The anterior cruciate ligament (ACL) is one of the most commonly injured components of the
knee. Surgery for this type of injury involves either reconstructing or repairing the ACL.
This surgery can be performed through either open surgery (large incisions) or minimally
invasive arthroscopic surgery (small incisions). According to the American Academy
Orthopaedic Surgeons (AAOS), ACL injuries occur approximately 200,000 times annually, and
100,000 ACL reconstruction procedures are performed each year.
Anatomy Of The Knee
The knee joint is a structure formed by the femur, tibia and the patella. The ACL is one of
the four main ligaments within the knee that connects the femur to the tibia, providing
stability to the knee. The other three ligaments are the medial collateral (MCL), posterior
cruciate (PCL), and lateral collateral (LCL). The meniscus, a cartilage covering the
weight-bearing surface of the knee, acts as a shock absorber to reduce the stresses on the
Symptoms Of An ACL Tear
When a patient experiences an ACL tear, a “pop” sound will most likely occur, and the knee
will lose stability. In the hours following the tear, the knee will experience pain and
swelling. Other common symptoms patients experience include:
- Loss of strength
- Limited function
- Limited range of motion
- Inability to apply pressure
Causes Of ACL Injuries
Generally, the incidence of an ACL injury is higher for people who participate in high-risk
sports, such as skiing, soccer, basketball and football; however, this type of injury can
happen to any patient. Additionally, an ACL injury usually occurs in combination with damage
to the articular cartilage, meniscus, and other ligaments too.
The AAOS estimates that 70 percent of ACL injuries will happen through non-contact mechanics
and 30 percent from direct contact with another object. The most common causes associate
with this type of injury include:
- Deceleration coupled with cutting maneuvers
- Pivoting or sidestepping maneuvers
- Out-of-control play
- Awkward landings
Immediately after the injury, the knee often feels unstable, and the patient will experience
pain and swelling in the joint. After a couple of hours, the patient will have a large
amount of swelling, loss of full range of motion, and pain or tenderness.
Treatment Options For ACL Reconstruction
Ligaments do not have the ability to heal on their own because they do not benefit from a
direct blood supply. Depending on the severity of the tear and the activity level of the
patient, the orthopaedic surgeon will first suggest non-surgical procedures, such as
medications, physical therapy and rest. If that fails to alleviate pain, the orthopaedic
surgeon may suggest surgical intervention. If surgery is recommended, the torn ligament is
reconstructed by a process called autograft, which involves a small part of the ligament
from elsewhere in the body being used to bride the gap between the torn sides of the damaged
Recovery & Rehabilitation
The goals of rehabilitation of ACL reconstruction include reducing knee swelling, regaining
range of motion of the knee, strengthening the muscles, and maintaining mobility of the
kneecap to prevent other pain problems.
Physical therapy is crucial to the success of an ACL surgery, and the orthopaedic surgeon
will recommend a specific, well-planned program to make sure the therapy is done properly.
The patient may return to sports when there is no longer pain or swelling, and the full range
of motion has been achieved.
ACL Reconstruction In New York City
Dr. Haar is a knee arthroscopy
specialist, and has extensive experience with sports injuries, such as ACL tears,
and he performs state-of-the-art treatment for all types of musculoskeletal disorders. Dr.
Haar has an in-office outpatient surgical facility in
City, which is fully accredited by the American Association for Accreditation of
Ambulatory Surgery Facilities. To make an appointment with Dr. Haar, please call the New
York City office at (212) 876-7000.