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Anterior Cruciate Ligament Injury

Overview

ACL MRI tear ACL injuries are common knee injuries in both the athletic population and workplace. Annually, there are over 250,000 ACL injuries within the general population. ACL injuries are primarily due to a non-contact event caused by sudden deceleration, twisting, or cutting. The patient often feels a popping within the knee followed by subsequent swelling. 50% of ACL injuries occur in conjunction with injury to the meniscus, cartilage or other ligaments, and it is often these injuries that are precursors to long-term damage of the knee if left untreated.


acl tear schematic

Anatomy

The Anterior Cruciate Ligament or ACL is one of four major ligaments of the knee, which connect the femur to the tibia. The ACL helps to stabilize the knee joint by preventing the tibia from shifting forward while also providing rotational stability.


ACL ANATOMY

Clinical Evaluation

Diagnosis of both ACL tears and sprains is often made clinically. However, X-rays and magnetic imaging studies (MRI) can also be helpful in confirming the diagnosis.


ACL MRI Normal

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Operative Treatment

Surgical management of these injuries involves reconstruction of the torn ACL. This is typically performed after knee motion has returned and swelling has dissipated. Reconstruction is performed arthroscopically using one of several graft options that the body then utilizes to incorporate over time into a functioning ACL. These graft options can include autograft, which is the patient’s own tissue or allograft, which is cadaver tissue. An autograft is obtained from the patient at the time of surgery and can be either the central 1/3 of the patellar tendon or hamstring tendons. An allograft patellar tendon can also be utilized in this procedure. The benefits of each graft can be discussed with the surgeon prior to surgical reconstruction although the surgical technique and rehabilitation programs are similar. Success rates for ACL reconstruction approach 95-98%, and are often dictated by the associated injuries sustained at the time of injury. The goal of this procedure is for the patient to successfully return to full athletic activity without a brace at 6 – 9 months. A general guideline of ACL rehabilitation can be found within the Rehabilitation Protocols.

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Download the physical therapy protocol for this condition.