Treatment for ACL Tear: Surgery, Post Operative Rehab, Recovery
What is the Treatment for ACL Tear?
First Step of Treatment for ACL Tear
First, it is important to consult with a sports doctor, if you have any doubt about ACL tear. Keep away from playing sports or any athletic activities till you are sure about it. The expert may refer an MRI for your knee to verify the findings. Sometimes, the test might reveal other injury, if any.
ACL tear can be treated initially by:
- Lifting up leg above the heart level.
- Applying ice on the injured knee joint.
- Taking pain soothers such as ibuprofen (Non-Steroidal Anti-Inflammatory Drugs or NSAIDs)
The patient/ injured person with ACL tear may also need:
- Crutches to ambulate till the betterment of pain and the swelling associated with ACL tear.
- Physical therapy (PT) for ACL tear may be warranted for the improvement of the joint motion and boosting of the strength of the leg.
- Reconstructive surgery of ACL (If there is a complete tear of the ACL).
Sometimes, people are found to function normally with ACL tear. Though, a good number people complain about the unstable knee and give up on daily activities or sports. If left unrepaired, ACL tear can lead to further damage of the knee joint.
What You Must Not Do If You Have an ACL Tear
Never do the following things in order to reduce the worsening of ACL Tear:
- Never move the knee with serious injury.
- Use a support in order to maintain the position of the knee straight till you see the doctor.
- Never take any venture to play games and sports till you are completely treated for ACL Tear.
The people with any kind of knee injury, let alone the serious injuries, seek for evaluation through various imaging tests, such as X-rays. If, after the infliction of the injury, the foot becomes blue and cool, it can be the symptoms of knee dislocation and injury to the blood vessels. This condition needs emergency care from professional experts.
Treatment Management of ACL Tear
Treatment Management of ACL tear is based on the factors like age of the patient, the extent and severity of the injury and functional disability and the physical and functional requirements of the patient.
ACL tear is more common in adults; however, if in case of children, as the bone growth still continues, it is mostly treated conservatively. It can occur in adolescents, where the problem of bone maturity still persists. In such cases, also a conservative approach with rehabilitation is usually adopted.
Non-Surgical Treatment For ACL Tear Is Suggested In Case Of Patients With
- Partial tear and no instability.
- Complete tears but no instability during low impact sports.
- Sedentary life or light manual work.
What Surgical Treatments are Available for ACL Tear?
If the conventional treatment is not working and surgery is mandatory for ACL tear, then instead of repairing the ACL ligament, doctors usually go with ligament reconstruction surgery. This is a minimal invasive surgery which uses an arthroscope.
Multiple techniques can be used for treating ACL tear and the patient is recommended the best option by the orthopedic specialist according to the patients' situation. (Considering the age, severity of the injury etc…) The ligament for the surgery can be taken from inelastic band near the patellar tendon. It may also be collected from the hamstring tendon in the back of the knee. Or, it can be donated by others. Every one of them has its benefits and drawbacks.
In an ACL tear, also parts of the knee joint can be damaged, these injuries can be treated at the same time while performing the ACL reconstruction surgery. The most important of them are ligaments and menisci (cartilage).
In case of children, instead of the connective tissues being torn, these can pull a piece of bone out sharply near the tibia. Surgery may be necessary in order to reattach the bony fragment, without ligament reconstruction.
The surgery in most cases is the best suggested option for the ACL tear patients in order to give them back their original activity level. But, the patients with a sedentary lifestyle or who do perform less physical work or who involve in just minimal activities like bicycling, running etc., non-surgical treatments are also reasonable options.
Usually the surgery cannot be done immediately after the injury; it is delayed for about 3 to 4 weeks, and sometimes more. During this time the initial bleeding and swelling get minimized, and the operation can be done successfully without any hitch.
Of all the members of the medical team, the professional physical therapists (PT's) play a major role because before and after the surgery for ACL tear, planning phase by phase is very important. Even after the ACL reconstruction surgery, often physical therapy (PT) and rehabilitation is required. The most important successful part of the surgery is an assurance to rehabilitate. The time before the surgery, a lot of patients are inspired to take "pre-hab" the damaged leg. In the incident of ACL tear, the quadriceps muscle gets weakened right away. In this step, it is very important to take care of the knee motion and strength.
In some patients with swelling and limited range of motion, it may cause problems in regaining movement after surgery. Some physical rehabilitation is often suggested before surgery in order to reduce post-surgical problems.
ACL reconstruction is performed by using graft either from other tendons from the patient's body (autograft) or from cadavers (allograft). The type is decided based on the patient condition and functional requirements.
Post-Operative Rehab and Recovery of ACL Tear
While proper wound management is essential for ACL tear, physical rehabilitation immediately after the surgery is very important for the success of ACL tear reconstruction surgery. Initially, the main aim is to reduce pain, swelling and discomfort. It begins with simple movements, elevation of knee, icing and other specific measures.
Sometimes, braces may be advised during recovery period. Crutches and exercise machines may be advised for partial weight bearing on the knee and improving range of motion for some period.
Rehabilitation Following ACL Tear Surgery
Rehabilitation usually begins immediately after surgery and may take around 6 months with slow progression of activities and exercises as the fitness levels improve. A trained physical therapist helps to plan specific activities based on the patient condition. Physical rehabilitation for ACL tear mainly aims at:
- Reducing swelling, pain and discomfort,
- Preventing anterior knee pain by maintaining knee stability,
- Improving range of motion and regaining full range
- Improving muscle strength
ACL Tear Recovery Following Surgery
It is important that the patient follows the given advice and maintains a consistent positive effort towards recovery from ACL tear following surgery.
It takes 6 to 9 months to recover completely and to go back to full activity following ACL tear:
- In the first 2-3 weeks, the physical therapy (PT) aims at increasing the power of knee motion in a controlled way to aid in early recovery. The grafting of cruciate ligament needs time to repair, so excessive bending or flexing is warned to avoid the graft to tear. The objective of the first 2 weeks is straightening of the knee as well as bending of the knee at 90 degrees.
- During the 3-6 weeks period following surgery for ACL tear, the aim is to get back the full activity of the knee. Some of the exercises like Strengthening, bicycling or climbing stairs are often considered helpful for early recovery.
- For the other subsequent months, the aim is to enhance the agility and the strength of knee motion. The progress is closely monitored by the surgeon and physical therapist, again to protect the reconstructed knee and to push the patient to the goal of full recovery.
The protective knee brace is used during the rehabilitation process for the protection of ACL graft from any complications that may arise due to stress. The use of protective brace may be sustained after the healing of ACL tear if needed. Especially, in the event of sports activity, there might be possibility of re-injury. The usage of the brace prevents this possibility.