ACL Tear
The anterior cruciate ligament (ACL) is one of four primary stabilizing ligaments in the knee joint. The purpose of these ligaments is to allow normal knee motions, but to limit abnormal motions.

What is an ACL tear?

When the ACL is injured, the knee may become unstable. People who have an ACL injury often describe a sensation that their knee "gave out" from under them. Understanding what the ACL does will help you understand why it is such an important ligament.
The ACL is one of a pair of ligaments in the center of the knee joint that form a cross, and this is where the name "cruciate" comes from. There is both an anterior and a posterior cruciate ligament (PCL). Both of these ligaments function to stabilize the knee from front-to-back.

When you have an ACL tear

ACL injuries are often diagnosed simply by knowing what happened to the athlete and what symptoms he or she is experiencing. The physical examination is the most reliable way to diagnose an ACL tear. X-rays and MRIs may also be needed. Other common symptoms of an ACL tear include knee swelling and a sensation that the knee wants to "give out" from under you.

Physical therapy is an important aspect of both operative and non-operative treatment of ACL injuries. Studies have shown that a comprehensive rehabilitation including lower extremity strengthening, cardiovascular conditioning, and specific skill and balance training, will offer you the best chance at recovering from an ACL injury without surgery.

What happens when the ACL is torn?

Most people who rupture their ACL can recall the exact moment at which they felt it pop. This usually happens when changing direction quickly in pivoting or cutting sports like soccer, landing from a jump in sports such as basketball, or falling while skiing. The four "classic" symptoms that people may feel when they tear their ACL are: They hear a "pop" from inside the knee They feel the knee give away at the time of injury They develop a swollen knee immediately, or within a few hours The pain is bad enough that they can not continue play that day. When the ACL ligament is stretched too far and ruptures, the blood vessels inside the ligament rupture as well, and this blood fills the knee joint, causing the knee to swell. While the ACL injury itself is usually not terribly painful, the swelling that results from blood inside the knee prevents most people from returning to the game or the athletic activity they were involved in at the time of injury.

Preventing ACL Injury

Stretch properly before exercise. To stretch properly, warm up first—get your heart rate up to its normal athletic rate—by walking a half lap around the field, gradually increasing to a brisk pace, and then run the other half lap. Repeat as necessary. Spend 5-10 minutes warming up. Then perform ACL stretches.

ACL Questions and answers

from Jonathan Cluett, M.D.

What is the ACL?
The anterior cruciate ligament (ACL) is one of four primary stabilizing ligaments in the knee joint. The purpose of these four ligaments is to allow normal knee motions, but to limit abnormal motions. When the ACL is injured, the knee may become unstable. People who have an ACL injury often describe a sensation that their knee "gave out" from under them. Understanding what the ACL does will help you understand why it is such an important ligament.

When you have an ACL tear:
How is an ACL tear diagnosed? 
 ACL injuries are often diagnosed simply by knowing what happened to the athlete and what symptoms he or she is experiencing. The physical examination is the most reliable way to diagnose an ACL tear. X-rays and MRIs may also be needed. Other common symptoms of an ACL tear include knee swelling and a sensation that the knee wants to "give out" from under the patient.
 
 
What is the Initial treatment of ACL tear?
Ice the injury.  One of the most important things to do after an ACL injury, or any knee injury for that matter, is to control swelling. Icing the injured knee will help control the swelling. This will serve two purposes. First, swelling stretches the joint capsule and synovial lining, and this causes pain. Controlling the swelling will help control pain. Second, by controlling the initial inflammatory response, the patient will be able to continue moving the knee. Studies have shown that maintaining range of motion will help to limit scar tissue formation and improves the results of later surgery.

ACL Injuries in Women and Prevention of ACL Tears
from Jonathan Cluett, M.D.
ACL injuries are much more common in female athletes than male athletes. No one knows exactly why this is the case, but there are some interesting theories.

ACL Injuries In Female Athletes:
Why Are ACL Tears More Common in Women? 
 Female athletes are known to have a higher risk of injuring their ACL while participating in competitive sports. Unfortunately, understanding why women are more prone to ACL injury is unclear. Several studies have been done, and what is well known is that in sports that place a significant demand on the ACL, such as basketball, soccer, cheerleading, and others, ACL injuries are up to ten times more common in women than in men.

