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Anterior Cruciate Ligament (ACL) Injuries

What is the ACL?

The anterior cruciate ligament in the knee is a thick band of connective tissue that connects the femur (the thigh bone) to the tibia (the shin bone). It is the primary knee stabilizer. Injury to the ACL is common in pivoting sports and leads to instability and dissatisfaction.

What are the common ACL injuries?

ACL tears are one of the most common injuries of the knee in patients between the ages of 16 and 39. ACL injuries typically occur without contact during pivoting, cutting and jumping with the knee slightly flexed.

Sports are the most common cause of an ACL injury, but any adult can experience a traumatic ACL injury caused by repetitive stress on the knee, a direct hit to the knee, an auto accident, slip and fall, a fall off of a ladder or missing a step.

The injury may be a stretched ligament, a partial tear or a complete tear (also known as a rupture). Treatment options include both surgery and non-operative treatment (conservative approach).

There is a consensus that in highly active patients engaged in jumping, cutting and pivoting sports, early anatomical ACL reconstruction is recommended due to the high risk of secondary injury to the meniscus and cartilage. Alternatively, with delayed surgery, a period of progressive rehabilitation to resolve impairments and improve neuromuscular function is recommended.

New research reports new findings that an ACL injury causes changes in the brain that need to be targeted with rehabilitation. At CAO Sports Performance Center we optimize rehabilitation to prevent reinjury.

What to expect from rehabilitation?

Rehabilitation is begun immediately after arthroscopic ligament replacement. Recovery generally takes about nine months and involves 6-18 months of progressive rehabilitation before a player is cleared by the medical team who will perform Return To Support (RTS) testing to gauge the athlete’s readiness and risk of reinjury. The goals of rehabilitation are to improve functional performance and reduce the risk of a second ACL injury. Exercises are designed to

  • restore range of motion, especially full knee extension
  • increase muscle strength and endurance
  • improve neuromuscular function (agility, stability, balance, core strength, muscle building and power)
  • sport specific training

Return to sport (RTS)

Even with appropriate surgery and rehabilitation there is still a high risk of reinjury. Studies report that up to 25% of athletes that return to sport suffer a second ACL injury, and 30% occur within the first 20 athletic exposures.

The decision to return an athlete back into competition has significant implications ranging from the safety of the athlete to performance factors. Return to sports is determined by the needs of each patient because of the high reinjury rate that occurs when returning to sports, the high incidence of osteoarthritis at follow-up and the effects on the long-term health of the knee and quality of life.

  • Generally, after primary arthroscopic ACL reconstruction 75% of patients return to sport in nine months. The American Orthopedic Society of Sports Medicine and Arthroscopy Association of North American reports that 65% of players can return to sport before nine months; and 66.4% started physical therapy one week post op with unrestricted activity at 6-9 months. The Major League Soccer Team Physicians and the NFL and NCAA football team physicians allow return to sports before nine months in up to 82% of cases. Functional performance testing is used in the decision making of return to sport.
  • Most patients who suffer a partial ACL tear and do not to have surgery will recover with rehabilitation within 3-6 months. These patients typically have less demanding physical activities and progressive physical therapy, and rehabilitation can restore function.

Center’s for Advanced Orthopaedics team of sports, rehabilitation and surgical professionals offer next level skilled performance training, athletic development training, surgical guidance, and rehabilitative care as part of a holistic care program to get you back to the sports you love better than ever.


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