ACL Recovery & Rehabilitation
ACL stands for anterior cruciate ligament which is located in the side of the knee. Tears of the ACL can occur due to injury or weakened connective tissues. Reconstruction is preformed through minimally invasive arthroscopic surgery, and a tissue graft if used to repair the ACL. The patient will often need to perform exercises to lengthen the surrounding connective tissue that may have shortened post surgery. Wearing a dynamic splint for rehabilitation will lengthen and remodel the tissue to restore range of motion to allow you to return to daily activities. If you have had ACL reconstruction, you may want to consider wearing a Dynasplint® System to aid in your recovery process.
The anterior cruciate ligament, or ACL, attaches to the femur, or thigh bone, and the tibia, or shin bone. The ACL keeps the tibia from sliding forward and upward, and also helps maintain the stability of the leg during movement. Tears or sprains of the ACL are among the most common knee injuries for athletes and non-athletes alike. Most injuries occur as the result of overextending the knee or pivoting the lower leg too far inward, both of which place extreme strain on the physical components of the knee. While some ACL injuries occur as the result of regular motion during walking, running or other non-contact activities, many injuries occur during contact sports when the knee or lower leg is acted on by an outside force. Football, soccer, lacrosse and baseball players are especially prone to ACL tears or sprains, from planting the leg and pivoting.
Most ACL injuries occur as the result of specific motions, including:
- Rapid direction change during movement
- Sudden or abrupt stopping
- Slowing while running
- Landing improperly following a jump
- Direct impact, such as tackling
The severity of an ACL injury depends on four primary factors: the force of the action casing the injury; the position of the knee at the time of injury; the direction of the force causing the injury; and the extent of the pivot or overextension.
Nearly half of all individuals experiencing an ACL tear will hear or feel a “popping” noise or sensation at the time of injury, as well as pain, swelling and tenderness along the joint line. About 50 % of ACL injuries cause or occur along with injury to other structures in the knee, including the articular cartilage, meniscus, or other ligaments. Most individuals experiencing ACL tears will require surgery to repair the ligament and regain function of the knee.
All ACL injuries, including tears, are referred to as sprains, and are grouped into three classes, based on severity:
- Grade 1: In a grade 1 sprain, the ACL is mildly damaged, but is still able to keep the knee stable. Surgery usually is not necessary, but splints and supports are usually used to help the knee remain stable while the ACL is healing or being rehabilitated.
- Grade 2. Also referred to as a partial tear of the ACL, in a grade 2 sprain the ligament is significantly stretched and becomes loose. Grade 2 sprains are uncommon; most tears are complete or near complete.
- Grade 3. Also referred to as a complete tear of the ACL, in a grade 3 sprain the ligament is split into two pieces, resulting in instability of the joint. This grade often requires the most intensive ACL rehabilitation process.
For more minor injuries, bracing and physical therapy are usually adequate to restore function to the knee joint. But for more serious injuries, surgery will be required to repair the ligament.
Recovering from an ACL Injury
An ACL reconstruction is sometimes referred to, incorrectly, as an ACL repair. A torn anterior cruciate ligament cannot be "repaired", and must instead be reconstructed with a tissue graft. An autograft involves the medical grafting of bone or tissue from the patient's body including the hamstring and patellar tendon. An allograft, bone or tissue taken from a donor's (typically a cadaver) body, may be used in the surgery.
Most surgery for ACL injury is not performed until after initial inflammation is resolved; inflammation is more frequently associated with scarring and delays in healing when surgery is performed too soon following an injury.
Immediately following surgery, the patient may be instructed to wear a brace that will keep the leg in full extension. A continuous passive movement device (CPM) is often used several hours a day to work on flexion (bending) of the knee. ACL rehabilitation following surgery may take six months or more for more severe injuries. In addition to a course of physical therapy, patients may be prescribed the use of a dynamic splint to help regain full range of motion.