Of all knee ligaments, the anterior cruciate ligament, or ACL, is the most commonly injured. Occurring roughly 200,000 times per year in America, an ACL injury can be debilitating if it is not addressed promptly. At Plymouth Bay Orthopedic Associates in Plymouth, MA, we offer several methods for treating ACL injuries.
How You Can Recover From an ACL Injury
The appropriate treatment plan for recovering from an ACL injury depends on several factors, including the extent of the injury and how much time passed between the injury and diagnosis. In mild-to-moderate cases, physical therapy may be enough to recover from a tear. In severe cases, a corrective procedure is necessary.
Immediately after you injure your knee, your focus should be on minimizing swelling. To do this, use the RICE (rest, ice, compression, and elevation) method. Keep your weight off of your knee as much as you can. Apply ice to your knee as soon as possible. Go to the closest drug store and get a compression garment for your knee and elevate it above your heart.
Depending on the level of pain you are experiencing, you may also want to take a non-steroidal anti-inflammatory drug, such as ibuprofen. This will help with both the pain and swelling and mitigate your risk of bruising and disfigurement. Once you have taken these four or five steps, call us at PBOA in Plymouth, MA at (781) 934-2400 to book an appointment.
Besides immediate treatment, physical therapy is the most common way to recover from a stretched or torn ACL. This is because it can be used in mild cases of a mild-to-moderate stretch, moderate cases of partial tears, and severe cases of complete tears.
The stretches and exercises you perform will depend on several factors, including your age, the cause of the injury, the severity of the injury, and your physical fitness before your injury. Your lifestyle and fitness goals will also dictate the focus of your PT. For example, you may focus more on balance than a basketball player who needs to focus on explosive power.
Depending on the circumstance, a knee brace may be used in lieu of physical therapy or as part of a comprehensive treatment plan. Knee braces are usually used as a recovery tool if you have a mild-to-moderate ACL tear. However, it may also be used before reconstruction or in the first week after a reconstruction.
In the most severe cases, reconstruction is required to recover fully from a torn ACL. At Plymouth Bay Orthopedic Associates in Plymouth, MA, we offer several reconstruction options to meet any need.
Depending on the cause of your injury, you may need a patellar tendon autograft, hamstring tendon autograft, quadriceps tendon autograft, and allograft patellar tendon. If you have a severe ACL tear, we will determine after imaging tests the appropriate procedure to help you get your life back on track.
Types of ACL Injuries
According to the AAOS, or American Academy of Orthopaedic Surgeons, there are three types of ACL injuries. These types of injuries are indicative of the severity of the injury and will determine which treatment method is appropriate. These types are as follows:
Grade I ACL injuries are mild injuries that are characterized by microscopic tears. If you have a Grade I injury, the best way to recover is to undergo rehabilitative therapy. This usually consists of physical therapy and exercise. Sometimes, it will include a mobility aid, such as a knee brace, crutches, or another mobility aid.
Once the swelling and pain are under control, the focus of rehabilitative therapy shifts to strengthening your weakened knee muscles and restoring your range of motion. Such exercises may include heel raises, prone hamstring curls, bridges, and partial squats. However, weight-bearing exercises will only be implemented as your symptoms improve.
Grade II ACL injuries are moderate injuries characterized by a partial tear of the ACL. This, by far, is the rarest severity of ACL injuries. Usually, you have a Grade I injury (mild stretch) or a Grade III injury (complete tear). A partial ACL tear may be treated with a partial reconstruction of the ACL or a combination of non-invasive therapies.
Grade III ACL injuries are severe injuries characterized by a complete tear of the ACL. If you are an athlete or employed in a position that requires a lot of pivoting, climbing, or jumping, reconstruction is the appropriate “immediate” recovery method for you. After you have recovered from your reconstruction, you will need a year of intensive PT.
What to Expect During Recovery After Reconstruction
Everyone recovers from his or her reconstruction at a different rate. Generally, the slower and steadier you take your post-op recovery process, the better your final outcome will be. For example, your risk of re-tearing your ACL within two years of your initial injury is significantly less if you don’t incorporate jumping into your PT until four months rather than three months.
While we can’t give you a specific timeline regarding your post-op recovery process, we can give you a general idea based on decades of combined experience. In general, the first five to seven days after your reconstruction, you will be focused on resting your knee. After that, you may start physical therapy. You may need a cane for the first seven days.
