ACL injuries, treatment and prevention

Almost everyone knows someone who has experienced one of the most common sports-related knee injuries - a rupture or tear of the anterior cruciate ligament (ACL). What is an ACL? There are four ligaments in the knee that connect the femur (thighbone) to the tibia (shinbone). Two ligaments called collateral ligaments are located on each side of the knee and provide side-to-side stability. The two other ligaments are the posterior cruciate ligament (PCL) which connects to the back of the shinbone and provides front-to-back stability and the anterior cruciate ligament (ACL) which controls the movement of the lower leg and helps prevent the knee from extending beyond its normal range of motion but also provides back-to-front stability. "The ACL injury typically occurs when a person is cutting or decelerating in sports like soccer, football and basketball," said Todd Olsen, D.O., an orthopedic surgeon and sports medicine specialist on staff at Bone & Joint Hospital. "The knee becomes stressed in a way that causes the ACL to stretch or tear. In most instances, a person will experience an ACL injury in a non-contact situation," he explained. "The symptoms of an ACL injury often include hearing or feeling a 'pop', pain and swelling," said Dr. Olsen. "It's typically painful and you know something is wrong." A history and physical exam are an essential part of diagnosing the injury. According to Dr. Olsen, it's also fairly common to undergo an MRI to determine if there's additional damage. It can also be a good pre-operative planning tool. Surgical and non-surgical options There are both surgical and non-surgical options for treating an ACL injury. "The patient needs to consider both options," said Dr. Olsen. "If they want to go back to athletics, they probably need to consider ACL reconstruction. However, if a person's lifestyle and age are such that they could modify their activities to protect their knee, they may not wish to have surgery," explained Dr. Olsen. Non-surgical options may include physical therapy, a change in activity level and/or wearing a knee brace. Surgical reconstruction may be recommended depending on the severity of the injury and what will provide the patient with the most stable knee to reduce risk of future knee damage. "The surgical procedure is done using arthroscopic techniques on an outpatient basis. It involves cleaning up the tear and reconstructing the ACL by replacing it with a graft from your own body (autograft) or from a donated graft (allograft). The graft takes approximately six months to one year for full incorporation," said Dr. Olsen. Rehabilitation After surgery, the patient will use crutches to walk and should be walking without crutches in approximately two to three weeks. "I like to have my patients riding a stationary bicycle within two to four weeks and jogging six to eight weeks post-surgery," said Dr. Olsen. "Patients can do sports-specific training at about three months until they are released to full activity typically within six months." Prevention Surprisingly, this injury occurs more frequently in females. "The female knee has a tendency to cave inward," explained Dr. Olsen. "Fortunately, training programs have been developed to prevent injuries and enhance performance," he said. One of the programs Dr. Olsen has found to be successful is The Santa Monica Orthopaedic and Sports Medicine Research Foundation's PEP Program. The program was designed to decrease the number of ACL injuries in female soccer players (their injuries are two to eight times greater than that of male soccer players) and includes warm-up stretching, strengthening, plyometrics and sport specific agilities to address potential deficits in the strength and coordination of the stabilizing muscles around the knee joint. "I've utilized the PEP program with patients to protect the injured knee and to help prevent re-injury after ACL reconstruction," explained Dr. Olsen. This program has been adopted by collegiate and high school programs and is also being used by the FIFA to help prevent injuries. "This program has good data proven in several studies," said Dr. Olsen. For more information on the PEP program visit these websites: ACLprevent.com or Olsenorthopedics.com.