Usually, when we hear of an athlete who has a torn Anterior Cruciate Ligament (ACL), we wince and may assume that his or her athletic career will never be the same. For many years, that loud “pop” and shattering pain of an ACL tear really was the cause of a career-ending injury. An ACL tear used to mean invasive surgery, large incisions, drilling, a lot of blood loss, and staples, followed by extensive physical therapy. In recent years, we have seen exciting advances in surgical methods in many areas, including ACL reconstruction and repair – so much so that even a professional athlete can be back on the field, greens, or court more quickly than many thought possible.
Let’s start with a quick anatomy lesson. The knee is comprised of four bones: Kneecap (patella), thigh bone (femur), shin bone (tibia), and the outer shin bone (fibula). A very important part of the anatomy that enables us to move the knee joint are the tendons that connect the bones to our muscles. Next are the ligaments, which are just as important because they are basically strong attachments that give our knees the stability we need to keep the bones from sliding into each other. We have 4 ligaments: anterior cruciate ligament (ACL), posterior cruciate ligament PCL), medial collateral ligament and the lateral collateral ligament. The final two pieces of this complicated puzzle are the menisci, medial and lateral, that cushion and minimize shock between the thigh and shin bones. We can’t forget the bursae, the fluid-filled sacs that hang out and help the knee move smoothly.
If you look at an image of the human knee, it is quite easy to see why this is the most injured joint in the body – it looks extremely delicate, as if those ligaments could be torn very easily. The good news is that the knee is much tougher than it appears. Many aches and pains will quickly heal with rest and physical therapy. Unfortunately, there are a lot of conditions that do not heal and do require intervention or special care, such as osteoarthritis, broken bones, and ligament tears.
Surgery is not always necessary for a torn ACL – it depends on the extent of the tear and the activity level of the patient. Often the non-super athlete types can perform their day-to-day activities with no issues. They may require physical therapy or a specific exercise program to help them feel better. For those that do require surgery, I typically find that people are back to their pre-surgery athletics by four months post-surgery, with very few restrictions.
A major advancement in recent years is the ability to complete an ACL reconstruction as an outpatient procedure due to arthroscopic surgery techniques. This means that I make a series of small incisions rather than one large one. I pump in a saline solution to expand the knee, then I insert the arthroscope, or camera. We see what is happening on a HDTV monitor in the operating room. Arthroscopic techniques allow me to see exactly what I am doing, which enables the best possible anatomical alignment. The patient is less likely to suffer a repeat tear.
Next, I make the necessary drill holes for where the replacement tissue will be anchored. I prefer to use allograft tissue, which is taken from a deceased donor, rather than the patient’s own tissue, because it means less trauma to the patient and quicker recovery times. After the graft is pulled through the holes I drilled, I will attach the graft and close the incision. The patient is then taken to recovery for a few hours.
My patients start working on their rehabilitation right away, and the hope is that people begin building strength and restoration of motion. My goal for my patients is that they return to their pre-surgery level of activity. Each person’s recovery is very individual, so I try to remind my patients to do their best, while also taking physical therapy very seriously. Physical therapy’s purpose is to help you get back into great condition, but you will have to make the effort to do your exercises on your own time.
Bottom line is that arthroscopic surgical techniques and using donor tissue have greatly advanced ACL reconstruction surgery. Please keep OSC in mind in the event that you or someone you love needs assistance with an ACL injury!
Boyd W. Haynes, III, MD is a fellowship-trained and board-certified Orthopaedic Specialist with Orthopaedic & Spine Center in Newport News, Virginia. Named a “Top Doc for 2012, 2013 and 2014” by a survey of Hampton Roads Physicians, Dr. Haynes’ practice is focused primarily on sports-related injuries and disorders, and on total and partial joint replacements of the hip and knee, including the MAKOplasty surgical system. Call 757-596-1900 to make an appointment. Visit www.osc-ortho.com to learn more about OSC and Dr. Haynes.