What is the treatment for an ACL injury?

The way an ACL injury is treated depends on the patient. If the ACL is completely torn, and the patient is an athlete who wishes to return to competing in his or her sport, surgery will typically be necessary. Active individuals involved in start-stop, change-of-direction sports, or who have strenuous jobs (e.g., climbing, pivoting, jumping, etc.) may also benefit from surgical reconstruction of the ACL.

Surgery to reconstruct a torn ACL is done with a graft of a tendon (tendons connect muscles to bones) from the patient, such as a hamstring (from the back of the thigh), or the kneecap/patellar tendon (from the front of the knee). Occasionally, a “cadaver” tendon (i.e., a tendon from someone who died and donated his/her body to science and medicine) can be used in older individuals who are still very active. Cadaver tendons are typically not used in young athletes because of the higher rates of re-tear.

The surgery is minimally invasive, which means that instead of cutting the knee open with a scalpel, the surgeon uses an arthroscope, a thin wand-like instrument. The surgeon inserts the arthroscope and the working instruments through small incisions in the knee.

In other, less severe injuries, the treatment may include a knee brace (sometimes with crutches) and/or physical therapy and exercises to strengthen the leg muscles.

What happens after ACL surgery?

After the ACL surgery, the patient will have physical therapy to strengthen the knee and the muscles around it. The first few days after surgery, the patient will perform gentle range-of-motion and simple strengthening exercises, and some weight-bearing exercises. As the patient gets stronger, formal physical therapy is started within the first week, including advanced strengthening and balance activities.

After about 12 to 16 weeks, if the patient is an athlete, sport-specific activities are added to the rehabilitation program, such as hopping, jumping, and agility drills. The athlete should be able to return to normal activity about 6 to 9 months after the ACL surgery.

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