The knee joint is an important weight-bearing joint in our body. Hence, it is important for this joint to be stable. The stability of the knee joint depends on tough fibrous bands known as ligaments that connect bones to create the knee joint. One of the major ligaments that provides 90% of stability to the knee joint is known as the anterior cruciate ligament (ACL). The ACL keeps the shin bone in place and prevents it from moving too far forward and away from the knee and thigh bone. An ACL injury is the over-stretching or tearing of the ACL in the knee. The tear can be partial or complete.
ACL tears are the most common among all knee injuries, accounting for nearly half of all knee injuries. It has been found that nearly 60 people for every 100,000 people every year have a tear of their ACL.
If you are actively involved in sports, then you are more likely to acquire an ACL injury. It is often seen among football players, basketball players, baseball players, rugby players, skiers, tennis player and gymnasts. A 100-fold increase of an ACL injury is seen in college football players when compared to the general population. Women are more likely to tear their ACL as compared to men.
ACL injuries can also occur following motor vehicle accidents. If you jump and land on feet with your knees straight, there is a higher risk of your ACL getting torn.
Injuries to the ACL occur most often in sports or activities requiring sudden stops and turns. Coming to a quick stop, combined with a direction change while running, pivoting, landing from a jump, or overextending the knee joint overstretches the ACL causing it to tear. A blow to the side of the knee can also cause your ACL to tear.
A “popping” sound at the time of injury would give an indication that you have torn your ACL. You will experience knee pain and instability, especially when you try to put weight on the injured leg. You will most likely have difficulty walking. Knee swelling would develop within 6 hours of injury. It is advisable to seek immediate medical attention if you suspect an ACL tear. When the problem of instability persists, it is best to be examined by a doctor.
Your doctor will ask you how the injury ocurred. Your doctor may perform some physical tests, known as ligament stability tests, on your knee to see if you have an ACL tear. A Magnetic resonance imaging (MRI) may be ordered to determine the presence and degree of an ACL tear along with any injuries to other structures of the knee. A MRI will confirm an ACL tear.
If you suspect an acl injury, you should stop any activity and see your physician. If you are at home, raise the knee joint to a level above the heart and apply ice to the affected joint for fifteen to twenty minutes. Do this preferably three to four times a day. Take pain relieving drugs such as acetaminophen (paracetamol) and use a splint to keep the injured knee straight till you get medical aid. Do not move the injured knee joint.
Your doctor’s main goal to treat this injury is to reduce your pain, reduce swelling, and regain range of movement and strength of the knee joint. There are both non-surgical and surgical methods used to treat an ACL tear. Based on your age, lifestyle, involvement in sports, occupation, degree of knee instability and any other associated injuries the doctor will decide the mode of therapy.
If you are young and lead an active lifestyle, then surgery could possibly be offered. If you are elderly and less active, then you are unlikely to have surgery for an ACL tear.
To rest and protect your joint, knee braces would be used immediately. Gradual weight-bearing exercises may be advised by your physician after the initial ACL injury.
Surgery would include either repair or reconstruction of the torn ACL. In surgical repair, the torn ligament is stitched and reattached to the bone from where it was detached or avulsed. To reconstruct the torn ligament, a piece of healthy tendon, called an autograft, is “harvested” from another area in the leg. The torn ACL is removed and replaced with the graft. The tendon graft can also be taken from a dead person (cadaver) as this is then termed as allograft.
After surgery, physical activity will be limited, and crutches have to be used to help you walk. A full-leg brace has to be worn for 4 to 6 weeks, depending on the severity of the injury.
Most people do well after ACL reconstruction and have no major complications. Recovery from surgery may take 6 to 12 months. The rehabilitation program following ACL reconstruction is important and has a significant impact on the outcome of the knee. This procedure helps to restore range of motion, regains strength in the knee, and reduces pain and swelling in the knee joint.
PRP Treatment for ACL Tear
The ACL is one of four major ligaments in the knee. Without it, the knee lacks stability. While some people choose to forgo surgical repair of the ligament, many people won’t, especially those who have lead an active lifestyle in the past and wants to continue to do so. A tear in the anterior cruciate ligament (ACL) is generally reconstructed rather than repaired. This is because repairs of the ACL have high failure rates. In fact, the non-union rate has been calculated as high as 90%.
