What is an ACL injury? How can it be treated? How long is the recovery?

Man having a pain in his knee

It has been said that the three most frightening letters for an athlete are A-C-L. An injury to this ligament is very serious. In the past, a tear of the ACL would have been career ending for any athlete. Nowadays it’s just considered season ending.

The anterior cruciate ligament helps stabilize the knee by connecting the tibia (shinbone) to the back part of the femur (thighbone). This connection of the two bones keeps the shinbone from sliding forward in the relationship to the thighbone.

In sports where there is stop-and-go activity, this ligament is a key stabilizer of the knee. An injury tot the ACL is much more common than one might think. The diagnosis of ligament injury may be by history and physical examination. MRI can be used to reinforce the diagnosis.

If there is a minimal or partial tear of the ACL with only a little instability, the athlete can avoid surgery and go forward with rehabilitation. A brace must be used for a return to play in most sports. A complete tear of the ACL with significant instability will usually require surgery to repair the ligament in order for the young athlete to return to play.

The timing of surgery in the younger athlete is important because kids have open growth plates. Special testing (bone age) must be done to see how much growth is remaining in the bones (a>https://kidshealth.org/en/parents/xray-bone-age.html).

The most commonly technique used for ACL reconstruction in kids uses a technique that minimizes the risk of growth plate injury. An adult-type ACL reconstruction is usually done in females over age 15 and males over 16. Otherwise, a graft is used to reconstruct the ACL and avoid hardware at the level of the growth plate. Any drill holes made to receive the graft should be small. With careful attention to surgical technique the ACL reconstruction in kids should be safe and effective.

Return to play after an ACL reconstruction is a minimum of six months. The initial period following ACL surgery uses a brace and rehabilitation. The athlete will progress to full weight bearing exercises, weight training, and sport specific drills and skills. When the athlete returns to play, especially in a contact sport, a brace is usually recommended.

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