When Your Life Will Return to Normal
Unfortunately, if you suffer from a Grade III ACL tear, it can take between six and nine months post-op to return to your former strength, flexibility, mobility, and range of motion. Roughly seven or eight days after your procedure, you will be advised to perform heel slides, quad sets and straight-leg raises, among others.
To ensure your recovery process is as smooth and quick as possible, you must not put weight on your knee too early. If you need to walk, you may be given a knee brace or cane. You must keep your heart rate and blood pressure within a healthy range for the first six weeks post-op. Then, you can start to increase the intensity of your exercises.
Signs of a Torn ACL
Often, the most immediate sign of an ACL injury is an audible “pop” at the moment the injury occurs. You may even be able to feel the popping. However, you can still have a torn ACL in the absence of these two common signs. Other common signs that you have torn your ACL include nearly instant swelling, feeling like your patellar bones are grinding, and severe pain.
Less immediate signs that you have torn your ACL include bruising around your knee, being physically unable to perform the activity you were performing when the injury occurred, and feeling unstable. However, the only way to know for sure if you have torn your ACL is to come in for a physical examination.
The Importance of an Early Diagnosis
Diagnosing your knee injury as soon as possible mitigates the risk of exacerbating the problem. In the case of a torn ACL, it’s very important that you limit the weight you put on your knee. If you put too much weight on your knee too soon, you drastically increase the odds that you will re-tear your ACL and you will extend the duration of your recovery process.
Unfortunately, the odds are already stacked against you. Roughly 34% of individuals who tear their ACL will re-tear their ACL within 24 months. As tempting as it can feel to rush back into your former activities, returning to your usual routine too aggressively will only prolong your discomfort, exacerbate your pain and worsen your condition.
Other Knee Ligament Injuries
Another reason you should quickly come in quickly for diagnostic tests is you may not have stretched or torn your ACL. In fact, knee pain brought on by a traumatic injury can be caused by one of four cruciate ligament injuries. Besides ACL injuries, there are also PCL (posterior cruciate ligament) injuries, MCL (medial collateral ligament) injuries, and LCL (lateral collateral ligament) injuries.
Risk Factors of a Torn ACL
While a torn ACL is a condition that usually plagues athletes, one of the most significant risk factors of a torn ACL is a lack of physical conditioning. Luckily, this risk can be mitigated by conditioning yourself slowly and steadily if you are out of shape. If you’re not sure where to start, ask your PCP for a referral to a licensed physical therapist.
For athletes, the most significant risk factor of tearing an ACL is using improper equipment. Examples of improper equipment include shoes that are too large or ski bindings that are too loose. Another fairly significant risk factor of an ACL tear is playing on artificial turf instead of grass. The riskiest sports are gymnastics, football, and downhill skiing.
Causes of an Injured ACL
Torn ACLs are caused by extreme stress placed on your knees. Activities that can cause this extreme stress include hyperextension, stopping or changing direction suddenly, landing in an awkward position and cutting. Mild injuries usually result in a stretched ACL. However, a tear may occur if you are a female or you have had a tear in the past two years.
Furthermore, certain exercises are likely to trigger an ACL stretch or tear. The most obvious triggers aren’t easily avoided if you play sports, such as jumping, pivoting, cutting, and stopping quickly. Exercises performed in the gym that often cause an ACL stretch or tear can be avoided more easily. If you’re in a high-risk category, avoid TKEs.
How to Prevent Future ACL Injuries
There is no way to prevent future ACL injuries entirely, but you can minimize risk factors by improving your flexibility and strength. However, you may still land on your knee wrong after jumping, pivot too quickly, slow down too quickly, or receive a blow to your leg while playing a sport.
If you play sports, there are further steps you can take to prevent future ACL injuries. For example, make sure you’re hydrated before you play and remain hydrated while you play. To prevent an overuse injury, take breaks when your body tells you that it needs rest. Finally, play only when you are wearing appropriate safety equipment.
Communicate With Your Physical Therapist
Conversations with your physical therapist shouldn’t be one-sided. Communicate with him or her exactly what happened at the moment of injury. Depending on what caused your ACL tear, you may focus on improving hamstring strength, quadriceps strength or core strength. If a strength imbalance caused your injury, yoga may be ideal for you.
Schedule Your Initial Consultation Today
If you think you’ve torn your ACL, acting quickly is crucial. A diagnosis of the type and extent of injury you have allows you to act quickly and recover quickly. To determine if you’re suffering from an ACL injury and identify the appropriate course of action, please contact us today at Plymouth Bay Orthopedic Associates in Plymouth, MA to book an appointment.