[ACL Rehab Video] Everything You Need to Know About Your Torn ACL
[ACL Rehab Video] Everything You Need to Know About Your Torn ACL
In this series presented by Dr. Emil Dilorio from Coordinate Health explains the journey one goes through when tearing an acl to rehabbing the reconstructed acl.
The series consists of the following:
- ACL Tears Part 1: Anatomy of a Tear
- ACL Tears Part 2: ACL Symptoms and Evaluation
- ACL Tears Part 3: ACL Reconstructed Surgery
- ACL Tears Part 4: ACL Reconstructive Surgery
- ACL Tears Part 5: ACL Rehab
ACL Tears Part 1: Anatomy of a Tear
The ACL is the most commonly torn ligament in the knee. It’s one of four stabilizing ligaments in the knee, along with your PCL, MCL and LCL. Your ACL runs from your thigh bone to your shine bone. The ACL and PCL are responsible for limiting your knees front, back and rotational movement. The MCL and LCL limit side to side movement. The ACL is responsible for walking, running, twisting, jumping and pivoting. ACL tears can occur by themselves, called isolated tears, but frequently occur with other injuries with the mcl,lcl or meniscus. The meniscus act as shock absorbers. The ACL and PCL are called cruciate ligaments because they cross one another. The acl prevents your shin bone from moving too far forward.
ACL tears most commonly happen in sports such as:
- A sudden deceleration(slowing down or stopping),
- a hyperextension,
- or a sudden pivot or change of direction.
Studies show women are two to four times more likely to tear their acl than men due to such factors:
- women have a strength imbalance between hamstrings and quads,
- a rise in the number of women competing in sports,
- poor body mechanics and looser,
- more flexible joints leading women to be more prone to acl tears.
ACL Tears Part 2: ACL Symptoms and Evaluation
Most acl tears are acute, traumatic injuries so the injuries occur in a sporting event or accident. ACL tear symptoms, Acute pain, swelling,discomfort and an inability to walk.The most common history a patient gives with an acl tear is with a cutting or twisting sport, they plant their foot and twist their knee and feel a pop an unable to continue playing basketball. There are patients that tear their acl and continue to play sports all day. However, that is rare. The amount of swelling or pain usually preclude them from continuing. When evaluating a torn acl, the knee is normally swollen and the athlete can only bend their knee so far until there is pain. Since there is fluid in the knee, it can only bend so far because of the fluid that takes up space and creates pressure. A classic way to assess an acl tear is by a “drawer test” where the thigh bone is stabilized and your doctor will pull the shin bone up to see how far forward it goes, kind’ve like a drawer, which is where the name came from. The athlete in the video has once known as a “Terrible Triad” which is a torn ACL, a torn meniscus and an mcl tear. The mcl will heal on its own, but the meniscus will not because it doesn’t get enough blood flow. Orthopedic surgeons aren’t worried about an ACL as a traumatic injury because they focus on other structures that are damaged such as the meniscus because unlike the ACL it cannot be replaced, only trimmed or removed depending on the severity.
ACL Tears Part 3: ACL Reconstructed Surgery
A patellar tendon graft: taking a piece of your patellar with it attached to your knee cap and your shin bone and is the same length as your ACL. This is the closest replication of your acl because it has a piece of bone attached on both ends of your ligament. This process is done arthroscopically by drilling holes where your injured acl was and placing the patellar tendon graft in. It is firmly secured in your bone tunnel by wedging a specially designed screw into the thigh bone tunnel, which prevents your new acl from sliding out, known as the interference screw. The other screw that goes into your shin bone tunnel is known as the post screw.
ACL Tears Part 4: ACL Reconstructive Surgery
Caution: Graphic video. This video may not be for individuals with weak stomachs as the video contains the surgery process of what happens when your asleep as the orthopedic surgeon drills into the knee known as arthroscopy.
ACL Tears Part 5: ACL Rehab
“The factors that a patient has control of that a patient can control the success of their surgery is pre-operative strengthening and adherence to a rigorous therapy program post-operatively. they have to be committed to therapy, they will be weaker and that strength will not come back magically, they have to work hard at it.” – Orthopedic Surgeon of Coordinate Health, Thomas Maede, MD.
The main goals of physical therapy following ACL surgery:
- Regain extension in the knee
- Regain range of motion and ability to bend the knee
- Reduce swelling
- Walk with a normal gait
- Strengthen knee
- Regain balance
- Return to activities
Within the the first 2-3 weeks, it’s important to regain your knee’s range of motion, especially extension. You have a 4-6 week window to regain extension because your body will build up enough scar tissue to make it difficult. This is the #1 priority post-acl because if you get that you can get normalized walking and your quad to contract well. When the ACL is torn, the balance fibers leave with it. One of the key goals is to work on proprioception, which your ACL has proprioception fibers telling you where your knee is in time and space. Later on as your physical therapy progresses, the next thing is working on movement mechanics, teaching you how to plant, and land pivot effectively. In the first 6-8 weeks, your physical therapist will look to see the bone to fill in around the graft. Secondly, they’re looking to see the blood supply to the graft because the graft wasn’t in that place originally so it’s important that it receives bloodflow in that position. These are key components to physical therapists to allow someone to return to sports. Your recovery process can take 6 months to a year, depending on your sport or activity level. This may end your season, but it does not end your career. Upon completing your ACL rehab and your resume normal activities, it’s important to utilize an ACL brace to add a little more stability. It’s essential to add a sport specific regime after your ACL rehab to fuel the competitive fire in you and to regain confidence in your knee.
As you can see, the journey from start to finish is a long process that requires your full commitment and dedication to returning to competitive sports. Like the surgeon mentions, your physical therapy is what will define your condition and progress towards retaining your athleticism. And if you accomplish each day of therapy, you’ll actually come back in far greater shape than you were before. If you’re going through your first acl surgery or are in your first months of rehab, don’t be discouraged. The work you put in during physical therapy will show when you reach your 6-9 month mark. During this time, it is more of a psychological battle than it is with physical because of the fear of tearing your acl. The way to conquer this is by constantly rehabbing your knee and using a sports specific regimen so that you build the confidence you had before your knee injury.