ACL Surgery or Rehab? Explore Your Best Options

Introduction

The anterior cruciate ligament (ACL) is a crucial component of the knee joint, playing a key role in stabilising the knee by restricting excessive forward movement of the tibia and controlling rotational movements. While it was once thought that ACLs could not heal independently, recent research indicates that healing is indeed possible. This article delves into the anatomy and function of the ACL, explores common injury mechanisms, and reviews rehabilitation options to aid in the prevention and recovery from ACL injuries.


ACL Anatomy and Function

The anterior cruciate ligament (ACL) is a key structure in the knee joint, connecting the femur (thigh bone) to the tibia (shin bone). It consists mainly of collagen fibres, which provide strength and stability. The ACL is composed of two bundles: the anteromedial (AMB) and the posterolateral (PLB). These bundles work together to prevent excessive forward movement of the tibia and to control rotational movements of the knee. 


Types of ACL Injuries

ACL injuries can vary in severity, typically classified into three grades:

  • Grade I (Mild sprain): The ACL is slightly stretched but still able to support knee stability.
  • Grade II (Partial tear): The ligament is partially torn, leading to some instability in the knee joint.
  • Grade III (Complete tear or rupture): The ACL is completely torn, resulting in significant knee instability and often requiring surgical intervention.

Common Movements Leading to ACL Injuries

ACL injuries commonly occur during movements that place stress on the knee joint, such as:

  1. Pivoting: Sudden changes in direction with the foot planted can cause the knee to twist, straining the ACL.
  2. Jumping and Landing: Landing awkwardly on one leg can put excessive force on the knee, leading to ACL tears.
  3. Hyperextension: Overextending the knee backward or twisting it in an unnatural direction can damage the ACL.
  4. Direct Contact: Collisions or impacts, like tackles in sports, can disrupt knee stability and tear the ACL.

High-Risk Sports for ACL Injuries

Certain sports pose a higher risk for ACL injuries due to their physical demands, including:

  • Skiing: Twisting motions and high speeds increase ACL injury risk.
  • Soccer, Netball, and Basketball: These involve frequent jumping, pivoting, and rapid directional changes.
  • Rugby League and Union: Physical contact and sudden movements are common in these sports.
  • Gymnastics and Martial Arts: Complex movements and high-impact landings can strain the ACL.
  • Mountain Biking and Motor Cross: High-impact landings and falls pose a significant risk.

Rehab Options for ACL Ruptures

ACL injuries can be managed through either surgical or non-surgical approaches, depending on the severity of the injury, the patient’s activity level, and personal preference.

1. Surgical Rehabilitation

Surgical intervention is often recommended for active individuals, especially athletes, who want to return to high-demand sports. The surgery typically involves ACL reconstruction using a graft from the patient’s own tissue (autograft) or donor tissue (allograft). Post-surgery rehabilitation is crucial and includes:

  • Early Stage (0-6 weeks): Focus on reducing swelling, restoring knee range of motion, and gentle strengthening exercises.
  • Intermediate Stage (6-12 weeks): Progressing strength and flexibility exercises, introducing balance and proprioception training.
  • Advanced Stage (3-6 months): Intensive strength training, sport-specific drills, and gradual return to full activity.
  • Return to Sport (6-12 months): Final phase includes ongoing power and strength training, agility training, cutting, and pivoting movements to prepare the athlete for full return to their sport.

2. Non-Surgical Rehabilitation

Non-surgical options may be suitable for individuals with partial tears, those with low activity demands, or when surgery is not feasible.

  • Rehabilitation Alone: This approach focuses on physical therapy to strengthen the muscles around the knee (quadriceps, hamstrings) to compensate for the lack of ACL stability. It includes exercises for flexibility, balance, and proprioception. This method may allow individuals to return to daily activities but might limit participation in high-impact sports.
  • Cross Bracing Protocol: This newer non-surgical method uses a specially designed knee brace to facilitate natural healing of the ACL. The brace helps align and support the knee, potentially allowing the torn ligament to heal over time. Combined with targeted physical therapy, this approach aims to restore knee stability and function without the need for surgical intervention. You can find more information on the Cross Bracing Protocol at https://healacl.com/

Conclusion

Understanding the basics of ACL injuries, from their anatomy to the common causes and treatment options, is essential for anyone involved in sports or physically demanding activities. Whether you opt for surgical or non-surgical rehabilitation, the goal is to restore knee stability and function, allowing you to return to your desired level of activity safely and effectively. It's crucial to work closely with healthcare professionals to choose the most appropriate treatment plan tailored to your individual needs.

If you're dealing with an ACL injury or want to prevent one, our team at Undisputed Performance & Rehab is here to help. With personalized treatment plans and expert guidance, we can support you on your journey to recovery and help you get back to doing what you love. Contact us today to schedule a consultation and take the first step toward your recovery.

Author

James O’Leary (Physiotherapist)

 

References:

  1. Heal ACL, n.d. Understanding ACL Injuries and Rehabilitation Options. Available at: https://healacl.com/ [Accessed 2 September 2024].
  2. Gasparini, J.R. and Dahm, D.L., 2023. Anterior Cruciate Ligament (ACL) Injury. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available at: https://www.ncbi.nlm.nih.gov/books/NBK559233/ [Accessed 2 September 2024].
  3. Woo, S.L., Vogrin, T.M. and Abramowitch, S.D., 2020. Knee Ligament Anatomy and Biomechanics. Sports Medicine and Arthroscopy Review. Available at: https://journals.lww.com/sportsmedarthro/abstract/2020/09000/knee_ligament_anatomy_and_biomechanics.2.aspx [Accessed 2 September 2024].

 

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