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Anterior Cruciate Ligament (ACL) Tear

The knee is a complex hinge joint, completely different than the shoulder. Its range is mostly limited to forward and backward movement. The Anterior Cruciate Ligament (ACL) and Posterior Cruciate Ligament (PCL) form an “X”, with the ACL in the front and the PCL in the back of the knee. These ligaments control the forward and backward motion of the knee.

The Medial Collateral Ligament (MCL) and the Lateral Collateral Ligament (LCL) are on the inside and outside of the knee, respectively. They control side motion and brace the knee against unusual movement. While all of these ligaments play an important role in stabilizing the knee, the ligament that gets the most attention is the anterior cruciate ligament (ACL).

Anterior Cruciate Ligament (ACL) Tear

The anterior cruciate (cross) ligament connects the femur and tibia. It prevents the tibia from sliding forward.

The anterior cruciate ligament (ACL) is an important stabilizer of the knee. It is frequently injured through sports and other trauma. Like all ligaments there can be partial and complete tears.

Patients with partial tears where the ligament remains attached may not be unstable. These patients can do quite well without surgery. However, with full tears of the anterior cruciate ligament patients will typically experience instability (a feeling of the knee being loose or giving out) or apprehension (a feeling that the knee may give out). This happens when the anterior cruciate ligament (ACL) tear is large enough that the ligament can no longer provide full support. The result is that the tibia slides forward.

When the tibia slides forward, the meniscus can get trapped and tear. This happens so frequently that high school, college, and professional athletes are not typically permitted to participate in sports until after they have surgery to reconstruct their Anterior Cruciate Ligament (ACL).

In addition to meniscus tears, anterior cruciate ligament (ACL) tears frequently cause cartilage injuries and are associated with the development of arthritis.

Anterior cruciate ligament (ACL) surgery has made tremendous advancements over the years. Patients used to spend days in the hospital, were placed in casts, and were not permitted to place weight on the leg. The advances in surgical technique, as well as the implants that are currently available allow patients to go home the same day. Further, they are usually permitted to walk on the leg immediately.

The surgery begins with a nerve block. We select anesthesiologists who are trained in the latest techniques. They use a special ultrasound machine to guide a small needle close to the nerves that control pain in the leg. They then inject anesthetic. This greatly decreases the amount of anesthesia required for the surgery, resulting in less nausea and a decrease in the need for post-operative narcotics.

Once the patient is asleep the knee arthroscopy is performed. Any meniscus or cartilage tears are addressed, and the damaged anterior cruciate ligament (ACL) is removed. Two small holes are drilled (one in the femur and one in the tibia) and a new anterior cruciate ligament (ACL) is reconstructed. The type of tissue depends on a number of factors and is discussed with the patient prior to surgery. Options include using bone or tissue from other parts of the patient’s body (Autograft), or from a cadaver (Allograft). The tissue is then placed inside the tunnels and secured. Physical therapy begins within days of the surgery.

We also perform Revision Anterior Cruciate Ligament Reconstruction to treat failed Anterior Cruciate Ligament Reconstructions (recurrent Anterior Cruciate Ligament tears).

In addition to treating isolated knee ligament injuries (one ligament), we also treat combined (more than one ligament torn) knee ligament injuries. The most severe knee ligament injury occurs with a dislocation (3 or 4 ligaments are torn). These Lateral Collateral, Medial Collateral, and Posterior Cruciate Ligament tears occur in combination with Anterior Cruciate Ligament Injuries. These tears require specialized care. We routinely accept transfers from all over Arizona for these complex knee ligament injuries.