Ask the Experts: When does an ACL injury require surgery?

By Kristy Bleizeffer Mar 13, 2017

You’re being good, staying active, and participating in your favorite weekend exercise. You hear the dreaded “pop” followed by excruciating pain in the knee.  It’s almost certainly an ACL injury.

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So, what do you do? Elevate, ice and hope it heals thyself?

The anterior cruciate ligament, or ACL, is one of the four primary ligaments of the knee, and it prevents thigh bone from sliding or twisting relative to the shin bone. It’s very important for higher demand activities such as skiing, trail running, tennis, basketball and soccer, says James Shaffer, M.D., an orthopedic surgeon at Advantage Orthopedics and Neurosurgery.

The ACL is also one of the most commonly injured ligaments of the knee. Here, Shaffer explains your treatment options.

Who is most at risk for an ACL injury?

Most ACL injuries do not involve contact with another athlete but result from landing awkwardly or twisting while the foot is planted.  Interestingly, female college soccer players happen to be the most at risk group for ACL injuries. Other high-risk activities include football, skiing, basketball and lacrosse.

What are the signs that the ACL has been injured?

One often hears or feels a “pop.”  Then the knee swells immediately and is painful and stiff.  Once the swelling and pain go away, the long-term problem is instability in the knee, often described as “going out.”

Most ACL injuries can be diagnosed with an office exam, but pain, swelling and stiffness may prevent this if the injury is very recent. Usually, an MRI will be done to confirm this and rule out other issues.

Does it require surgery?

Not all ACL tears need surgery.  Most people who are under 30 or very active will need surgery.  It is tough to ski, play singles tennis, or basketball without an ACL.  Most people over the age of 50 can do well without their ACL.  Most people can jog, play with their kids, hike, and workout without their ACL, if they have rehabbed properly.

What does ACL surgery entail?

In surgery, the ligament usually needs to be reconstructed or replaced.  This means using one of your own tendons (autograft) or a tendon from a tissue donor (allograft) as a replacement.  The new ligament is then attached to the thigh bone and the shin bone with some type of hardware.  Most of these procedures can be done as a “same-day surgery.” The size of the incisions varies depending on the exact technique, but sometimes just a few, very small incisions can be used.

How long is the recovery?

Getting back to work or school might only take a week if you can return with crutches and sit at work.  Also, you can drive pretty early if you have left knee surgery.  Getting back to soccer, football, downhill skiing and other demanding activities will probably take 9 to 12 months.  Returning to physical jobs will be somewhere in between.

James Shaffer M.D.

James Shaffer, M.D. is a board-certified orthopedic surgeon with 10 years of experience. He has special interests in joint replacement and other surgeries of the shoulder, hip and knee. Dr. Shaffer is Casper Orthopedic Clerkship director along with clinical instructor for the University of Washington School of Medicine. He is the orthopedic director for the Frontiers in Wyoming Medicine Conference and has been invited to educate other physicians in orthopedic care. His interests include the treatment of fractures and osteoporosis, perioperative pain and surgical process improvement. 

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