How Do We Treat An ACL Tear?

So you tore your ACL… now what?

There are two options when facing an ACL tear. Either have surgery to repair it, or let it heal by itself.

The problem with not having surgery is your knee may be unstable, which can also lead to new injuries in the future. So, how do you know which option is better for you?

We have to look at several things:

How bad is your ACL tear?

Before we treat an ACL tear we need to know how bad is it.

· Is it a partial tear or complete tear? Most tears are complete—the ligament just snaps. If you do have a partial tear (with some thin strands untouched) then your doctor has to find if there is instability. Sometimes those few strands keep the knee together. As for complete ACL tears, they are usually unstable.

· Do you have other injuries? In 50% of cases, ACL tears happen along with other knee injuries like:

• meniscal tears
• cartilage damage
• other ligaments are torn

The more structures you’ve damaged, the more unstable your knee will be. Also, some of these will need surgery, too—like meniscal tears.

• The unhappy triad: that’s how we call to a combination of injuries that usually happens together: ACL tear + medial collateral ligament tear + medial meniscus injury. It happens in high-energy accidents, for example in ski accidents at high speed.

Which patients could consider not having surgery?

The problem with not having surgery is your knee will be unstable and you can hurt yourself again in the future. Those who can consider not-surgery are:

• If you have a partial ACL tear with no instability
• People with no symptoms who won’t play high-demand sports
• Patients with a sedentary lifestyle. It’s not about your age, but your activity level. You can have ACL repair at any age, as long as you are active.

Who should go for surgery?

Everybody else.

If you are active, or plan on keep doing sports, etc… you probably want to have surgery. It will make your knee “more solid” and you won’t feel like it will give way with certain movements.

How do you treat an ACL tear?

Basically we need to replace your torn ACL with a graft. And there are two ways to get that graft:

• From your own body, by cutting a piece of a tendon—usually your patellar tendon or your hamstring.
• From a donor, the graft comes from a person who donated their organs. The same way there are liver or heart transplants, we use donor tendons, too.

There are several tendons that we can use:

• patellar tendon
• quadricipital
• hamstring
• Achilles tendon