Knee Injuries And Your ACL

The anterior cruciate ligament (ACL) is one of the major ligaments in the knee that connects the femur and tibia. ACL sprains and tears are common, with 250,000 reported annually in the United States. These injuries often happen during sports because of sudden stops or changes in direction. The injury almost always leads to surgery, but some patients feel little to no pain despite apparent damage. An orthopedic surgeon can determine if ACL surgery is necessary based on the extent of the injury.

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Signs and symptoms

The most common symptom is a popping feeling or sound in the knee. A popping sound is almost always a sign of a tear. Most tears and sprains will also have pain, rapid swelling, loss of range of motion, and a sense of instability. Although these are common symptoms, there are cases when an ACL injury is relatively painless. There are even cases of athletes continuing to play games with a damaged ACL. Still, patients must be careful, as seeking immediate medical care is vital.

Diagnosing the injury

A doctor will perform a series of tests to determine the extent of the damage. These tests can give some insight into why the knee is pain-free. First, the doctor will perform a physical exam to check for swelling, tenderness, and range of motion. Most patients need further tests such as x-ray, magnetic resonance imaging (MRI), or arthroscopy to determine the severity of the injury. Pain-free ACL injuries can mean a mild sprain or partial tear. In some cases, however, the pain stems from a full-thickness tear that’s catching on the joint or additional cartilage damage.

Possible treatment options

If the knee injury is minor, the doctor will recommend the RICE model to lessen pain and swelling. RICE stands for rest, ice, compression, and elevation. Anti-inflammatory medication can help reduce swelling and pain. Sometimes, a corticosteroid injection into the knee reduces pain and inflammation. Physical therapy is often coupled with medication to improve strength and healing outcomes. Doctors have also seen progress with regenerative medicine. A patient’s stem cells, bone marrow, or platelet-rich plasma are injected into the knee to promote healing.

Surgical treatment

Sometimes, anterior cruciate ligament surgery is necessary, even with a pain-free knee. Typical reasons include if non-surgical treatments fail, if the ACL is completely torn, or if the knee is unstable. With ACL reconstruction surgery, the doctor removes the torn ACL and installs a new tendon, called a graft. Most ACL injuries occur using minimally invasive means. The surgeon uses just 2-3 buttonhole incisions to access, remove, and replace the ligament. Minimally invasive surgery means less pain, fewer chances of infections, and faster recovery.

Why would you need ACL surgery?

There is a common myth that all ACL injuries are painful and debilitating. However, some patients sprain or tear the ACL and feel no pain. Non-surgical treatments are usually the first line of treatment, but some athletes still feel instability after trying this approach. A fully torn ACL can cause complications later. The patient may compensate on the other knee, increasing the chances of injury. The injured leg will also seek stability elsewhere, leading to meniscus tears or lower leg injuries. ACL surgery is often the last resort and would be recommended if non-surgical treatments fail. Whether the damage is painless or painful, trust the doctor’s diagnosis and suggested treatments to prevent further complications.

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