Anterior Cruciate Ligament (ACL) Tears: Treatment Options

Anterior Cruciate Ligament (ACL) Tears: Treatment Options

It is important to understand the treatment options available for anterior cruciate ligament, or ACL, injuries.

If left untreated, the knee can remain unstable and may wear down the surface cartilage, eventually leading to osteoarthritis.

Older patients who are not particularly active, as well as younger patients who do not participate in cutting or pivoting sports, may be treated without surgery.

Nonoperative treatment includes the use of a brace for stability and physical therapy to improve strength and range of motion. Regardless of injury severity, the primary goal is to improve balance and muscular support to stabilize the knee since the ACL can no longer perform its normal function.

However, surgical reconstruction of the ACL has been shown to provide greater joint stability and reduce the risk of additional injury to structures such as the meniscus or surface cartilage.

Patients who are very active in sports or have physically demanding jobs will likely benefit from surgical treatment if they have a grade three, complete tear of the ligament.

Many factors influence the timeline for returning to full sport or activity after ACL surgery. These considerations should be discussed with the surgeon to ensure a safe and effective recovery.

In some cases, the ACL tear is located near the top of the ligament. When this occurs, it may be possible to repair the ligament rather than reconstruct it using new tissue. Tears located in the middle of the ligament typically have better outcomes with reconstruction.

If surgery is chosen, here is what the process looks like on the day of surgery. The patient is brought into the operating room and positioned lying face up on the operating table. A leg holder is used to stabilize the leg during the procedure.

To perform an ACL reconstruction, the surgeon uses a tissue graft to create a new ligament. If the patient’s own tissue, called an autograft, is used, the three most common graft options are the patellar tendon, hamstring tendon, or quadriceps tendon. A separate incision may be required to harvest the graft, depending on which option is selected.

In some cases, donor tissue from a cadaver, known as an allograft, may be used. The patient and surgeon will decide together which graft option is most appropriate.

After surgery, recovery begins. A specialized brace is used to protect the knee while still allowing controlled movement to prevent stiffness. Physical therapy focuses first on restoring range of motion, followed by strengthening. The strengthening phase can take the longest, as the patient works toward safely returning to their desired level of activity.