Treatment options include the following:

Give Up Sports
Use A Brace + / - Arthroscopy
Surgical Reconstruction
Conservative Treatment





Give Up Sports
The anterior cruciate ligament is only required for pivotal motions. If you walk on smooth surfaces and do no pivotal sports, you can get by without an ACL.







Use a Brace +/- Arthroscopy
The use of a functional brace may be required if you want to return to recreational activities. The brace will stabilize a knee to allow low level recreational sports, but is not as effective for sports such as soccer, that require the use of cleats on the shoes.






Since about 50% of anterior cruciate ligament injuries have associated meniscal tears, the joint may have to have arthroscopy to deal with the tear. In the older patient, the removal of a portion of the meniscus is the usual treatment. In the younger patient, the repair of the meniscus is preferable. However, the results of meniscal repair are more successful when the ACL is also repaired.

This is why the younger athlete who is involved in competitive sports is advised to have a surgical reconstruction. We also know that the long term results of surgery depend upon having a normal intact meniscus.







Surgical Reconstruction
The surgical reconstruction is indicated for:

Young
Competitive
Pivotal
Athletic Patients

There have been numerous procedures in the past to repair the ligament or to replace it with a synthetic ligament. Nowadays, the only recommended surgical procedure is to replace the damaged ligament with a graft of tissue taken from the patient.

The 2 common graft choices are:

patellar tendon graft




The middle 1/3 of the patellar tendon with bone block from the tibia and femur is removed for the replacement graft of the anterior cruciate ligament.

semi-tendinosus graft or hamstring graft




The semi-tendinosus and gracilus hamstrings are removed to form the 4 bundle graft to replace the torn anterior cruciate ligament. The operation consists of the pre-op assessment under anaesthesia. At this time the instability of the joint is confirmed by the clinical examination and the KT-1000 measurements. A diagnostic examination is performed to asses the articular surfaces, the menisci, and the ligaments.




Meniscal resection or repair is carried out as indicated.

a)   The suitable graft is harvested.

b)   The tibial tunnel is drilled with a guide.

c)   The femoral tunnel is drilled through the tibial tunnel with a quide.

d)   The graft is then pulled into position and fixed with interference Bioabsorbable screws.

e)   The graft is visualized and probed with a hook, to ensure the graft is under tension.

f)   The KT-S is used to measure the anterior - posterior displacement of the knee at the end of the operation. This is compared to the pre-op measurement. If stability is not achieved, then the fixation is revised.

g)   At the end of the operation, 2 procedures are used for pain control. These are an intra-articular injection of local anaesthesia and morphine with a block of the femoral nerve.

h)   A cryo-cuff and continuous passive motion machine are used to control swelling and start early motion.

i)   Weight bearing is allowed as soon as possible.

j)   Physiotherapy is started at 3-4 days after the operation. This lasts for about 1 month. Exercises in the gym are done for the next 3-4 months.

k)   Return to sports with a brace is allowed at 4-6 months post-op. The brace is used only for the first season after injury. Eventually the patient should not require the brace to continue with sports over the long term.




Conservative Treatment

Acute phase:

The treatment consists of:

Use of crutches and a removable splint.
Use of cryo-therapy to reduce pain and swelling.
Use of physiotherapy to regain range of motion and strength.
Use of a special custom made ACL brace.
Gradual return to sports after full range of motion and strength equal to the opposite side is achieved.

Chronic phase:

The treatment consists of:

Use of the functional brace.
Maintainence of good strength in quadriceps and hamstrings muscles.
Reducing pivoting sports.
Intermittent use of physiotherapy, cryo-therapy and anti-inflammatory medications.