anterior cruciate ligament Q&A

an OLBH orthopedic surgeon shares the most common athletic risk

An estimated 80,000 anterior cruciate ligament (ACL) tears occur annually in the US, with the majority of these knee injuries sustained by 15- to 45-year-olds. Below, OLBH orthopedic surgeon, George Aitken, M.D., answers some ACL questions.

What is the ACL?
Dr. Aitken: Lying deep in the knee, the ACL connects the tibia -- the inner of the two bones between the knee and the ankle -- to the femur -- the bone that extends from the hip to the knee. Together with the posterior cruciate ligament (PCL), the ACL forms an X pattern in the knee joint and provides major stabilization of the knee.

What can cause an ACL injury?
Dr. Aitken: A tear in the ligament, technically a sprain, can occur during contact sports as a result of a direct impact to the outside of the knee or lower leg. In other instances, injury occurs due to a sudden stop, pivot, twist, change in direction at the knee joint or when the knee extends beyond its normal range of motion.

What are the typical symptoms of a torn ACL?

Dr. Aitken: Most patients feel a pop when the ligament tears. Other symptoms include significant swelling and deformity within a few hours of the injury, along with discoloration of the knee due to bleeding from inside the knee joint. In complete tears, the tension across the injured ligament is removed and pain may not be felt.

What is the general treatment for ACL tears?
Dr. Aitken: The initial treatment is to reduce inflammation with ice and anti-inflammatory medications, protect weight-bearing on the injury with the aid of crutches and an exercise program to regain motion, strength and function. In most cases, the original symptoms will settle and the patient will feel better but the ligament does not heal so people are at significant risk for reinjury. Once the patient has recovered from the initial injury, further treatment, depending upon age, activity level and occupation, may include physical therapy, bracing or surgical ligament reconstruction.

Why are ACLs usually reconstructed through arthroscopic surgery?

Dr. Aitken: Arthroscopic surgery, which uses an arthroscope to see the inside of the knee, results in smaller incisions and less scarring than traditional open surgery. It is an outpatient procedure, often performed at the OLBH Same Day Surgery Center, thus allowing patients to go home the same day of surgery. Arthrosopy allows me to visualize the joint, the extent of the damage and eases reconstruction of the ligament structure. In addition, rehabilitation is often faster after this type of surgery.

What would you recommend to help people prevent knee injuries?
Dr. Aitken: Individuals should wear comfortable, supportive shoes that fit the feet and, if applicable, the activity in which they participate. Warm-up exercises should be performed before participating in athletic activities. It is important to remember not to push one's self too hard, too fast. Intensity should be increased gradually.

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