Anterior Cruciate Ligament (ACL) Tears & Sprains

Treatments for ACL injuries in Asheville

If you are experiencing knee pain and swelling or your knee is giving out on you after making a sudden move, landing incorrectly, or engaging in contact during a game, you may have injured your anterior cruciate ligament, or ACL.

ACL tears are one of the most common sports-related knee injuries, and occur most frequently in athletes who play contact sports (i.e., football, rugby, basketball) or other activities that require jumping, sudden stopping, or quick, lateral movements, such as tennis, dancing, skiing, or skating.

At Carolina Hand & Sports Medicine, Asheville orthopaedic surgeon Dr. Matthew B. Massey offers both surgical and non-surgical treatments for ACL injuries. Fellowship-trained in knee, foot and ankle surgery and sports medicine, Dr. Massey has helped numerous patients, including NFL, MLB, NBA and collegiate athletes as well as recreational athletes, repair ACL injuries and make a full return to activity.

What is the anterior cruciate ligament (ACL)?

The bones that meet at your knee are held together with four ligaments:

  • Two “collateral ligaments” on either side of your knee, which keep your knee stable from side to side. These are the MCL and LCL.
  • Two “cruciate ligaments” (ACL and PCL) that overlap in an “X” shape the middle of your knee joint, which keep the knee stable in front to back movements.

As the “anterior” cruciate ligament, the ACL forms the front part of the “X”.

What are the symptoms of a torn ACL?

ACL sprains and tears are usually acute injuries, meaning they happen very quickly as a result of a specific incident of contact or movements. Characteristic symptoms include:

  • A popping sound or sensation at the time of injury
  • Pain and swelling within 24 hours of injury
  • Reduced range of motion
  • Tenderness in the joint
  • Instability (i.e., your knee feels like it’s going to give out on you)

How do ACL injuries happen?

ACL sprains and tears typically result from sudden, irregular movements, such as:

  • Rapid change in direction (i.e., during juking)
  • Sudden slowing or stops (running into base, plow stops when skiing)
  • Landing incorrectly after a jump
  • Contact or collision (i.e., during a tackle)

However, ACL injuries can happen in other ways too. If you are experiencing the symptoms, it’s best to see a qualified orthopaedic surgeon.

Diagnosing an ACL tear or sprain

The first step to diagnosis is a physical exam. Dr. Massey will meet with you and ask questions about your injury. He will also test the stability and range of motion of your knee.

At this appointment, we may perform X-rays to rule out any damage to bone. An MRI usually is not necessary to diagnose a torn ACL, but may be recommended depending on your symptoms, as ACL injuries commonly involve damage to other knee structures, such as the meniscus, cartilage or other ligaments.

ACL injuries are diagnosed according to level of severity:

  • Grade 1 sprain: mild damage, pain and swelling may occur, but knee is still stable.
  • Grade 2 sprain/partial ACL tear: ligament has been significantly stretched and knee is unstable
  • Grade 3 sprain/complete ACL tear: ligament has been completely torn in two. This is the most commonly-occurring of the three levels

Grade 1 sprains can typically be treated non-surgically, but partial and complete tears usually require surgery.

Non-surgical treatments for ACL injuries

Currently, the only way to heal an ACL tear and restore stability to the knee joint is through surgery; therefore, non-surgical treatments are typically best suited for patients who are less active and do not want or need surgery to allow them to lead their desired lifestyle. Non-surgical treatments can also provide temporary stability while you await surgery. Options include:

  • Knee bracing. A brace can help keep the knee stable.
  • Physical Therapy. A customized rehabilitation program can help increase strength of surrounding muscles to improve knee stability following a milder ACL sprain.

Surgery to repair a torn ACL

Most patients with a torn ACL require surgery to rebuild the ligament and restore function. Typically, we will schedule a patient after acute swelling has resolved to ensure optimal results and minimize risk of scar tissue formation. During surgery, the ACL is reconstructed using a tissue graft (taken from nearby tendons), which allows the ligament to regrow at the proper length.

Dr. Massey typically performs ACL reconstruction arthroscopic techniques for a less invasive surgery, a shorter recovery, and less post-operative pain. The video below briefly illustrates the ACL reconstruction procedure.

How long does it take to recover from ACL surgery?

On average, patients require about 6 months of rehabilitation following ACL reconstruction before they are cleared to return to full activity. Some pain and swelling are normal after the procedure and can be alleviated with medication and ice packs. Your knee will be placed in a post-operative brace and you may be on crutches for several days.

Physical therapy rehabilitation begins immediately after surgery, beginning with simple exercises to restore mobility and muscle control, and progressing to exercises to restore overall strength, endurance and function.

What are the risks of ACL surgery?

Serious complications are very rare with ACL reconstruction. However, all surgery carries some risk. Possible complications with ACL surgery include:

  • Infection
  • Bleeding or blood clot
  • Anesthesia risks
  • Reduced mobility, stiffness, or instability in the knee
  • Growth plate injury (higher risk for children who are not finished growing)
  • Kneecap pain

You can reduce your risks for complications and increase the likelihood of a successful outcome by choosing a board certified orthopaedic surgeon with plenty of experience performing ACL reconstruction.

Is ACL surgery worth it?

The American Academy of Orthopedics estimates that the procedure successfully restores knee mobility and stability in 82% to 95% of patients. It is key to follow your doctor’s instructions for recovery and rehabilitation to ensure the best outcome possible.

If you have questions or are looking for a qualified doctor to help you overcome an ACL injury, please contact us. Dr. Massey and our experienced orthopaedic team are ready to help you heal and get back to the activities you love.