Torn ACL? What Does That Mean for Your Running & Sports Career? Orthopedic and Sports Medicine Specialist, Manish S. Noticewala, MD

When people hear the phrase “torn ACL”, they automatically think it’s the end of their active lifestyle, but this isn’t always the case. Understanding the anatomy of the knee, the different intricacies an ACL tear can have, and possible treatment options, can help explain the complexity of a torn ACL.

A Look Into the Anatomy of the Knee

The knee is a hinge joint formed by three bones: the femur, tibia, and knee cap. These bones are  held together by four ligaments:  medial collateral (MCL), lateral collateral (LCL), anterior cruciate (ACL) and posterior cruciate (PCL). The ACL runs diagonally in the middle of the knee, preventing the tibia from sliding out in front of the femur, as well as providing rotational stability to the knee.

A layer of cartilage covers the surface of the bones and these surfaces on the femur and tibia are separated by the medial meniscus and lateral meniscus. The meniscii act as shock absorbers and work with the cartilage to reduce the stresses between the tibia and the femur.

The Truth About ACL Injuries

The ACL is one of the most commonly injured ligaments of the knee.  In general, the incidence of ACL injury is higher in people who participate in pivoting sports, such as basketball, football, skiing, and soccer, but can occur from running or other physical activities as well.

More than half of all ACL injuries occur in combination with damage to the meniscus, articular cartilage, or other ligaments.

Causes

ACL injuries most commonly occur through non-contact, with only a small percentage occurring as a result a direct contact injury.

The cause of injury is typically a person decelerating while doing either a cutting, pivoting or sliding maneuver or awkward landings associated with jumping.

Several studies have shown that female athletes have a higher incidence of ACL injuries than male athletes in certain sports, such as soccer. This higher incidence is potentially due to differences in neuromuscular control.

When an Injury Occurs

Immediately after the injury, patients usually experience pain, swelling and the knee feels unstable. Most people  cannot return to play and some may have difficulty placing full weight on the leg. Within hours of the injury, patients often have a large amount of knee swelling, a loss of full range of motion, pain or tenderness along the joint line, and discomfort while walking.

The outcomes of non-operative management of an ACL injury depend on the extent of ACL injury, a patient's activity level, presence of instability symptoms, and presence of associated injuries.

A partially torn ACL typically responds well to treatment with physical therapy and functional bracing. However, even patients with a partially torn ACL may continue to experience persistent instability symptoms.

Complete ACL ruptures have a much less favorable outcome without surgical intervention. After a complete ACL tear, many patients are often unable to return to activities or sports that involve cutting or pivoting. A significant number of patients experience  instability symptoms during even routine everyday activities, such as walking or going up and down stairs.

About half of ACL injuries occur in combination with damage to the meniscus, articular cartilage or other ligaments. However, patients who suffer an isolated ACL tear and opt for non-operative treatment may develop secondary damage to other knee structures from repeated episodes of instability. These patients will have meniscus damage and/or cartilage damage when re-assessed 10 or more years after the initial injury.

Treating a Torn ACL

Orthopedic Specialists will determine the best course of treatment depending on each person’s unique injury. Many factors help the provider decide if a non-surgical or surgical course of treatment is the best course of action. 

Non-Surgical Treatment

Non-surgical treatment consists of nonsteroidal anti-inflammatory (NSAID) medications to relieve  pain and swelling. In addition, a course of physical therapy focused on knee range of motion, quadriceps and hamstring strengthening is prescribed. Finally, a function ACL brace is recommended.

Non-surgical management of isolated ACL injury may be successful in certain patient groups with:

• sprains or stretching of the ACL
• partial tears and no instability symptoms
• complete tears and no instability symptoms
• those who will not be engaging in cutting or pivoting sports
• relatively sedentary lifestyles

Surgical Treatment

Recommending surgical treatment for ACL injuries is NOT based on age. Rather, an Orthopedist will use the  patient’s activity level and presence of instability symptoms to determine whether surgical intervention would be most beneficial.

Certain patient groups should consider surgical management of ACL injuries, including those with:

• persistent instability symptoms following a trial of non-surgical management
• partial tears and instability symptoms
• complete tears and instability symptoms
• complete tears and injuries to other structures in the knee
• a desire a return to sports or work that requires cutting, pivoting, jumping, or turning.

A torn ACL cannot simply be  sewn or put back together -  it must be reconstructed, or replaced with a graft composed of tendon. The graft used to reconstruct the ACL can either be an autograft or an allograft. Autografts come from the patient themselves and allografts come from a cadaver. The decision on which particular graft should be used is selected depending on the individual patient.

A torn ACL doesn’t necessarily mean the end of your sports or running career. Your Orthopedic Sports Medicine Specialist will examine the intricacies of your injury and determine the best source of treatment for you. It’s important to follow your treatment plan and speak with your doctor if you feel an adjustment to your treatment is needed.

Our goal at Crystal Run is always to preserve the joints and use surgery as a last resort whenever possible. We’re focused on fixing your injury and getting you back to optimum mobility.

Manish S. Noticewala, MD, earned his Medical Degree from Yale University School of Medicine in New Haven, CT and completed his Residency in Orthopaedic Surgery at New York Presbyterian Hospital, Columbia University in New York, NY. He completed Fellowship training in Orthopaedic Sports Medicine at Barnes Jewish Hospital, Washington University St. Louis School of Medicine in St. Louis, MO. Dr. Noticewala specializes in Orthopedic Surgery and Sports Medicine and provides care to patients at Crystal Run Healthcare’s Rock Hill office.