity level, ACL surgery is encouraged.

People who lead a more sedentary lifestyle may get by with exercise and sometimes a brace to stabilize the knee. However, some may experience giving way with simple activities such as going down stairs or stepping off a curb. In these cases, your surgeon will often recommend surgery to restore normal activities and prevent further damage to the knee.

Because the ACL does not heal, the ligament needs to be replaced (reconstructed). During ACL surgery, the ACL is reconstructed using a minimally invasive camera (arthroscope), and specially designed instruments, inserted through small incisions.

Watch this ACL surgery video to see the steps of an ACL reconstruction surgery:

During the procedure, a replacement ligament (graft) is placed in the joint at the site of the old ACL and fixed to the ends of the bone, creating a new graft and resulting in a stable knee. Your surgeon can use either an “autograft” (your tissue) or “allograft” (cadaver donor tissue) to replace your ACL. You and your surgeon will discuss the specific options appropriate for you.

Every procedure is different. As a result, recovery times vary. Typically, the surgery is performed as an outpatient procedure, so you can go home the same day. Your surgeon will prescribe pain medication to minimize your discomfort during the initial postoperative period.

In most cases, physical therapy will start immediately after your surgery to restore range of motion and strength. Physical therapy is a vital component of a successful recovery.

In general, you must have good motion, strength, and control of your knee. How quickly you return to sports depends on several factors, including:

• Your rate of healing.
• The damage found at surgery.
• If you have any postoperative complications.
• How hard you work in rehabilitation.

In most cases, it will take a minimum of six months to return to more basic athletic activities and nine months to a year for cutting and pivoting sports.

At Town Center Orthopaedics, the surgeons and physical therapists work together to ensure each patient achieves a successful recovery after ACL surgery.