Anterior Cruciate Ligament (ACL) Tears

Ligaments are bands of tough, elastic connective tissue that surround a joint to give support and limit the joint’s movement.  The ligaments in the knee connect the femur (thighbone) to the tibia (shin bone). When ligaments are damaged, the knee joint may become unstable. There are 4 major ligaments in the knee:

Anterior cruciate ligament (ACL) controls rotation and forward movement of the tibia (shin bone). It is located toward the front of the knee and is the most common ligament to be injured. The ACL is often stretched or torn during a sudden twisting motion (when the feet stay planted one way, but the knees turn the other way). Skiing, basketball, and football are sports that have a higher risk of ACL injuries.

Posterior cruciate ligament (PCL) controls backward movement of the tibia (shin bone). The PCL is located toward the back of the knee and is a common knee ligament to be injured. The PCL injury usually happens with sudden, direct impact, such as in a car accident or during a football tackle.

Medial collateral ligament (MCL) is located on the inner side of the knee and provides stability for the inner knee. It is injured more often than the LCL, which is on the outer side of the knee. Stretch and tear injuries to the collateral ligaments are usually caused by a blow to the side of the knee, such as when playing hockey or football.

Lateral collateral ligament (LCL) gives stability to the outer knee.

You probably know you have a problem because of sudden and often severe pain and maybe a loud pop or snap when you’ve injured your knee. You often will have swelling, a feeling of looseness in the joint and severe pain or even inability to put weight on the joint. When you come to my office we’ll ask about past injuries and what you were doing when your injury occurred. In addition to your medical history and physical exam, we will take an x-ray and possibly an MRI to help diagnose your problem.

Every patient is unique and all injuries have different levels of severity and treatment options. I will discuss with you both surgical and nonsurgical options. We will then make a plan together that is best for you.

Depending on what we find in your physical evaluation we might first recommend trying:

• Ice pack application (to reduce swelling that happens within hours of the injury)
• Compression (from an elastic bandage or brace)
• Elevation
• Pain relievers
• Muscle-strengthening exercises
• Protective knee brace (for use during exercise)
• Activity limitations

The surgery to correct a torn knee ligament involves replacing the ligament with a piece of healthy tendon. A tendon from the kneecap or hamstring, for example, is grafted into place to hold the knee joint together. The tendon graft may come from the person (autograft) or from an organ donor (allograft). This is a minimally invasive procedure done on an outpatient basis under anesthesia. Several small incisions are made. A camera is inserted through the incision providing a video feed on a nearby monitor allowing me to look into your knee. Several other small incisions will be made and specialized instruments will be used to repair your knee problem. We’ll thoroughly explain what type of repair you will have and what to expect before and after surgery and during recovery.