Partial Tears And ACL Reconstruction
Anterior cruciate ligament (ACL) injuries are common among athletes. Various intensities of the injury exist, ranging from mild sprains to complete tears. A critical factor in the treatment and prognosis is the extent of the tear. Severity typically falls into 3 categories: grade 1, grade 2, and grade 3, representing a mild sprain, partial tear, and complete tear, respectively. For partial grade 2 tears, total reconstruction is usually not required, with a few exceptions.
What is the ACL?
Situated within the knee joint, the ACL is pivotal in maintaining stability and facilitating seamless motion. One of the 4 primary ligaments in the knee, the ACL connects the thigh bone to the shinbone. Crucial to sports involving sudden stops, rapid direction changes, or jumps, the ACL acts as a stabilizing force to prevent the tibia from sliding out in front of the femur. The ACL is particularly susceptible to injuries, ranging from minor sprains to severe tears.
Signs of an ACL injury
People who engage in certain high-demand sports activities, such as soccer, basketball, skiing, and football, are more susceptible to ACL injuries. Typically, sudden deceleration movements, awkward landings, abrupt direction changes, or a direct blow to the side of the knee can lead to a tear, resulting in a popping sound when the injury occurs. An ACL tear might cause immediate, severe pain, and the knee might swell significantly within the first few hours. The swelling often accompanies a feeling of instability and difficulty in fully extending or flexing the knee.
How is an ACL injury diagnosed?
Initially, a medical professional will conduct a thorough physical examination of the knee, checking for swelling and tenderness. Special tests such as the Lachman test, pivot shift test, and anterior drawer test can help assess the integrity of the ACL. To further evaluate the tear, x-rays and magnetic resonance imaging (MRI) can help the provider take a closer look.
Injury severity
Anterior cruciate ligament injuries vary in severity and are typically categorized into 3 grades. Grade 1 sprains are the mildest, where the ligament is mildly stretched but still capable of keeping the knee stable. Grade 2 injuries, or partial tears, occur when the ligament has been stretched to the point of becoming loose. Grade 3 injuries occur when the ACL is completely torn or ruptured, resulting in the knee joint’s instability, with the ligament unable to maintain the alignment and stability of the knee.
Does a partial tear require surgery?
The decision about how to treat a grade 2 injury depends on various factors, such as age, activity level, health, and personal goals. Non-surgical interventions may suffice for less active individuals. However, athletes or active individuals facing significant instability might consider ACL reconstruction, despite potential risks, to regain full knee function and stability. The decision to undergo reconstruction requires thorough consultation with an orthopedic expert.
Treatment options for partial tears
Conservative management is the first line of approach for partial ACL tears. Non-surgical treatment includes physical therapy (PT), which aims to strengthen the muscles around the knee, particularly the quadriceps and hamstrings. Physical therapy also helps improve range of motion (ROM) and flexibility. Wearing a knee brace can provide additional support and protection during the healing process. With conservative management, over-the-counter (OTC) pain medication can help control any pain arising from the ACL injury.
The reconstruction route
A complete ACL reconstruction involves replacing the torn ligament with a graft, usually taken from the patient’s patellar, hamstring, or quadriceps tendon. The procedure starts with the surgeon making small incisions around the knee joint, using a technique known as arthroscopy. An arthroscope, outfitted with a tiny camera, allows the damaged knee joint to be visualized and projected on a screen. This approach helps the surgeon perform the procedure with precision. The surgeon removes the damaged ACL, replacing the section with a graft, and secures the knee bones with screws or other fixation devices.
Is ACL reconstruction the answer?
Before deciding on ACL reconstruction, consult with a skilled orthopedic surgeon. A healthcare professional can help assess the degree of the tear, the individual’s lifestyle, and the desired activity level. The ultimate goal is to restore knee function and quality of life, but achieving a balance may vary depending on the individual case.
