ACL Tear Treatment Options
The treatment options available for an ACL tear will depend on the severity of the tear, any associated injuries, the age of the patient, the patient’s activity level and overall health, and the patient’s goals. Dr. Petrigliano is an expert at treating ACL injuries and carefully evaluates each of his patients to determine the best treatment options for them.
ACL tears can be treated nonoperatively with physical therapy. However, when there is persistent knee instability after nonsurgical treatment or when the patient is an athlete who desires to return to physically demanding activities, surgical reconstruction is recommended.
What is nonoperative (nonsurgical) treatment?
Nonoperative treatment involves:
- PRICE: protection with bracing, rest, icing, compression, and elevation to reduce pain and swelling
- Pain management with over-the-counter anti-inflammatory and pain medications (NSAIDS)
- Non-weight bearing, using crutches
- Activity modification
- A comprehensive rehabilitation program to strengthen and stabilize the knee. Rehabilitation is also valuable to prepare the patient for surgery by improving strength, coordination and mobility.
Nonsurgical treatment is an option for patients with physically low-demand lifestyles and those who do not intend to return to pivoting sports. For recreational athletes with an ACL tear, initial treatment may be nonoperative with physical therapy or surgery with rehabilitation.
Older patients who desire to return to high-functioning athletic activities may be good candidates for surgical reconstruction which can provide good knee stability and good functional outcomes. Importantly, studies report that the outcomes of ACL reconstruction in older athletes are similar to those in younger patients.
About 50% of patients who choose nonsurgical treatment later choose surgery. Moreover, studies report that nonoperative treatment of ACL injuries failed in 60% of patients who were young or participated in high impact sports.
What is ACL reconstruction?
ACL reconstruction is the gold standard treatment to replace a torn ACL. About 130,000 arthroscopic ACL reconstructions are performed annually. Most are performed on an outpatient basis and with success rates as high as 95%.
Most young, active patients elect to proceed with surgical reconstruction because nonsurgical treatment is associated with an unacceptably high risk of recurrent instability, secondary tears of the meniscus, osteoarthritis and the risk of need for a future total knee replacement.
Who is a good candidate for ACL reconstruction?
- young adult athletes who desire to return to sport
- patients with more than one injured ligament
- patients who also have a torn meniscus. 50% of ACL tears occur with a torn meniscus
- patients whose instability remains after nonsurgical treatment
Dr. Petrigliano may recommend reconstruction to reduce the risk of injury to the cartilage and meniscus, and to facilitate a return to sport and activities. Successful post-operative rehabilitation is essential to recovery.
Timing of ACL reconstruction depends on multiple factors. Importantly, restoration of knee range of motion and quadriceps control are important goals before ACL reconstruction regardless of age. The advantages of early ACL reconstruction include shorter time from injury to surgery which reduces the risk of scarring, and potential reduction in meniscal injuries.
Whether to pursue surgical treatment depends on the type and severity of the injury, the patient’s age, activity level preinjury, occupation, functional status and associated injuries, if any. Young and active patients usually choose operative treatment to return to play. However, patients with significant knee instability or damage to multiple knee structures may opt for surgical reconstruction.
What happens during ACL reconstruction?
ACL reconstruction surgery is minimally invasive arthroscopic surgery that involves the use of a tissue graft to replace the damaged ACL. The graft may be retrieved from another part of the patient’s body (autograft) or donor tendon (allograft). The damaged ACL is removed and replaced with the graft. The graft is secured to the bones with screws and other devices.
The key to successful reconstruction is the ability of the graft to integrate into the bone.
To facilitate the growth of new tissue, Dr. Petrigliano may employ biological augmentation a regenerative technique to enhance healing and improve outcomes.
Return to play or full activity is estimated to take 6-12 months after reconstruction with significant progress in physical therapy and the type of sport being important factors. Early return to activity creates a risk of re-injury and graft failure.
Why choose Dr. Petrigliano?
Dr. Frank Petrigliano is an orthopaedic surgeon who was fellowship trained in sports medicine and shoulder surgery at the prestigious Hospital for Special Surgery where he provided care to athletes of all ages. He currently serves as the head team physician for the LA Kings hockey team and associate team physician for USC Athletics. Dr. Petrigliano is a renowned orthopaedic surgeon and researcher who employs state of the art treatments and procedures to get you back to your active life and back to sport. He always treats his patients with compassion and respect. Dr. Petrigliano is located in El Segundo California, and serves greater Los Angeles, Beverly Hills, the South Bay, and the Santa Clarita Valley. Contact Dr. Petrigliano to schedule a consultation today.
At a Glance
Dr. Frank Petrigliano
- Associate Professor of Orthopaedic Surgery at USC
- Chief of the Epstein Family Center for Sports Medicine
- Team physician for the LA Kings and USC Athletics
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