Preventing ACL Injuries In Women:
Can ACL tears be prevented? 
 Studies have shown that specific training programs can reduce the risk of ACL tears in female athletes significantly. Learn about why specific training programs may help reduce the risk of ACL injuries. 

ACL Injury Prevention:
How Do Neuromuscular Training Programs Prevent ACL Tears? 
Recent research has focused on the prevention of ACL tears with the use of neuromuscular training. Neuromuscular training is used to teach proper biomechanic movements of the body to prevent ACL tears.
   
The PEP Program 
One of the better known neuromuscular training programs, the Prevent Injury, and Enhance Performance program (commonly known as the PEP program), was developed at the Santa Monica Orthopaedics and Sports Medicine Research Foundation. View the PEP program.

Knee Replacement

from Jonathan Cluett, M.D.

So you just found out that you may need total knee replacement surgery... Perhaps you've heard about knee replacement surgery, from friends, from doctors, on the news, but what is the actual procedure? What is replaced? Why is knee replacement necessary? Why do I need a knee replacement?

Who Needs Knee Replacement Surgery?
Knee replacement surgery is most commonly performed on patients who have osteoarthritis, also called degenerative joint disease or wear-and-tear arthritis. Patients with this type of arthritis do not have the normal protective lining of cartilage remaining on the ends of the bone. Therefore, when the knee is bent, raw bone is irritated and causes pain. 

Rheumatoid arthritis causes a different type of joint destruction. Rheumatoid arthritis is a systemic disease that can cause a number of problems. Among these, rheumatoid arthritis can cause inflammation of the lining of joints. This link will connect you to a number of useful resources to help you understand the diagnosis of rheumatoid arthritis.

When Is Knee Replacement Necessary?
What Are Signs I Do/Don't Need A Knee Replacement? 
Usually patients 'know' when they are ready for knee replacement surgery. If you have tried more conservative treatments for knee arthritis and you have persistent knee pain, it may be time for a knee replacement. If you are unsure, look through these signs that you may be ready for knee replacement surgery.
 
How Young Can Patients Have Knee Replacement? 
Once reserved for elderly patients who have no other options, total knee replacement is now being performed in younger patients with excellent results. Rather than using age to determine when a knee replacement is performed, doctors look at symptoms and treatment response to determine if knee replacement is appropriate.
 
Worried You're Too Young? 
More information to help you decide if now is the right time to consider knee replacement surgery. This article includes some excellent "indicators" that will let you know when the time is right to cinsider a knee replacement.

Do I Need To Have Surgery? 
An ACL injury does not require surgical treatment. No one has ever died because their ACL was injured. That said, ACL reconstruction may prevent further damage from occurring within the joint, and it may allow return to athletic activities.
 
Do I Need ACL Reconstruction? 
Patients who sustain an ACL tear need to understand their options. Surgery may not be needed if you have sustained an ACL tear. That said, not having surgery may place you at higher risk for further knee joint damage. Not having surgery may also prevent your participation in some sports. Some patients choose not to have surgery, and instead undergo physical therapy treatment.

What are the Sports That Require ACL Reconstruction? 
Deciding if you need ACL reconstruction surgery depends, in large part, on what activities you want to return to after treatment. High-demand sports are those in which most athletes require a functioning ACL, such as soccer, hockey, tennis and rugby. Athletes who participate in low-demand sports may not need an ACL to return to competition.

Non-Operative Treatment For ACL Tears 

from Jonathan Cluett, M.D.
 
Physical Therapy 
Physical therapy is an important aspect of both operative and non-operative treatment of ACL injuries. Studies have shown that a comprehensive rehabilitation including lower extremity strengthening, cardiovascular conditioning, and specific skill and balance training, will offer the patient the best chance at recovering from an ACL injury without surgery.
 
Rehabilitation Exercises 
Some simple exercises will help patients maintain muscle strength and improve range of motion following an ACL tear. After sustaining an injury to the anterior cruciate ligament, it is important to perform regular exercises to maintain knee function. The exercises are safe, effective ways to accomplish this goal.
 
Bracing of the Knee 
If you do not have ACL reconstruction surgery, a functional knee brace may help prevent knee instability, or the sensation that the knee is "giving out." However, these functional knee braces do not reduce the risk of developing further knee joint damage seen in patients who have an ACL tear that is not reconstructed.