ACL Tear Treatment Options

Physical Therapy

This therapeutic approach focuses on strength, flexibility, balance, and proprioception. After an ACL injury, the knee often swells and can stiffen, while the surrounding muscles might weaken from disuse. Often physical therapy is the first treatment prescribed even for people who are undergoing ACL reconstruction surgery to ensure they have optimal motion and strength heading into surgery. However, it is also a viable treatment option for some patients on its own.

Initial Stage: The early focus of physical therapy is to reduce swelling, restore full passive extension comparable to the uninjured knee, and regain quadriceps control. Pain management techniques such as icing, compression, and elevation are used.

Intermediate Stage: The next phase emphasizes the recovery of range of motion, proprioceptive and balance training, and increasing muscular strength and endurance. Weight-bearing exercises, cycling, and swimming are commonly recommended during this stage.

Advanced Stage: The final stage involves a gradual return to sport-specific training and exercises. Plyometric exercises (jump training), agility drills, and balance activities become key.

Therapy duration can span from several weeks to months, depending on the individual’s progress and goals. This treatment requires a considerable time commitment and active patient involvement.

Physical therapy plays a vital role in the nonoperative management of ACL tears. Typically, therapy involves a combination of strengthening exercises, flexibility work, balance training, and education on safe movement patterns to prevent further injury. A physical therapist will design a program tailored to your needs and abilities.

Bracing

Braces provide passive support to the knee, especially in movements that may put the ACL at risk. They are designed to limit the amount of rotation and forward movement of the shin bone to protect the ACL.

Functional Braces: Functional braces are intended to be worn during sports or other physical activities to protect the ACL as it heals and to prevent an ACL tear. These braces are custom-fit for each person to ensure that they provide the correct amount of support.

Rehabilitative Braces: These braces are often prescribed immediately after an ACL tear or post ACL surgery. They are designed to limit the movement of the knee, allowing the ACL to rest and heal. The brace can usually be adjusted as the knee heals and the range of movement increases.

Bracing should not replace other modes of treatment, such as physical therapy, but serve as an adjunct to comprehensive nonoperative or postoperative care.

Injections

Injections are primarily used to manage symptoms of pain and inflammation associated with ACL injuries. They are usually done under ultrasound guidance to ensure accurate delivery of the medication.

Corticosteroids: These potent anti-inflammatory medications can provide rapid relief of pain and swelling from ACL tears. However, they are generally used sparingly due to potential adverse effects like cartilage damage and tendon weakening.

Hyaluronic Acid: These injections aim to restore the normal lubricating properties of the knee joint fluid. They can help decrease pain and improve knee function, especially in early osteoarthritis cases, but won’t repair the torn ACL.

Platelet-Rich Plasma (PRP): PRP injections involve extracting a small amount of the patient’s blood, concentrating the platelets using a centrifuge, and re-injecting it into the knee. These platelets release growth factors that can stimulate tissue repair and potentially reduce inflammation. However, they will not heal an ACL tear and the knee will remain unstable.

It’s worth noting that nonoperative treatments are most effective when the individual actively participates in the therapy process. Diligence and consistency in following the prescribed treatments are key for successful recovery.

Arthroscopic ACL Reconstruction

This surgery is often recommended for active individuals, athletes, or those with jobs that require knee stability and have an ACL tear. It’s also recommended for individuals who have instability symptoms despite nonoperative treatment. The choice of graft largely depends on individual factors.

ACL Repair Surgery

ACL repair may be an option in specific circumstances such as a tear near the femur with good tissue quality, often in conjunction with a repairable meniscus tear. It may also be suitable for pediatric or adolescent patients where the growth plates are still open, avoiding potential growth disturbances caused by traditional ACL reconstruction. However, it’s not commonly performed due to historically high failure rates compared to reconstruction.

Bridge-Enhanced ACL Repair (BEAR)

This procedure, while still under investigation, shows promise for certain patients. It might be an excellent option for older individuals with a proximal tear, as it preserves the native ACL tissue and may decrease the risk of developing osteoarthritis. However, its effectiveness and safety are still being studied.

The decision to have ACL surgery depends on the individual’s lifestyle and activity level, the extent of the injury, and the desired outcome. Young, active individuals, especially athletes who want to return to their sports, often opt for surgery. Even some older, active adults might choose surgery to maintain their lifestyle. Regarding timing, there’s no rush to operate immediately after an ACL tear unless there are other severe injuries to the knee. In order to prevent postoperative stiffness, Dr. Mayo often prefers to wait a few weeks until the swelling has decreased and the range of motion is improved.