So I get a text from a friend of mine . . . and my heart sinks . . . she tells me her daughter may have torn her ACL during a soccer game his weekend! She writes “If you have time can you call me about Marie’s ACL and what questions we should ask the surgeon?”
Being a Physical Therapist, I get phone calls, texts and emails like this frequently. I also have personal experience with kids sports injuries. You see the moment they go down and pray its nothing serious, you cringe or gasp, your heart pounds as you calmly reassure yourself that everything is going to be fine. Most of the time they get up and keep playing, other times they walk off and rest, but the worst is when they are carried off or god forbid an ambulance is called!
Deep breath . . .
Once the adrenalin rush has subsided, your child is comfortable, and you’ve had a chance to process the injury then you reach out to people you know, who have experience, for advice . . . What’s next?
So after sympathizing greatly with her, I asked my friend:
- What happened? Was it a contact or non contact injury?
- Did Marie hear or feel a pop? Is her knee swollen? Can she put weight on it? Does she have full range of motion? How much does it hurt? Does it buckle?
- Has she had any imaging ~ X-ray, MRI?
- How is she feeling emotionally? How are mom and dad doing?
- How can I help? What do you need or want from me?
And I listen . . . Any healthcare provider you choose should ask similar questions and then listen.
Then she asked me:
- What could be wrong in the knee? Is it the ACL?
- Does she need surgery? Could she get away without it?
- What should I ask the orthopedic surgeon?
- How soon could she play? Is this going to affect her permanently/forever? Will it limit her ability to play soccer going forward? And as an adult?
As you can imagine this conversation is a little different for everyone . . .
The Nutshell Version: What You Need to Know About ACL Injury.
The Mechanism by which an ACL tear
- Cutting and planting moves (with rotation) or quick change in direction ~ non contact injury.
- Getting hit in a manner that pushes your femur backward or your tibia forward past the point at which the ligament can hold ~ contact injury.
You may hear or feel a pop, and the knee joint will probably swell up, it may or may not hurt much past the initial injury. In order to confirm it is actually a tear in your ACL and not injury to muscle, knee cap or meniscus instead, you need a clinical evaluation by a Physical Therapist or an Orthopaedic Surgeon and an MRI.
The ACL or Anterior Cruciate Ligament is a ligament which connect the femur to the tibia. If it tears completely it makes the knee joint unstable to correct this there are two options:
- Surgery to reconstruct the ligament and restore joint stability.
- Physical Therapy to train the muscles to maintain joint stability in any and all activities in which a person wants to engage ~ from standing and walking to sports performance.
The general recommendation is surgery IF . . .
- You have a complete tear and it impacts other structures like other ligaments or the meniscus.
- You want to return to a high level of athletic play.
Surgical options include:
- Allograft ~ a cadaver tendon is used to reconstruct the ACL
- PROS: Only one location in the knee to heal, better motion, less time in operating room
- CONS: chance of rejection of graft since it is not your own tissue. Higher failure rates, slower to adapt to person body.
- Recommended for: older patients
- Autograft ~ your own patellar or hamstring tendon is used to reconstruct the ACL
- PROS: no chance of issue rejection, its your own tissue so it doesn’t have to adapt, its stronger and lower failure rates
- CONS: have two sites to heal the ACL and patellar or hamstring tendon. This may slow the recovery time as it can create tissue irritation at the graft harvest tendon location.
- Recommended for: younger patients, athletes
When you see the Orthopedic Surgeon you should ask the same questions my friend asked me . . . once you know the diagnosis ask these questions:
- Is surgery needed? What are the options?
- What kind of surgery do you recommend or what kind of graft will you use?
- Can I have Physical Therapy before surgery?
- What happens after surgery? How long do I have to wear the brace? Use crutches? When can I start physical therapy? Sleep or walk without the brace? Return to sports?
For answer to those last questions see my next post coming this weekend . . .
. . . The Nutshell Version: What You Need to Know About ACL Rehabilitation!
Until next time . . .