Uh Oh, I tore my ACL… Now What? (Part One)
How many people do you know who have torn their ACL? I’m sure quite a few, right?
It is approximated that 350,000 ACL reconstructions (ACLRs) are performed annually in the United States. Studies have shown that ACL tear rates have not only increased among the adult population but also in the pediatric population at a rate of 2.4% annually.
I remember the day in 2006 when I fell to the floor as my knee buckled underneath me. I was a healthy, athletic, 16-year-old female with a dream of playing collegiate level soccer. I was a three-sport high school athlete and played on two recreational soccer teams. I was the definition of an aspiring college athlete. I was training 5-6 days per week during the on and off seasons. The day I was told I tore my ACL seemed like the end of the world. I felt like a boulder had been dropped on top of me and that my dream of playing college level soccer just went out the window. Truth be told, the road was bumpy, but I did get there.
My parents took me to the “family” doctor everyone in my family had seen for the past twenty years and I was scheduled for ACL reconstruction surgery. My parents and I were clueless regarding the treatment plan and options for ACL reconstruction. That day, we were given options regarding surgical timeline & type of graft. We were presented with choices, but what stood out to me was “fastest healing time and least complications”. So, as a 16 year old girl, knowing nothing about medicine at the time, I, yes I (not my parents), decided on what is now considered the “least optimal” graft for an athletic female aspiring to be a college athlete. Oh, how I wish I knew better then.
What do I wish? I wish that I had some guidance and a little more help making the right decision. So, from my professional “been there, done that” perspective, I present to you a short guide for the “what if” scenario that may affect you or your loved one at a future date.
Step 1: The Injury
So, you’re playing a sport- running, jumping, pivoting, cutting, or just doing your normal daily tasks when you suddenly hear or feel a random pop in your knee. You’re in shock and fall to the ground thinking, “What in the world just happened to me.” You try to get up, but realize your knee is swollen and it’s difficult to walk. The knee often becomes swollen and you may even have significant bruising. So where do you go from here?
After you injure your knee your first move should be to get it looked at by a medical professional. Athletic Trainers (AT), Physical Therapists (PT) and Orthopedic Surgeons are your go-to people when diagnosing an ACL injury. Now, where do you find these people? If you’re injured at a high school or collegiate level sporting activity, there very well may be an athletic trainer present. Otherwise, you’ll be looking for your trusted physical therapist or orthopedic surgeon. A physical therapist will evaluate you very similarly to an athletic trainer and decide whether an orthopedic consult is required. More than likely, if you heard a pop, have instability, and had a significant amount of swelling, an orthopedic consult will be recommended. Finding a proper orthopedic surgeon is always important! Make sure you ask the right questions such as: how many ACL injuries do you see and how many ACL reconstructions do you perform per year. I always tell my patients it is important to find someone very familiar with the injury and surgical procedure.
AT’s, PT’s and orthopedists will initially perform hands-on testing to deem if an ACL injury is present. Unless the newly injured person can relax, sometimes the most reliable hands-on tests can provide a false negative result (meaning that the ACL is really torn but the hands-on testing was negative). I can tell you that this happened to me back in 2006. I fell at an athletic event and the athletic trainer at the event told me that he didn’t think that I did anything and that I could keep running. After listening to my body and observing my symptoms, I scheduled an appointment with an orthopedic surgeon. The key is, listen to your body. If you feel like something is off, get it checked out! Three days after the initial incident, an orthopedic surgeon also had a false negative screening. Until the MRI was performed, I was told that I probably didn’t tear my ACL.
That is one reason why an orthopedic consult is required. The MD will order an MRI for confirmation of knee injury. Now, don’t be surprised if there’s some other medical jumbo you hear when you get your MRI results. It’s not uncommon for meniscal injuries or collateral ligament injuries in conjunction with your ACL tear.
So, what comes next after the initial diagnosis?
Step 2: The Treatment Plan
For some, surgery will not be recommended but for others it is the only option. Anyone who is looking to return to sport or lead active lifestyle is more than likely a prime candidate for an ACL reconstruction.
What comes after you are deemed a surgical candidate can be a bit intimidating. That is one reason having some guidance (from your trusted AT/PT/orthopedist) is important!
Due to the biological properties of the ACL, it cannot be re-sewn together and has to be replaced by donor tissue known as a graft. A graft is a piece of tissue that will be used to replace the torn ACL. These can either be harvested from your own tissue (autograft) or harvested from a cadaver (allograft). In some rare cases a synthetic choice may also be offered; however, this has become less prevalent due lack of supporting evidence. Patellar tendon and hamstring autografts tend to have better research correlating to return to higher activity levels & decreased re-rupture rate with proper surgical techniques & rehabilitation. Allografts tend to involve fewer secondary complications due to not having to harvest tissue, but they have a slightly higher re-rupture rate and not necessarily a quicker return to sport. If you have questions, be sure to address these options with your surgeon. He or she should help you make the best educated decision regarding graft choice based upon severity of injury (multi-ligament, revision, etc.), age, body biometrics & activity levels.
After your initial diagnosis, you will most likely be stuck in a short waiting phase. Why is this? Doctors want your knee to function as normal as possible before surgery! Before ACL surgery takes place, most orthopedic surgeons will recommend a course of pre-surgical physical therapy to help to restore your normal knee range of motion and help improve strength, balance, and walking mechanics. Research has shown that a course of pre-surgical physical therapy improves outcomes post-surgery! So, what are the benefits?
Most orthopedic and sports physical therapists are very well versed on ACL injuries, reconstruction and rehabilitation. They will not only help to regain your normal knee mechanics and improve your strength, but also help you to understand a little bit more about your injury and upcoming surgery. They can help put any hesitations at ease and help you to understand post-surgical rehabilitation expectations and timelines. Also, developing a relationship with a provider who you will be spending hours with post-surgery is always a good thing! You still have time to switch if you don’t like them ?!
So, after physical therapy comes surgery. Stay tuned for part two where we will address the day of surgery and everything afterwards!
Please reach out to us with any questions!