All About the ACL

ACL.  It's an acronym, but most people don't know what it stands for.

Oh, they know what it means.  They know that it is in the knee.  They know that if it is torn that the season is over.  They know that it rarely means good news.

The Anterior Cruciate Ligament is in the middle of the knee and is easily the most important stabilizer of the knee.  In other words, it is essential to holding the knee together.  You might be able to do some things without a good ACL but not many.

It crosses from front to back, attaching the lower leg bone (tibia) to the upper (femur). 

There is a PCL, or Posterior Cruciate Ligament, but it very rarely gets injured and even when it does, a lot of people can function normally without it.

Too often, it seems, I have had to deliver the bad news that the ACL had been injured.  And trust me, EVERY athlete knows that means bad news.   It's the injury they fear the most.

Before I go on, let me offer a few statistics.   Females have a lot more ACL injuries than males.  At a ratio of maybe 8-1.  Most of that is anatomy but part of it is that a lot of female athletes avoid strength training either until they are older or just avoid it altogether.  Or go about it all wrong.

There are roughly 100,000 ACL ruptures per year in this country, with a significant portion of those being athletes.   The tear occurs most often with a twisting or deceleration injury.  About 70% of all ACL injuries do not involve contact.

Football gets blamed for a lot of the ACL injuries but there is no sport that is immune.  And not playing something is unacceptable.   That leads to a sedentary lifestyle and that simply isn't an option if your health is important to you.

But there is good news.   Because of advances in orthopedic surgical techniques and rehabilitation, you will be healthy again one day.   Not today, but sooner than you think.

I will often see someone that has had surgical repair to their ACL within a few days of that surgery.   Your first thought might be "that's too soon," but I assure you it is not.   We know that early intervention means good results.  It might hurt a bit to move that knee (again, not nearly as much as you think) but in the hands of a skilled physical therapist, that movement will not only be essential to the rehabilitation process but will also rapidly help you to feel much better.

Most ACL rehabilitation programs are "criteria-based," which means that they are largely driven by the progress of the patient.   Basically, that just recognizes that some people heal quicker than others.   Still, there often can be no substitute for time so there are certain principles that we must all follow that are based on evidence.

At various times in the past couple of decades, there has been an attempt to return athletes to competitive sports as quickly as possible.  We now know that practice can be a big mistake.   It is far better to allow adequate healing while at the same time restoring things like motion, strength, balance, and agility.  It's going to take at least 4-6 months and there is really nothing you can do to shorten the rehab.

One of the most gratifying things that can happen in my profession is to be there when a young athlete gets back to their sport, especially that point when they realize that their knee is normal again.   If you were there when they first hurt that knee and can relate that heartbreak to the joy of return, it is especially sweet.