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TREATMENT

Just 5-7 years ago, torn ACLs commonly ended athletes' careers. For athletes and other patients involved in pivoting sports or labor-intensive jobs, ACL reconstruction surgery is recommended. For less active people, there is nonsurgical treatment. These patients can strengthen the quadriceps and the hamstring and wear a brace. But neither exercises nor braces can give them full support, stability, or strength. The surgery entails taking a graft of another ligament from the patient's body (an autograft) or from another body or a cadaver (an allograft). That graft is placed in the knee, where the original ACL had been, and fixed in place using a screw, glue, or a staple. During the recovery period, the body incorporates the new ligament, and it replaces the ACL.

PREVENTION

There is no way to prevent ACL injuries in contact sports. However, recent studies have shown that female athletes are at a higher risk of sustaining ACL injuries than male athletes. The reason may be that there are anatomic differences that predispose women to this injury.

RECOVERY

The average recovery period is 6-8 months. The patients begin walking quickly after the surgery, and physical therapy begins within 2 weeks. At that time, the patient begins stationary bicycle exercises and quadriceps and hamstring strengthening. In 10-12 weeks, patients can begin jogging on a treadmill, swimming, and golfing. At around 4 months, the patient can begin pivoting maneuvers and drills. Finally, after 6-8 months, the athlete is able to return to his or her sport.

LONG-TERM OUTLOOK

With modern treatment, a torn ACL is no longer a career-ending injury. Treatment works very well and allows many athletes to compete at their pre-injury levels, although some who have suffered a torn ACL may feel that they lose some of their maneuverability.

Medical information was provided by Michael J. Ciccotti MD, director of sports medicine at the Rothman Institute at Thomas Jefferson University Hospital in Philadelphia. Ciccotti is also the team physician for the Philadelphia Phillies.

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