Dr. Darryl Richmond, PT, DPT, MSc
Over the past 3-4 decades there has been much in the sports world about the ACL. Typically, we see one of our favorite professional or collegiate athletes have a season ending injury due to rupturing this critical structure of the knee. Famous names such as Derrick Rose or Adrian Peterson may come to mind when we hear about the extreme cases. However, there are many names that will go unnoticed to the public when it comes to these types of injuries. Studies have shown that the rate of ACL injuries is increasing as sports participation increases. About 1/3 of pre teen and teen football & soccer players will at some point of their young career sustain an ACL tear.
What exactly is the ACL?
The Anterior Cruciate Ligament (ACL) is a deep structure inside of the knee joint that is responsible for preventing anterior sheering forces of the tibia on the femur.
Common Types of ACL injuries:
Sprains, partial tears, and complete tears.
Grade I Sprain. The ligament has been stretched beyond comfort, causing swelling but the knee joint is still highly functional.
Grade II Sprain. Often called a partial tear of the ACL. The ligament has been stretched past its allowed degrees of freedom resulting in a halfway tear.
Grade III Sprain. Most commonly named “Complete Tears” of the ligament.
Note: Grade II Sprains are least common. The majority of ACL sprains are Grade 3 complete or near complete tears. ACL tears are often diagnosed with MRI imaging.
ACL injuries during Sporting Events
Non Contact ACL injuries
Changing direction too quickly
Deceleration from running
Stopping suddenly
Contact ACL injuries
Direct contact or collision, such as a direct blow to the knee, such as a football tackle.
(Adrian Peterson Contact ACL injury) (Derrick Rose Non contact ACL injury)
Treatment for ACL Injuries
Nonsurgical Treatment
A grade I sprain will likely not require surgery and is likely to be treated conservatively by a doctor of physical therapy. Grade II & III or torn ACL’s will not heal without surgery.
Surgical Treatment
ACL reconstruction or replacing the ligament with a tissue graft is considered the gold standard for repairing the ligament by an orthopedic surgeon. Most surgeries are performed with an arthroscope using small incisions. This approach is less invasive, reduces swelling, less time hospitalized, and allows for quicker recovery time.
Rehabilitation & Returning to Sport
Physical therapy plays a critical role in both surgical or non surgical treatment. Doctors of physical therapy are highly skilled professionals who specialize in orthopedic rehabilitation.These professionals work closely with orthopedic surgeons to established research based protocols to safely rehabilitate and return the athlete back to sport. Following surgery, physical therapy focuses on controlling swelling, improving range of motion, and regaining strength.Although different surgeons and physical therapists will have slightly different protocols, the goal for all forms of post-operative ACL rehabilitation is the same: to return the athlete to a normal and complete level of function in as short a time possible without compromising the integrity of the surgically reconstructed knee.
In order to achieve this goal, therapy is typically broken down into stages (or phases) of activity, with goals for each stage. Here is an example of a standard four-phase protocol:
• Phase I — First 2 weeks after surgery
• Phase II – 2- 6 weeks after surgery
• Phase III – 6 weeks to 3-4 months after surgery
• Phase IV – 4-6 months after surgery
• No soft tissue or range of motion complaints
• Surgeon must clear the patient to resume full activities
• The goal is safe return to sports
• Education of patient about possible limitations
• Maintenance of strength, endurance, and proprioception
• Functional bracing may be recommended by some surgeons for the first one to two years after surgery for psychological confidence.
• Phase V - return to sport, usually at six months
• Patient must meet all the above criteria for return to sports
• Sports physical therapist will transition rehabilitation to sport specific intervention.
(Reference: Rehab timeline expectations. EmoryHealthcare. https://www.emoryhealthcare.org/centers-programs/acl-program/recovery/rehab-timeline.html.)
Confidence After Rehabilitation
Returning back to 100% participation following major surgery and months of rehabilitation can be tough. The injury is always in the back of your mind and the fear of re-injury can affect both confidence and performance. A good majority of the doubt the athlete has within him/herself is derived from not being challenged enough throughout the rehabilitation process. Choosing the right physical therapist is very important. Athletes should look for a doctor of physical therapy who has a proven track record in working with athletes for their specific injury. We at Motion Rx Sports Medicine & Physical Therapy have years of experience in returning both school-aged and professional athletes back to their sport with full confidence. Choose the right physical therapist, choose Motion Rx to get you back in the game. Never lose hope!
(Rushed for 2,097 yards the year following a season ending ACL & MCL tear)
(Derrick Rose after multiple ACL surgeries scores 50 points)