Blog Post 3: Dunphy-ACL Injuries

 What Heals an ACL Injury

   For an ACL to be fully healed, it takes a long-term process including surgery, rehabilitation and medication.  However, there are few medications out there that have the ability to relieve of such a painful injury, therefore rehab is more reliable when relieving of ACL pain.

Based on information addressed by OrthoInfo in their article “Repairing of the ACL”(http://www.OrthoInfo/utm_campaign=cdhproton_fy15&utm_source=webmd&utm_medium=300x250&utm_content=banner&utm_term=target), approximately 50 percent of ACL injuries occur in combination with damage to the meniscus cartilage, or other ligaments. Additionally, patients may have bruises of the bone beneath the cartilage surface.  Simply put it, an ACL injury is one that affects multiple areas inside the knee.  

The simple route would be surgery.  The surgery usually begins with an examination of the patient's knee while the patient is relaxed due the effects of anesthesia. This final examination is used to verify that the ACL is torn and also to check for looseness of other knee ligaments that may need to be repaired during surgery or addressed postoperatively. If the physical exam strongly suggests the ACL is torn, the selected tendon is harvested (for an autograft) or thawed (for an allograft) and the graft is prepared to the correct size for the patient.  After the graft has been prepared, the surgeon places an arthroscope into the joint. Small (one-centimeter) incisions called portals are made in the front of the knee to insert the arthroscope and instruments and the surgeon examines the condition of the knee. Meniscus and cartilage injuries are trimmed or repaired and the torn ACL stump is then removed.

In terms of rehabilitation, an ACL won’t be fully healed, but the patient will have the ability to stabilize it and be relieved of the pain.  The goals for rehabilitation of ACL reconstruction include reducing knee swelling, maintaining mobility of the kneecap to prevent anterior knee pain problems, regaining full range of motion of the knee, as well as strengthening the quadriceps and hamstring muscles.  The patient may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored.  The patient's sense of balance and control of the leg must also be restored through exercises designed to improve neuromuscular control.  This usually takes four to six months. The use of a functional brace when returning to sports is ideally not needed after a successful ACL reconstruction, but some patients may feel a greater sense of security by wearing one.

The goals for rehabilitation of ACL reconstruction include reducing knee swelling, maintaining mobility of the kneecap to prevent anterior knee pain problems, regaining full range of motion of the knee, as well as strengthening the quadriceps and hamstring muscles.

The patient may return to sports when there is no longer pain or swelling, when full knee range of motion has been achieved, and when muscle strength, endurance and functional use of the leg have been fully restored.

The patient's sense of balance and control of the leg must also be restored through exercises designed to improve neuromuscular control.  This usually takes four to six months. The use of a functional brace when returning to sports is ideally not needed after a successful ACL reconstruction, but some patients may feel a greater sense of security by wearing one. -So

Finally, though there are few medications out there that relieve the pain of an ACL, medications such as Tylenol, nonsteroidal antiflammatory drugs (NSAIDS) such as ibuprofen and naproxen.  

All in all, repairing an ACL injury requires a long process, and there are mutliple solutions as to do so, but it can never be fully recovered.  Further research needs to be done in order for doctors/physicians/therapists to know how to fully-repair and fully-heal a torn ACL.

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