ACL Injury Part 3: Treatment

Now that you know the mechanism of injury and function of the ACL and the risk factors along with ways to prevent and ACL injury, it's time to learn about how to treat an injury once sustained.

Treatment for an ACL injury will depend on the grade of the injury itself. Ligament injuries range from Grade 1-3.

Grade 1:minimal damage to ligament, no instability
Grade 2:partial tear, mild/moderate instability
Grade 3:complete rupture, very unstable

For a grade 1 sprain the mainstay of treatment will be to reduce inflammation and the PRICE method will be used along with the use of crutches in the acute/sub-acute face (3 days - 3 weeks) to reduce weight bearing through the knee. However, for more substantial injuries other options need to be explored.

Grade 2 and Grade 3 Injuries

Early Stages:

In the early stages of and ACL partial or complete tear the management is exactly the same as any ligament injury and focusing on getting the swelling down. Li At this point medical attention will be need and a discussion will be had about whether or not to have surgery.

Surgical Intervention:

More often than not - especially in athletes - ACL injuries will be surgical repaired. There are conflicting ideas of whether surgery is required. Studies have shown that there is no difference in the function of the knee 2-10 years after injury for those who had surgery vs those who had not. Other studies report that Early surgical intervention reduces the risk of meniscus damage.

If surgery is required then the ligament will either be repaired by stitching the ruptured ends together or completely reconstructed. Reconstructed ACLs can come from the individual (autograft) or a cadaver (allograft). Autograft reconstructions will typically use either the patellar tendon or hamstring tendon to make the ligament.

Pre-surgery Rehabilitation

If surgery is the treatment of choice the surgeon will likely give you a home exercise routine or refer you to physiotherapy to prepare for surgery. To prepare fo surgery strength and range of motion of the knee need to be maintained. A typical program will include something like: 

isometric quadriceps
heel slides
1/4 squats
stationary bike 
Straight Leg Raises

Post-surgery Rehabilitation

The best post-surgery rehabilitation can be debated. While certain things such as the use of ice, anti-inflammatories and pain killers are commonplace, the type of rehab is largely dependent on the surgeon's protocols. Some surgeons may only want you to do open chain exercises - such as sitting knee extension. Others may want just closed chain - such as 1/4 squats. I would imagine that most surgeons will use a mixture, or introduce open chain or closed chains at different times. Whatever their reasoning, it's important that the surgeons post-surgery protocol be followed by the injured person and the physical therapists. A typical post-surgical protocol may look similar to the one found here"

Non-Surgical Intervention

Not everyone will go down the surgical route for an ACL injury, and studies have shown that non-surgical intervention can be just as effective in the long-term as surgery, albeit there is controversy surrounding the matter. Indeed many people choose to forgo surgery and are living normal lives - such as my brother. Studies have shown that factors such as obesity, age, history of meniscal injury, and sex may play a part in the effectiveness of non-surgical intervention with regards to secondary osteoarthritis and knee instability.

Conservative management will be essential the same as a pre and post surgery protocol, but sans surgery. Again, hamstring strength will be a major focus because of it's function in preventing excess knee extension.

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