ACL Injury Specialist in San Antonio
How The ACL functions in the knee
The Anterior Cruciate Ligament (ACL) is a key component within the knee, connecting the femur (thighbone) to the tibia (shinbone). Situated deep within the knee, the ACL gets its name from its forward position relative to the Posterior Cruciate Ligament (PCL). The term "cruciate," meaning to cross, describes how the ACL intersects with the PCL, providing essential stability for the knee during dynamic actions such as cutting or pivoting, crucial for athletic performance.
Symptoms of an Acl Injury
Experiencing a "pop" or feeling the knee collapse is a frequent initial symptom of an ACL injury, though not everyone feels this pop. Typically, the knee swells significantly within hours of the injury, leading to restricted movement and considerable pain when walking.
As time passes, usually within a week or two, the swelling and limited mobility may start to subside, misleading some athletes into thinking the injury isn't severe due to the reduction in pain and swelling. However, this perception can be deceiving. Attempting to return to sports too soon can reveal the knee's instability, as it may buckle or give way under pressure. This instability often leads athletes to feel they cannot rely on their knee for support or execute pivoting movements effectively.
A Standard Treatment Approach for ACL Injuries
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When you visit Dr. Rush, the conversation will begin with your injury details, symptoms experienced, and any treatments received since the incident. Dr. Rush will inquire about your sports activities, past knee issues, and medical history to form a comprehensive understanding.
A thorough physical examination is pivotal. Often, Dr. Rush can identify an ACL tear through this exam. The ACL's role is to stabilize the lower leg, preventing it from shifting forward on the thigh bone. A common diagnostic test involves applying forward pressure on the lower leg to assess the ACL's integrity. It's also typical to find associated injuries to the knee's meniscus or collateral ligaments, such as the MCL, with 50-70% of ACL tear patients experiencing a concurrent meniscus injury.
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Initial diagnostics may include x-rays to detect swelling or fractures that accompany an ACL tear. These images are crucial, even though ligaments and menisci aren't visible, as they can reveal swelling and bone fractures near the knee. For younger patients, a specific focus on the growth plates is essential to determine the appropriate surgical approach.
An MRI is the next step if an ACL tear is suspected, offering detailed views of the ligament, meniscus, cartilage, and other knee structures.
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Managing swelling and pain early on is critical. The RICE method (Rest, Ice, Compression, and Elevation) is a proven approach. Ice packs, or even frozen peas or corn, applied with a barrier like a sock or towel, can significantly reduce swelling when used for 15-20 minutes every couple of hours during the first week.
Medications like Acetaminophen or NSAIDs such as Ibuprofen may be recommended. Movement and gentle exercises to regain motion, especially straightening the knee, are encouraged before considering surgery.
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While complete ACL tears necessitate surgery for healing, partial tears might be managed without surgery, using braces and physical therapy to restore function. Most ACL reconstructions are outpatient procedures using arthroscopy for minimal invasiveness. The choice of graft for reconstruction, whether from the patient's patellar, hamstring, or quadriceps tendon, depends on various factors, including age, sport, and specific needs.
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Post-operative care may involve crutches or a brace, with physical therapy playing a crucial role in recovery. The aim is to diminish swelling, improve flexibility and strength, and enhance balance to prevent future injuries. Rehabilitation often includes sport-specific exercises to prepare for a safe return to activities.
Returning to sports typically takes 8-12 months, with a series of tests to assess balance, strength, and mobility before clearance.
This comprehensive approach ensures patients receive tailored care for ACL injuries, from diagnosis through recovery, leveraging the latest in orthopedic treatment and rehabilitation techniques.
ACL Surgery Outcomes
ACL reconstruction surgery typically achieves excellent outcomes in stabilizing the knee, with 80-90% of patients successfully returning to their sports activities. However, there is a risk of the graft re-tearing, with extensive research indicating a re-rupture rate of 5-20%. This risk is particularly high among younger athletes engaged in sports requiring sudden changes in direction or pivoting movements. Consequently, it is crucial to await medical clearance from your doctor before resuming any sports to ensure the best possible outcome and minimize the risk of further injury.
FAQs about acl tears and surgery
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Women face a higher risk of ACL tears due to several factors, including anatomical differences like a narrower intercondylar notch in the knee. During athletic activities, women's knees tend to be more inward and straight upon landing, putting excessive stress on the ACL compared to a bent-knee, wider stance landing.
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Absolutely. Although a "pop" sensation is common in ACL tears, it's not universal. About 70% of patients report feeling it, meaning you could still have an ACL injury without this specific sensation.
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An MRI is often recommended if an ACL tear is suspected, as x-rays don't show ligaments. While a physical exam can suggest an ACL tear, an MRI confirms the diagnosis and checks for other potential injuries like meniscus or cartilage damage.
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After initial swelling subsides, many patients feel improvement. However, this doesn't mean the knee has fully healed. Without surgery, returning to sports might lead to instability or further injury since a complete tear leaves the knee unstable.
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Prevent further injury by avoiding sports and applying RICE (Rest, Ice, Compression, and Elevation) to manage swelling and pain until the doctor's evaluation.
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In young athletes with open growth plates, special surgical techniques are used to avoid damaging future growth. Options like hamstring, quadriceps tendon, or IT band grafts are preferred over bone-containing grafts.
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The choice between patellar tendon, hamstring tendon, and quadriceps tendon grafts depends on various factors, including the child's sport and knee history. Discuss with your surgeon to choose the best option.
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The duration varies; it could be a few days to a couple of weeks, extending to 6-8 weeks if a meniscus repair is involved.
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ACL reconstruction typically lasts 1 to 1.5 and is usually done on an outpatient basis, meaning no overnight hospital stay is needed.
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Yes, physical therapy is crucial for recovery, focusing on reducing swelling, improving range of motion, strengthening muscles, enhancing balance, and preventing future injuries.
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The timeline varies by sport and surgical details, but generally, athletes return to sports between 8 and 12 months post-surgery, following the surgeon's advice.
Meet Dr. Jeremy Rush
Dr. Jeremy K. Rush, MD, FAAP, is San Antonio's only orthopedic surgeon who is Dual-Fellowship Trained in pediatric orthopedic surgery and sports medicine. He specializes in arthroscopic surgery of the knee, shoulder, elbow, and ankle, as well as the treatment of fractures and other injuries in young athletes.
