A torn ACL, or anterior cruciate ligament, has become one of the most widely recognized sports injuries in America today. The list of high profile athletes who have lost entire seasons to this injury gets longer each year. While people outside the medical field may not fully understand what a torn ACL actually means, everyone knows it is a serious injury. If you find yourself asking, "I tore my ACL, now what?" you'll want to continue reading.
Fortunately, medical knowledge about knee injuries, including ACL tears, has improved greatly over the last several years. From diagnostic tools to surgical techniques to rehabilitation programs, medical professionals are getting athletes back in the game more quickly than ever. So while you may be scared or frustrated, learning more about the knee can help you choose the right treatment approach and get on the road to recovery.
Understanding the anatomy of your knee
The knee is a complex structure consisting of bones, tendons, and ligaments that work together to help you bend, run, change direction, and jump. As a result, it’s no surprise that knee injuries are so common among athletes in sports like football, soccer, and basketball. The diagram below shows the different parts of the knee.
You may recognize some of the terms from the diagram from other common sports injuries, like meniscus and MCL tears. The reality is, a “torn ACL” will mean something different for every athlete, and often it can include additional tears to these surrounding ligaments. That’s why before deciding on a treatment approach, the doctor will need to perform a physical exam and an MRI to determine the extent of your injury. There is a big difference between a specific tear to the ACL and a more complicated injury to the entire knee.
Diagnosis and your timetable for surgery
For a long time, the consensus among physicians was that a torn ACL should be treated as an emergency, and athletes underwent surgery as soon as possible to avoid long-term damage. Unfortunately, this rush to repair the ACL often caused other damage to the knee, and sometimes resulted in a need for additional procedures later on. There is a saying among orthopedists that “no knee is so bad that it can’t be made worse by operating on it.”
One of the most important things a doctor will look for when performing a physical exam is how loose the knee feels. If it is noticeably loose, it indicates that other ligaments in addition the ACL have been torn. If, on the other hand, the knee feels stable, your doctor may need to look at MRI images to get a clear idea of the damage. This primary distinction helps inform your physician about if, and when, you need to have surgery.
For injuries that involve tears to ligaments other than the ACL, it is usually necessary to surgically repair those ligaments within the first week. However, the ACL itself may be able to wait; by starting with the other ligaments and focusing on rehabilitation, your surgeon will have an easier time repairing the ACL later on. By waiting, there is a lower risk of the long-term stiffness that used to be a given after ACL surgery.
If you’ve only torn the ACL and nothing else in the knee, the physical examination will likely not show the knee to be loose. Often this type of ACL tear is only visible in an MRI. In these cases, immediate surgery is not necessary, so if your doctor cannot physically demonstrate that your knee is loose, you may want to seek a second opinion.
Even if surgery is necessary, it can be beneficial to wait until the swelling has gone down and you’ve had an opportunity to perform simple rehabilitation exercises. After 6 weeks of this conservative approach, the doctor can re-examine you and often he or she will have a clearer sense of how bad the injury is.
While knee injuries are complicated and force doctors and patients to make difficult decisions, it’s important to remember not to rush into anything. As sports medicine has advanced, doctors have begun to understand that rushing into surgery can be even more harmful than doing nothing. So stay calm, consider all of your options, and don’t be afraid to ask questions.
No matter what you and your doctor decide about surgery, recovering from a serious knee injury requires hard work. Surgeons are capable of amazing things, but the real recovery begins with rehabilitation. The more effort you put in, the better your long-term outcome will be.
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