A Closer Look: Fixing an ACL
ACL. It’s a familiar acronym that crosses most people’s mental desks. Arriving from many disparate directions, but almost always referencing the same sore subject. Injury. However, earning this lousy luck comes in many flavors on and off the field. This article will try to summarize how these injuries come to be and explore the methods behind mending them. Let’s tear into this.
Knees are complicated as joints go. They’re webs of bone, cartilage, and muscle all working together to make motion possible. Within this complex mechanism is the anterior cruciate ligament or ACL. One of the four ligaments helping to stabilize the knee.¹ Working in harmony, these strands of fibrous connective tissue create a dance of tension and compression with every motion. The ACL’s role in this performance is to prevent the tibia from slipping too far forward.¹ However, sometimes forces exceeding a ligament’s limits come along. And like any cable, the ACL can fray or even snap altogether.
There are typically two ways this can happen. Rotating the knee too quickly or applying a sudden strong force.² Often these occur when someone tries pivoting toward a different direction or stopping abruptly.² So it shouldn’t be surprising why most people’s exposure to ACL injuries comes from sports like soccer or football. In them, knees are constantly under these sorts of pressures. But there are other venues for breaking a ligament. Car accidents and landing from a fall badly can exert these same sorts of forces.²
All of these sources can ultimately lead to damage. Per John Hopkins Medicine this damage falls into one of three grades called sprains.³
Grade One: The tendon has been over-stretched but still stabilizes the knee.
Grade Two: The ligament has torn somewhat, which destabilizes the joint.
Grade Three: The ACL rips in half or pulls one end out of its anchor in the bone. The ligament is no longer stabilizing the joint.
Additionally, injuries may result from tearing the ligament, but they’re beyond this article’s scope. To treat this damage ACL injury can be repaired either with or without surgery.
Nonsurgical treatment may be advisable if someone is elderly or their knee is still stable. Skipping surgery means this course begins a physical therapy regimen after swelling subsides.¹ Sometimes a brace is also provided to stabilize the joint during recovery.¹ Since no surgery is required, this process is significantly shorter at around three months.²
When the ligament is beyond mending, surgery can replace it. This process starts by finding a similar tissue known as a graft to take its place.¹ Tendons are selected not only to stand in for the ACL but also to minimize any side effects for the patient.⁴ Surgery affixes the donor tissue to both the femur and tibia. Now the first step to recovery has been taken. A lengthy process involving approximately eight to twelve months of exercise and rehabilitation.⁵
This article started with three letters, but as we’ve covered the ACL is much more than that. It’s a simple component in a wonderfully complicated assembly that lets us do so much. Yet one wrong move can break it. And breaking things is often much easier than mending them. After reading this article, perhaps you’ve gained some appreciation for this little strand of connective tissue.
Bibliography
1. American Academy of Orthopaedic Surgeons. Anterior Cruciate Ligament (ACL) Injuries — OrthoInfo — AAOS. Aaos.org. Published 2014. Accessed September 7, 2022.
https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/
2. PeerWell. ACL Tear: Symptoms, Recovery Time and Treatment. PeerWell. Published December 4, 2017. Accessed September 7, 2022. https://peerwell.co/blog/acl-tear-recovery-treatment-symptoms/
3. Johns Hopkins Medicine. Anterior Cruciate Ligament (ACL) Injury or Tear. John Hopkins Medicine. Published 2020. https://www.hopkinsmedicine.org/health/conditions-and-diseases/acl-injury-or-tear
4. admin. What You Need to Know About Grafts in ACL Surgery. Cary Orthopaedics. Published August 29, 2018. https://www.caryortho.com/need-know-grafts-acl-surgery/
5. Mayo Clinic. ACL reconstruction — Mayo Clinic. www.mayoclinic.org. Published March 6, 2021. https://www.mayoclinic.org/tests-procedures/acl-reconstruction/about/pac-20384598#:~:text=Results
