How does an ACL tear occur?
An ACL tear is most often a sports-related injury. ACL tears can also occur during rough play, mover vehicle collisions, falls, and work-related injuries. About 80% of sports-related ACL tears are "non-contact" injuries. This means that the injury occurs without the contact of another athlete, such as a tackle in football. Most often ACL tears occur when pivoting or landing from a jump. The knee gives-out from under the athlete when the ACL is torn.
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The diagnosis of an ACL tear is made by several methods. Patients who have an ACL tear often have sustained an injury to the knee. The injury is often sports-related. They may have felt a "pop" in their knee, and the knee usually gives-out from under them.
ACL tears cause knee swelling and pain. On examination, your doctor can look for signs of instability of the knee. These special tests place stress on the ACL, and can detect a torn ligament.
An MRI may also be used to determine if the ligament is torn, and also to look for signs of any associated injuries in the knee.
ACL tears do not necessarily require surgery. There are several important factors to consider before undergoing ACL surgery. First, do you regularly perform activities that normally require a functional ACL? Second, do you experience knee instability? If you don't do sports that require an ACL, and you don't have an unstable knee, then you may not need ACL surgery.
The is also a debate about how to treat a partial ACL tear. If the ACL is not completely torn, then ACL reconstruction surgery may not be necessary.
Many patients with an ACL tear start to feel better within a few weeks of the injury. These individuals may feel as though their knee is normal again, but the problems with instability may persist.
The are several options for how to perform ACL surgery. The most significant choice is the type of graft used to reconstruct the torn ACL. There are also variations in the procedure, such as the new 'double-bundle' ACL reconstruction.
Risks of ACL surgery include infection, persistent instability and pain, stiffness, and difficulty returning to your previous level of activity. The good news is that better than 90% of patients have no complications with ACL surgery.
While general guidelines exist for ACL rehab, it is critically important that each individual progress through their rehab as their knee allows. Progressing too quickly or too slowly can be detrimental to overall results from surgery, therefore it is important to ensure your therapist and physician are guiding your rehab.
ACL tears are often seen in high profile athletes. Recent athletes who have sustained ACL tears include football player Tom Brady, golfer Tiger Woods, and soccer player Frankie Hejduk.
The concern of performing ACL surgery in children is that there is a risk of causing a growth disturbance in growing children. Growth plate problems as a result of ACL surgery could potentially lead to early growth plate closure or alignment deformities. However, recent research is showing that the risk of growth plate problems is much less then the risk of permanent knee damage if the ACL is not fixed.