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ACL Injury: When Is Surgery Recommended?


ACL injuries are one of the most common knee injuries, with an incidence of 100,000 to 200,000 in the US every year. It is a common occurrence for many individuals, often leaving them wondering about the necessity of surgery.

Understanding the factors influencing the decision for surgical intervention is crucial for informed choices and effective recovery. 

In this comprehensive guide, we will delve into the nuances of ACL injuries, explore the scenarios where surgery is recommended, and discuss alternative paths for recovery.

What is an ACL injury?

An ACL injury refers to an injury to the anterior cruciate ligament, which is one of the major ligaments in the knee. The knee joint is stabilized by four main ligaments, and the ACL plays a crucial role in providing stability and controlling the movement of the knee. 

It runs diagonally in the middle of the knee, preventing the tibia (shinbone) from sliding out in front of the femur (thighbone).

ACL injuries often occur during activities that involve sudden stops, changes in direction, or direct impact on the knee. Sports such as soccer, basketball, football, and skiing are commonly associated with ACL injuries.

What are the signs and symptoms of an ACL injury?

The injury can range from a mild sprain to a complete ligament tear. Its symptoms can vary in severity, but typical indicators include the following:

  • Popping sound: Many people report hearing a popping or snapping sound at the time of injury.
  • Pain: Acute pain is often felt at the time of the injury. Pain may continue, ranging from mild to severe, depending on the extent of the injury.
  • Swelling: Swelling usually occurs within a few hours of the injury. The knee may become noticeably swollen and feel tender to the touch.
  • Loss of range of motion: Individuals may experience a limited range of motion in the knee.
  • Instability: The knee may feel unstable or give way, making it difficult to bear weight or participate in physical activities.
  • Difficulty walking: Walking may be challenging, and some people may develop a limp.
  • Bruising: Bruising around the knee or lower leg may develop.

It’s important to note that not everyone with an ACL injury will experience all of these symptoms, and the severity can vary.

Some people may not notice the symptoms immediately after the injury, but may become more apparent over time.

What are the non-surgical treatment options for ACL injuries?

If you suspect an ACL injury, it’s crucial to consult with an orthopedic doctor for a proper diagnosis and appropriate treatment. They may recommend imaging tests, such as an MRI, to assess the extent of the injury.

For less severe injuries, surgery is not the only path to recovery. Non-surgical alternatives such as physical therapy, rehabilitation programs, and lifestyle modifications can effectively treat the injury. 

When is surgery recommended?

Surgery for an ACL injury is typically recommended in specific scenarios where non-surgical interventions may not be sufficient to restore knee stability or prevent further complications. 

Most orthopedic doctors consider the severity of the injury, age, and activity level of the patient before deciding to go with a surgical approach.

Severity of the injury

The severity of the ACL injury is a primary determinant in the decision-making process. Minor sprains or partial tears might not necessitate surgery and could be managed through conservative measures. 

However, complete tears or significant damage to the ligament often lean towards surgical intervention.

Age and activity level

Age and activity level also play vital roles in the decision-making process. Young, active individuals often opt for surgery to regain full functionality and reduce the risk of future complications. 

On the other hand, older individuals or those with a more sedentary lifestyle may find non-surgical approaches sufficient. The goal is to tailor the treatment plan to the patient’s specific needs and circumstances.

What happens during an ACL reconstruction?

ACL reconstruction is a procedure aimed at repairing a torn or ruptured ACL in the knee. The surgery involves replacing the damaged ligament with a graft to restore stability and function to the knee joint. Here is an overview of what typically happens during ACL surgery:

  • ACL surgery is commonly performed under general anesthesia, which means the patient is unconscious and feels no pain during the procedure.
  • The surgeon decides on the type of graft to be used for the reconstruction. Common graft options include autografts (using the patient’s own tissue), such as the patellar tendon or hamstring tendons, or allografts (using donor tissue).
  • The surgeon makes small incisions around the knee to access the joint. In arthroscopic procedures, a tiny camera (arthroscope) is inserted through one incision to provide a clear view of the interior of the knee.
  • The selected graft is placed in the knee joint to replace the removed ACL. The graft is secured using screws, staples, or other fixation devices to anchor it in place.
  • Once the graft is securely in place, the surgeon closes the incisions with stitches or adhesive strips.

Following surgery, the patient is monitored in the recovery room. Physical therapy and rehabilitation play a crucial role in the postoperative phase, helping the patient regain strength, flexibility, and range of motion in the knee.

A structured rehabilitation program is initiated to guide the patient through the recovery process. This involves a gradual increase in activities, strengthening exercises, and functional training to restore normal knee function.

Where to find the best outpatient orthopedic clinic?

Raleigh Orthopaedic Surgery Center is both the largest and most modern ambulatory surgery facility in Eastern North Carolina to specialize exclusively in orthopaedics. Our patients receive outstanding patient satisfaction, superior clinical outcomes, and reduced costs. 

Experience personalized care that extends beyond the operating room. From preoperative consultations to postoperative follow-ups, our Raleigh orthopedic surgeons are dedicated to your well-being every step of the way.

Call Raleigh Orthopaedic Surgery Center at 919-719-3070 for more information.

The material contained on this site is for informational purposes only and DOES NOT CONSTITUTE THE PROVIDING OF MEDICAL ADVICE, and is not intended to be a substitute for independent professional medical judgment, advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified healthcare providers with any questions or concerns you may have regarding your health.