Those who choose not to have their ACL surgically repaired have other options available to them. Physical therapy and rehabilitation are amongst the most oft utilized. Though they will not return a person’s knee to its previous state, they can increase its stability and improve it enough so that its new state is sufficient enough for certain groups. A non-surgical repair is generally good enough for children (because their growth plates are still open), those with no additional tears, individuals that only engage in light, manual work and people who lead sedentary lifestyles. Rehabilitation and physical therapy won’t be sufficient for athletes and those who perform strenuous manual labor on a regular basis.
PRP (Platelet Rich Plasma) therapy is considered a breakthrough therapy for soft tissue injuries, i.e., muscles and ligaments. Because it has proven to be effective in this regard, there has been some discussion about whether or not it is suitable for treating ACL tears. Subsequent studies have been funded in an effort to determine the aforementioned.
PRP therapy involves using a patient’s own blood to treat whatever injury ails them. A small amount of blood is taken from the patient and placed in a centrifuge, where its’ components are separated. The platelets, which contain growth factors that help speed up the healing process, are extracted. The platelets are then injected into the injured part of the body.
PRP therapy has not yet been proven to be a suitable form of treatment for ACL tears. Studies have shown that it is difficult to keep the platelets in the knee cavity because they are in liquid form. PRP tends to work best in enclosed spaces, where the liquid is more likely to stay put. Researchers have attempted to use substances, such as collagen, PPR gel and thrombin, to thicken the liquid so that it stays in the intended spot. However, these attempts have largely been unsuccessful.
Early failures do not mean that there is no future for PRP therapy and ACL repair. While, it has not yet proven sufficient for ACL repair in lieu of surgery, it may be very helpful post-surgery. A complete return from an ACL reconstruction surgery typically takes between five and seven months. PRP may be able to shorten a patient’s recovery time.
Individuals that opt for PRP therapy for an ACL tear should be prepared to pay between $500 and $1500 per injection. Most insurance companies will not pay for PRP therapy because it is considered to be a semi-experimental procedure. Individuals unable to pay for PRP therapy, out-of-pocket, should ask their doctor about payment options available to them. Some doctors may accept installment payments.
PRP Related Questions To Ask Your Doctor
- What exactly can PRP therapy do for my ACL tear?
- Why should I consider PRP therapy?
- Have you ever used PRP therapy for an ACL tear?
- How long have you been performing PRP therapy?
- Do you accept installment payments?
ACL tears do not heal on their own. Some people are able to lead a normal life with torn ACL; however many often complain that their knee is unstable and may “buckle” or “give out” with physical activity. A person with a torn ACL and significant functional instability has a high risk of developing secondary knee damage. ACL tears, if left untreated, may also lead to early arthritis in the affected knee.
The prognosis for a partially torn ACL is often favorable, with the recovery and rehabilitation period usually lasting three months. ACL reconstruction is a highly successful operation. It has been observed that 90-95% of people can be expected to return to full sports participation within 6 months. With aggressive rehabilitation, athletes can return to sports once their reconstructed knee demonstrates strength and balance equal to their uninjured knee. This generally occurs within 6 to 12 months, depending upon the sport and the person’s dedication to the rehabilitation program.
An ACL injury can be prevented by use of prevention programs that are usually tailored to a particular sport. Use proper techniques when playing sports or exercising. Neuromuscular training is used to prevent ACL tears. This training teaches athletes how to land from a jumping position, pivot side-to-side, and move the knee without placing as much force on the ACL.
Other Questions to ask your doctor at your first doctor visit
- How can my ACL injury be confirmed? Are there any tests that I have to undergo?
- Is my condition temporary or will it cause lifelong disability?
- What treatment do you suggest?
- Will I need to undergo surgery?
- What would happen if I do not opt for surgery?
- Will I need to undergo rehabilitation and for how long?
- What will the treatment cost, and will my insurance cover the medications, surgery and rehabilitation?
- Will I be able to get back to sports?
- How can I prevent this injury from recurring?